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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. List some specifics of lead poisoning(4)?
Nucleosides
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Penicillin - V
Pentamidine

2. What are three types of antacids and the problems that can result from their overuse?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Norepinephrine (Alpha1 -2 and beta 1)
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

3. Which drug(s) cause this reaction: Gynecomastia (6)?
Polymyxins
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

4. What is the MOA for Ampicillin and Amoxicillin?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Same as penicillin. Extended spectrum antibiotics
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
- Bleomycin - amiodarone - busulfan

5. What is the definition of zero - order kinetics? Example?
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Local anesthetic.
Resistant Gram - infections
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

6. What drugs target anticholinesterase
Due to the presence of a bulkier R group
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Primaquine
AZT - to reduce risk of Fetal Transmission

7. What is the loading dose formula?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
YES

8. Which drug(s) cause this reaction: Hot flashes?
Severe Gram - rod infections.
check PFTs - LFTs - and TFTs
Heparin catalyzes the activation of antithrombin III.
- Tamoxifen

9. Toxicities associated with Acyclovir?
Delirium - Tremor - Nephrotoxicity
Stimulates beta adrenergic receptors
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

10. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Gram + - Gram - - Norcardia - Chlamydia
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Choline acetyltransferase

11. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
GET on the Metro
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

12. What is the category of drug names ending in - pril (e.g. Captopril)
Praziquantel
Resistant Gram - infections
Inhibit Ergosterol synthesis
ACE inhibitor.

13. Which RT inhibitors cause Lactic Acidosis?
Butyrophenone (neuroleptic).
Protease Inhibitors and Reverse Transcriptase Inhibitors
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Nucleosides

14. What is the lab value used to monitor the effectiveness of Warfarin therapy?
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
The PT.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Yes - it does not cross the placenta.

15. Which drug(s) cause this reaction: Torsade de pointes (2)?
Yes - it does not cross the placenta.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

16. What are the clinical uses for Imipenem/cilastatin?
Gram + cocci - Gram - rods - and Anerobes
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
- Methotrexate - 5 FU - 6 mercaptopurine
Those patients who are taking nitrates.

17. What is the effect of guanethidine on adrenergic NE release?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
It inhibits release of NE.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

18. What is Ketoconazole specifically used for?
Aplastic anemia (dose independent) - Gray Baby Syndrome
viral kinase
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

19. What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
The PT.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Succinylcholine

20. What is the mechanism of action of the thrombolytics?
Inhibits DNA dependent RNA polymerase
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.)
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

21. Decrease Digitoxin dose in renal failure?
Dermatophytes (tinea - ringworm)
Protamine sulfate
NO
No - hemicholinum block the uptake of Choline and thus Ach synthesis

22. List the specific antidote for this toxin: Methanol & Ethylene glycol
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
- Ethanol - dialysis - & fomepizole
1. Pioglitazone 2. Rosiglitazone.
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

23. How is Rifampin used clinically?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
AZT
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

24. What are four H2 Blockers?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
post MI and digitalis induced arrhythmias
It affects beta receptors equally and is used in AV heart block (rare).
Same as penicillin. Extended spectrum antibiotics

25. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
decrease conduction velocity - increase ERP - increase PR interval
Useful in muscle paralysis during surgery or mechanical ventilation.
Scopolamine
- Chloramphenicol

26. What should not be taken with Tetracyclines? / Why?
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
compensatory tachycardia - fluid retention - lupus - like syndrome
cortical collecting tubule
Anaerobes

27. Resistance mechanisms for Aminoglycosides
Modification via Acetylation - Adenylation - or Phosphorylation
proximal convoluted tubule
Slow - limited by half lives of clotting factors
Alpha -1 antagonist

28. Furosemide - clinical use?
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Inhibition of 50S peptidyl transferase - Bacteriostatic
proarrhythmic
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

29. What is a Ribavirin toxicity?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Small lipid - soluble molecule
RESPIre
Hemolytic anemia

30. MOA: Block protein synthesis at 50s subunit
Oral treatment of superficial infections
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Pretreat with antihistamines and a slow infusion rate

31. Quinidine - toxicity?
Blocks Influenza A and RubellA; causes problems with the cerebellA
AmOxicillin has greater Oral bioavailability
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

32. Name four HMG- CoA reductase inhibitors.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Teratogenic - Carcinogenic - Confusion - Headaches
Does not cross
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

33. What is the mechanism of Leuprolide?
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH
- Physostigmine salicylate
Megaloblastic anemia - Leukopenia - Granulocytopenia
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.

34. What is a common drug interaction associated with Griseofulvin?
Increases coumadin metabolism
Rare.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
- Steroids - Tamoxifen

35. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Acetylcholine esterase
Norepinephrine (Alpha1 -2 and beta 1)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

36. What are common side effects of Protease Inhibitors?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Lidocaine - Mexiletine - Tocainide
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

37. Amiodarone - toxicity?
very short acting
sedation - positive Coombs' test
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic

38. MOA: Disrupt fungal cell membranes
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Malaria (P. falciparum)
Amphotericin B - Nystatin - Fluconazole/azoles
Keratin containing tissues - e.g. - nails

39. What drug is given for Pneumocystis carinii prophylaxis?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Pentamidine
Norepinephrine (Alpha1 -2 and beta 1)
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

40. Which drug(s) cause this reaction: Tendonitis and rupture?
Penicillin - G
- Fluoroquinolones
propanolol - esmolol - metoprolol - atenolol - timolol
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)

41. Which of these three drugs will cause a reflex bradycardia in your pt (Norepi - Epi - or Isoporterenol)
Methylxanthine.
Norepinephrine
first dose orthostatic hypotension - dizziness - headache
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

42. What is the MOA for Rifampin?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
- Physostigmine salicylate
- Flumazenil
Inhibits DNA dependent RNA polymerase

43. What is the category and mechanism of action of Zileuton in Asthma treatment?
physostigmine
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Antileukotriene; blocks synthesis by lipoxygenase.
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)

44. Amprotericin B ___________ the BBB
Does not cross
Rifampin (DOC) - minocycline
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Beta adrenergic receptors and Ca2+ channels (stimulatory)

45. What is the effect of norepinephrine on bp and pulse pressure?
Due to the presence of a bulkier R group
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Captopril - Enalapril - Lisinopril
Bacitracin - Vancomycin

46. Which diuretics increase urine K+?
depresses ectopic pacemakers - especially in digoxin toxicity
Tricyclic antidepressant.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride

47. Decrease Digoxin dose in renal failure?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
YES
Paranteral (IV - SC)
physostigmine

48. Resistance mechanisms for Macrolides

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49. How is Chloramphenical used clinically?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Used in combination therapy with SMZ to sequentially block folate synthesis

50. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Blocks Influenza A and RubellA; causes problems with the cerebellA
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
for RSV
Antileukotriene; blocks leukotriene receptors.