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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. The MOA for Chloramphenicol is?
- Fluoroquinolones
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Enterobacter
Inhibition of 50S peptidyl transferase - Bacteriostatic

2. What is the clinical use for Sucralfate?
Peptic ulcer disease.
PT
Keratin containing tissues - e.g. - nails
Early myocardial infarction.

3. Which cancer drugs effect nuclear DNA (4)?
Nephrotoxicity
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Benzodiazepine.
Directly of indirectly aid conversion of plasminogen to plasmin Which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin - bound plasminogen to plasmin.)

4. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Intrathecally
Chronic (weeks or months)
Antibiotic - protein synthesis inhibitor.
Methylxanthine.

5. Which of these three drugs will cause a reflex bradycardia in your pt (Norepi - Epi - or Isoporterenol)
Norepinephrine
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Choline acetyltransferase

6. What is the clinical utility of cocaine?
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
DOC in diagnosing and abolishing AV nodal arrhythmias
Heparin catalyzes the activation of antithrombin III.
The only local anesthetic with vasoconstrictive properties.

7. What are two toxicities of the Glitazones?
Nevirapine - Delavirdine
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Intrathecally
1. Weight gain 2. Hepatotoxicity (troglitazone)

8. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
- Disulfram & also sulfonylureas - metronidazole
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
NO

9. Describe the MOA of Interferons (INF)
- Chloramphenicol
CL= (rate of elimination of drug/ Plasma drug conc.)
- Normalize K+ - Lidocaine - & Anti - dig Mab
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

10. Name the common Nucleoside Reverse Transcriptase Inhibitors
- Haloperidol - chlorpromazine - reserpine - MPTP
thiazides - amiloride
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
- Acetaldehyde - Nausea - vomiting - headache - & hypotension

11. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
Constant FRACTION eliminated per unit time.(exponential)
These B-2 agonists cause respiratory smooth muscle to relax.
Epinephirine(Alpha1 -2 and Beta 1 -2)
Antifungal.

12. How would you reverse the effect of a neuromuscular blocking agent?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Give an antichloinesterase - neostigmine - edrophonium - etc

13. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
- Atropine & pralidoxime
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

14. How are Interferons (INF) used clinically?

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15. Which drug(s) cause this reaction: Diabetes insipidus?
Phenothiazine (neuroleptic - antiemetic).
With supplemental Folic Acid
- Lithium
- Tamoxifen

16. What are signs of Sildenafil (Viagra) toxicity?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Delirium - Tremor - Nephrotoxicity
Headache - flushing - dyspepsia - blue - green color vision.
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

17. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
AmOxicillin has greater Oral bioavailability
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Penicillin.
GI disturbances.

18. What microorganisms are clinical indications for Tetracycline therapy?

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19. What is a common drug interaction associated with Griseofulvin?
Rheumatoid and osteoarthritis.
torsade de pointes - excessive Beta block
Increases coumadin metabolism
Carbachol - pilocarpine - physostigmine - echothiophate

20. What microorganisms is Aztreonam not effective against?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Gram + and Anerobes

21. What process does Zafirlukast interfere with?
These B-2 agonists cause respiratory smooth muscle to relax.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Leukotrienes increasing bronchial tone.
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

22. What do Aminoglycosides require for uptake?
Only in limited amounts
The only local anesthetic with vasoconstrictive properties.
- Oral Contraceptives
Oxygen

23. What are common toxicities associated with Macrolides? (4)
Digitoxin 70% Digoxin 20-40%
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
With an amino acid change of D- ala D- ala to D- ala D- lac
Norepinephrine

24. Describe Phase II metabolism in liver(3)?
Ipratropium
new arrhythmias - hypotension
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
physostigmine

25. What are Fluoroquinolones indicated for? (3)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Benzathine penicillin G
- Bleomycin - amiodarone - busulfan
Rapid (seconds)

26. How does dantrolene work?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
cyanide toxicity (releases CN)
Tricyclic antidepressant.
scopolamine

27. What side effect of using atropine to induce pupillary dilation would you expect?
Severe Gram - rod infections.
for RSV
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

28. What microorganisms are Aminoglycosides ineffective against?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Chronic anticoagulation.
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Anaerobes

29. What are Polymyxins used for?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Resistant Gram - infections
Blocks Norepi - but not Dopamine
ACIDazolamide' causes acidosis

30. Antiarrhythmic class IV- toxicity?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Erectile dysfunction.

31. What are the major toxic side effects of the Cephalosporins?
TMP- SMZ
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Binds to the Pyrophosphate Binding Site of the enzyme

32. Adverse effects of Hydrochlorothiazide?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
troponin - tropomyosin system
Triple sulfas or SMZ
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

33. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
thiazides - amiloride
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Penicillin.

34. Furosemide - class and mechanism?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Babiturate.
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

35. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Ipratropium

36. What are toxic side effects for Metronidazole?
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Disulfiram - like reaction with EtOH - Headache
Rare.
GI side effects. (Indomethacin is less toxic - more commonly used.)

37. Adverse effects of Loop Diuretics?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- Ethosuxamide - sulfonamides - lamotrigine
Pregnant women - Children; because animal studies show Damage to Cartilage

38. Antiarrhythmic class IA effects?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Heparin catalyzes the activation of antithrombin III.
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

39. Adverse effects of Hydralazine?
- Nitrate - hydroxocobalamin thiosulfate
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides

40. What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
Indirect agonist - uptake inhibitor
Rapid (seconds)
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.

41. What is an occasional side effect of Aztreonam?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
GI upset
Pseudomonas species and Gram - rods

42. Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Rash - Pseudomembranous colitis
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Oxygen

43. Name the common Azoles
Hypersensitivity reactions
hyperaldosteronism - K+ depletion - CHF
Acetylcholinesterase; ACh is broken down into choline and acetate.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

44. If a patient is given hexamethonium - What would happen to his/her heart rate?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
- Quinidine - quinine

45. Furosemide - toxicity? (OH DANG)
Long.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Short.
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

46. Are not penicillinase resistant
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Protease inhibitor.
Carbenicillin - Piperacillin - and Ticarcillin
- Tricyclic antidepressants

47. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Antifungal.
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

48. Beta Blockers - site of action?
- Alkalinize urine & dialysis
Beta adrenergic receptors and Ca2+ channels (stimulatory)
aPTT (intrinsic pathway)
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

49. Which diuretics increase urine K+?
Acute gout.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Chronic anticoagulation.

50. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Tendonitis and Tendon rupture
Antifungal.