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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. List the specific antidote for this toxin: Iron
- Deferoxamine
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
Tetracycline - Doxycycline - Demeclocycline - Minocycline
bradycardia - AV block - CHF

2. What neurotransmitter does Amantadine affect? How does it influence this NT?
Pralidoxime regenerates active cholinesterase.
Abortifacient.
Inhibits cell wall mucopeptide formation - Bactericidal
Dopamine; causes its release from intact nerve terminals

3. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Quinidine - Amiodarone - Procainamide - Disopyramide
- Antipsychotics

4. How can the toxic effects of TMP be ameliorated?
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
With supplemental Folic Acid

5. Which Tetracycline is used in patients with renal failure? / Why?
Doxycycline - because it is fecally eliminated
DOC in diagnosing and abolishing AV nodal arrhythmias
GET on the Metro
Inhibits cell wall mucopeptide formation - Bactericidal

6. What is the lab value used to monitor the effectiveness of Heparin therapy?
The PTT.
Dopamine; causes its release from intact nerve terminals
1. Renal damage 2. Aplastic anemia 3. GI distress
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.

7. How is Amphotericin B administered for fungal meningitis?
- Normalize K+ - Lidocaine - & Anti - dig Mab
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Intrathecally

8. Decrease Digoxin dose in renal failure?
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
not a sulfonamide - but action is the same as furosemide
YES
No - it inhibits the release of Nor Epi

9. What is the memory key for the action of Sildenafil (Viagra)?
Dopamine; causes its release from intact nerve terminals
Acetylcholine esterase
Sildenafil fills the penis
Pregnant women - Children; because animal studies show Damage to Cartilage

10. What is the effect of guanethidine on adrenergic NE release?
It inhibits release of NE.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Deferoxamine
Ca2+ (Loops Lose calcium)

11. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
AluMINIMUM amount of feces.
Rare.
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.)

12. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Same as penicillin. Extended spectrum antibiotics
VACUUM your Bed Room'
cardiac depression - peripheral edema - flushing - dizziness - constipation

13. Which drug(s) cause this reaction: Hot flashes?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Pyridoxine (B6) administration
- Tamoxifen
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

14. What are two toxicities of the Sulfonylureas?
Blood
Methylation of rRNA near Erythromycin's ribosome binding site
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

15. Mannitol - clinical use?
Abortifacient.
- Fluoroquinolones
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
ARF - shock - drug overdose - decrease intracranial/intraocular pressure

16. What are the four conditions in Which Omeprazole - Lansoprazole is used?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Chronic anticoagulation.
DHPG (dihydroxy-2- propoxymethyl guanine)

17. What is the clinical use for Warfarin?
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
- polymyxins
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Chronic anticoagulation.

18. Ca2+ channel blockers - mechanism?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
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.)
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic

19. Name three K+ sparing diuretics?
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Yes - it does not cross the placenta.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Headache - flushing - dyspepsia - blue - green color vision.

20. For Warfarin What is the Treatment for overdose
RESPIre
GI distress - Skin rash - and Seizures at high plasma levels
IV vitamin K and fresh frozen plasma
Mebendazole/Thiabendazole - Pyrantel Pamoate

21. Which drug(s) cause this reaction: P450 inhibition(6)?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
cross - allergenic

22. How does resistance to Vancomycin occur?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
- Lithium
Antileukotriene; blocks synthesis by lipoxygenase.
With an amino acid change of D- ala D- ala to D- ala D- lac

23. Does Warfarin have a long - medium - or short half life?
Long.
Malaria (P. falciparum)
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Triple sulfas or SMZ

24. What antimuscarinic drug is useful for the tx of asthma
Ipratropium
Resistant Gram - infections
Nitrates
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

25. Why would you use pralidoxime after exposure to an organophosphate?
Pralidoxime regenerates active cholinesterase.
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Non - Nucleosides
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

26. Which cancer drugs effect nuclear DNA (4)?
Rapid (seconds)
GI discomfort
- Alkalate DNA - Brain tumors - CNS toxicity
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

27. What is the clinical use for Ampicillin and Amoxicillin?
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Spironolactone - Triamterene - Amiloride (the K+ STAys)

28. List the specific antidote for this toxin: Salicylates
YES
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
- Alkalinize urine & dialysis
The only local anesthetic with vasoconstrictive properties.

29. Antiarrhythmic class II- mechanism?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
- Penicillin

30. How does dantrolene work?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
thick ascending limb
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

31. Which diuretics decrease urine Ca2+?
Nephrotoxicity
1. Acarbose 2. Miglitol
Acetylcholinesterase; ACh is broken down into choline and acetate.
thiazides - amiloride

32. Furosemide increases the excretion of What ion?
Ca2+ (Loops Lose calcium)
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal

33. Ca2+ sensitizers'- site of action?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Beta - lactamase cleavage of Beta - lactam ring
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
troponin - tropomyosin system

34. How do Sulfonamides act on bacteria?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Primaquine

35. What are the indications for using amphetamine?

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36. What is the most common cause of Pt noncompliance with Macrolides?
GI discomfort
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Epinephrine
- Phenytoin

37. Toxic effects of TMP include?
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Megaloblastic anemia - Leukopenia - Granulocytopenia
dizziness - flushing - constipation (verapamil) - nausea
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

38. Which drug(s) cause this reaction: Cinchonism (2)?
Pentamidine
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- Quinidine - quinine

39. Hydralazine - toxicity?
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
compensatory tachycardia - fluid retention - lupus - like syndrome

40. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Rapid (seconds)
HTN - CHF - calcium stone formation - nephrogenic DI.
Clavulanic acid
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.

41. Name the common Nucleoside Reverse Transcriptase Inhibitors
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
viral kinase
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.)

42. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
Useful in muscle paralysis during surgery or mechanical ventilation.
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
DOC in diagnosing and abolishing AV nodal arrhythmias
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

43. What is the mechanism of action of the Sulfonylureas?
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Competitive inibitor of progestins at progesterone receptors.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
distal convoluted tubule (early)

44. What are common toxicities related to Vancomycin therapy?

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45. What drug is used during the pregnancy of an HIV+ mother? - Why?
Diarrhea
AZT - to reduce risk of Fetal Transmission
Blocks Influenza A and RubellA; causes problems with the cerebellA
Modification via Acetylation - Adenylation - or Phosphorylation

46. Classes of antihypertensive drugs?
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

47. What is Metronidazole used for clinically?
Acute (hours)
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Prevents the release of Ca from SR of skeletal muscle
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

48. What are common side effects of Protease Inhibitors?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
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.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
GET on the Metro

49. How would you treat African Trypanosomiasis (sleeping sickness)?
Aminoglycosides
Suramin
Rapid (seconds)
Pentamidine

50. Which drug(s) cause this reaction: Hepatitis?
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- Isoniazid