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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. What are four advantages of newer low - molecular - weight heparins (Enoxaparin)?
H2 antagonist
Sulfonamides - Trimethoprim
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

2. Adverse effects of Reserpine?
- Oral Contraceptives
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
sedation - depression - nasal stuffiness - diarrhea
Chronic (weeks or months)

3. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Acute gout.
Benzathine penicillin G
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
cardiac muscle: Verapamil>Diltiazem>Nifedipine

4. What is the mechanism of action of Allopurinol used to treat chronic gout?
Inhibits cell wall mucopeptide formation - Bactericidal
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
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

5. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Antifungal.
With an amino acid change of D- ala D- ala to D- ala D- lac
new arrhythmias - hypotension
Nitrates

6. List the mechanism - clinical use - & toxicity of Bleomycin.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Early myocardial infarction.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
not a sulfonamide - but action is the same as furosemide

7. List the specific antidote for this toxin: Carbon monoxide
Methylxanthine.
DHPG (dihydroxy-2- propoxymethyl guanine)
-100% oxygen - hyperbaric
ACIDazolamide' causes acidosis

8. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
cardiac depression - peripheral edema - flushing - dizziness - constipation
- Shifts the curve to the right - increases Km
Staphlococcus aureus
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.

9. List the mechanism - clinical use - & toxicity of Etoposide.
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
bradycardia - AV block - CHF
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Minor hepatotoxicity - Drug interactions (activates P450)

10. What is the clinical use for Nystatin?
distal convoluted tubule (early)
Topical and Oral - for Oral Candidiasis (Thrush)
propanolol - esmolol - metoprolol - atenolol - timolol
local anesthetic. CNS stimulation or depression. CV depression.

11. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
Cardiac glycoside (inotropic agent).
Hydralazine and Minoxidil
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
for RSV

12. Which drug(s) cause this reaction: G6PD hemolysis(8)?
Only in limited amounts
Aminoglycosides
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
- Chlorpromazine - thioridazine - haloperidol

13. What is the mechanism of action of Probenacid used to treat chronic gout?
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Inhibits reabsorption of uric acid.
Ca2+ (Loops Lose calcium)
No - hemicholinum block the uptake of Choline and thus Ach synthesis

14. What is the effect of epinephrine infusion on bp and pulse pressure?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
carbonic anhydrase inhibitors - K+ sparing diuretics
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Potent immunosuppressive used in organ transplant recipients.

15. Adverse effects of Hydrochlorothiazide?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Beta1 more than B2

16. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
Captopril - Enalapril - Lisinopril
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
aPTT (intrinsic pathway)
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

17. Antiarrhythmic class IB- toxicity?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
- Ethanol - dialysis - & fomepizole
local anesthetic. CNS stimulation or depression. CV depression.
- Fluoroquinolones

18. What is the category of drug names ending in - olol (e.g. Propranolol)
- Penicillamine
Beta antagonist.
Resistant Gram - infections
Verapamil - Diltiazem - Bepridil

19. Digoxin v. Digitoxin: bioavailability?
- Tetracycline
Cell membrane Ca2+ channels of cardiac sarcomere
Digitoxin>95% Digoxin 75%
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

20. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
ACE inhibitor.
DHPG (dihydroxy-2- propoxymethyl guanine)
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

21. What are five toxicities associated with Tacrolimus (FK506)?
Nephrotoxicity
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Pregnant women - Children; because animal studies show Damage to Cartilage

22. Clinical use of Isoniazid (INH)?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Gram + cocci - Gram - rods - and Anerobes
Nitrates

23. What is the clinical use for Heparin?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Blocks Influenza A and RubellA; causes problems with the cerebellA
- EDTA - dimercaprol - succimer - & penicillamine

24. List the specific antidote for this toxin: Lead
- aminoglycosides - loop diuretics - cisplatin
Chronic (weeks or months)
- EDTA - dimercaprol - succimer - & penicillamine
Rheumatoid and osteoarthritis.

25. What is are two clinical uses of Cyclosporine?
Pseudomonas species and Gram - rods
thiazides - amiloride
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Teratogenic - Carcinogenic - Confusion - Headaches

26. Acetazolamide - toxicity?
HTN - CHF - calcium stone formation - nephrogenic DI.
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Inhibt Assembly of new virus by Blocking Protease Enzyme
Dermatophytes (tinea - ringworm)

27. List the specific antidote for this toxin: Antimuscarinic (anticholinergic)
Gram + cocci - Gram - rods - and Anerobes
No
Rheumatoid and osteoarthritis.
- Physostigmine salicylate

28. What is the MOA for Ampicillin and Amoxicillin?
Same as penicillin. Extended spectrum antibiotics
Bacitracin - Vancomycin
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias

29. In coma situations you rule out What (7)?

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30. What drug is used during the pregnancy of an HIV+ mother? - Why?
AZT - to reduce risk of Fetal Transmission
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

31. For Warfarin What is the Duration of action
Binds ergosterol - Disrupts fungal membranes
Chronic (weeks or months)
- aminoglycosides - loop diuretics - cisplatin
Prevents the release of ACh - Which results in muscle paralysis.

32. What is the effect of the Glitazones in diabetes treatment?
Leukotrienes increasing bronchial tone.
Increase target cell response to insulin.
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

33. What is the clinical use of Tacrolimus (FK506)?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Potent immunosuppressive used in organ transplant recipients.
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Antibiotic - protein synthesis inhibitor.

34. List the mechanism - clinical use - & toxicity of Paclitaxel.
Prevents the release of Ca from SR of skeletal muscle
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
is resistant
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

35. What is the category of drug names ending in - operidol (e.g. Haloperidol)
Butyrophenone (neuroleptic).
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
GI upset
Inhibit Ergosterol synthesis

36. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
For serious - Gram + multidrug - resistant organisms
loop diuretics - spironolactone

37. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
- Penicillin
- Tetracycline
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

38. Which RT inhibitors cause a Rash?
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
RESPIre
Non - Nucleosides

39. What is the clinical utility of clonidine?
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
scopolamine
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

40. What are common toxicities associated with Tetracyclines?

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41. What is a possible result of overdose of Acetaminophen?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Botulinum

42. How does angiotensin II affect NE release?
It acts presynaptically to increase NE release.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
check PFTs - LFTs - and TFTs
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

43. Which cancer drugs inhibit nucleotide synthesis(3)?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Antileukotriene; blocks leukotriene receptors.
- Methotrexate - 5 FU - 6 mercaptopurine
Neurotoxicity - Acute renal tubular necrosis

44. For Heparin What is the Structure
Large anionic polymer - acidic
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
post MI and digitalis induced arrhythmias
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.

45. MOA: Bactericidal antibiotics
torsade de pointes
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

46. How is Amphotericin B administered for fungal meningitis?
for RSV
Quinolones
Hemolytic anemia
Intrathecally

47. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
- Corticosteroids - heparin
Beta Blockers
- Oxalic acid - Acidosis & nephrotoxicity
Buy AT 30 - CELL at 50'

48. What type of gout is treated with Allopurinol?
Chronic (weeks or months)
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
effective in torsade de pointes and digoxin toxicity
Chronic gout.

49. MOA: Block DNA topoisomerases
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Quinolones
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Norepinephrine (Alpha1 -2 and beta 1)

50. What are three possible toxicities of NSAID usage?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Increases coumadin metabolism
Chronic Hepatitis A and B - Kaposi's Sarcoma
1. Renal damage 2. Aplastic anemia 3. GI distress