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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. Antiarrhythmic class IV- primary site of action?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
AV nodal cells
cardiac muscle: Verapamil>Diltiazem>Nifedipine
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

2. Name the common Nucleoside Reverse Transcriptase Inhibitors
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
AV nodal cells
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
No - warfarin - unlike heparin - can cross the placenta.

3. What antimuscarinic drug is useful for the tx of asthma
Ipratropium
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Cilastatin
Prophylaxis for Influenza A - Rubella; Parkinson's disease

4. MOA: Block protein synthesis at 50s subunit
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Those patients who are taking nitrates.
Nitrates

5. What are Amantadine - associated side effects?
- N- acetylcystine
amphetamine and ephedrine
Ataxia - Dizziness - Slurred speech
It acts presynaptically to increase NE release.

6. Which diuretics increase urine NaCl?
sedation - depression - nasal stuffiness - diarrhea
all of them
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)

7. Furosemide - toxicity? (OH DANG)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Protamine sulfate
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Leukotrienes increasing bronchial tone.

8. Which drug(s) cause this reaction: Cardiac toxicity?
Those patients who are taking nitrates.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Daunorubicin & Doxorubicin
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

9. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Antileukotriene; blocks leukotriene receptors.
fetal renal toxicity - hyperkalemia

10. What is the category of drug names ending in - azol (e.g. Ketoconazole)
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Amphetamine and Ephedrine
Antifungal.
GI discomfort

11. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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12. What is the most common cause of Pt noncompliance with Macrolides?
Lidocaine - Mexiletine - Tocainide
Digitoxin 70% Digoxin 20-40%
GI discomfort
Antileukotriene; blocks synthesis by lipoxygenase.

13. How does angiotensin II affect NE release?
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
- Daunorubicin & Doxorubicin
viral kinase
It acts presynaptically to increase NE release.

14. How can the t1/2 of INH be altered?
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Intrathecally
Fast vs. Slow Acetylators
Those patients who are taking nitrates.

15. For Heparin What is the Site of action
Chronic (weeks or months)
torsade de pointes - excessive Beta block
Blood
Malaria (P. falciparum)

16. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
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
effective in torsade de pointes and digoxin toxicity
Megaloblastic anemia - Leukopenia - Granulocytopenia

17. A common side effects of Interferon (INF) treatment is?
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.)
- Isoniazid
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Neutropenia

18. What is the mechanism of action of Heparin?
Heparin catalyzes the activation of antithrombin III.
- Alkalate DNA - Brain tumors - CNS toxicity
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
DHPG (dihydroxy-2- propoxymethyl guanine)

19. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
sedation - depression - nasal stuffiness - diarrhea
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.)
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

20. Toxicities associated with Acyclovir?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
atropine - homatropine - tropicamide
Delirium - Tremor - Nephrotoxicity

21. What is the MOA for the Macrolides?
Binds to the Pyrophosphate Binding Site of the enzyme
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
ACE inhibitor.

22. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
- Penicillamine
Epinephirine(Alpha1 -2 and Beta 1 -2)
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

23. List the specific antidote for this toxin: Iron
Lidocaine - Mexiletine - Tocainide
- Deferoxamine
PT
pulmonary edema - dehydration

24. Mannitol - clinical use?
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Chronic gout.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
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.

25. Which RT inhibitor causes Megaloblastic Anemia?
cross - allergenic
AZT
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Cyclooxygenases (COX I - COX II).

26. Describe the MOA of Interferons (INF)
These B-2 agonists cause respiratory smooth muscle to relax.
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
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Epinephirine(Alpha1 -2 and Beta 1 -2)

27. What is the memory key to remember Which pathway (extrinsic vs. intrinsic) and Which lab value Warfarin affects?
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Minor hepatotoxicity - Drug interactions (activates P450)
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

28. What are two clinical uses of Azathioprine?
new arrhythmias - hypotension
Babiturate.
CMV - esp in Immunocompromised patients
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

29. What is the major side effect for Ampicillin and Amoxicillin?
Chronic anticoagulation.
The only local anesthetic with vasoconstrictive properties.
Hypersensitivity reactions
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

30. How do you calculate maintenance dose?
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Blood
Local anesthetic.
Norepinephrine (Alpha1 -2 and beta 1)

31. MOA: Block nucleotide synthesis
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Ataxia - Dizziness - Slurred speech
AV nodal cells
Sulfonamides - Trimethoprim

32. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Cilastatin
- Ethosuxamide - sulfonamides - lamotrigine
Cyclooxygenases (COX I - COX II).

33. Which drug(s) cause this reaction: Atropine - like side effects?
- Tricyclic antidepressants
- Daunorubicin & Doxorubicin
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Prevents the release of ACh - Which results in muscle paralysis.

34. Which of epi - norepi - or isoproterenol results in bradycardia?
- Ethanol - dialysis - & fomepizole
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
check PFTs - LFTs - and TFTs
Norepinephrine

35. Toxic side effects of the Azoles?
Hemolytic anemia
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
- Halothane - Valproic acid - acetaminophen - Amantia phalloides

36. For Warfarin What is the Ability to inhibit coagulation in vitro
Cardiac glycoside (inotropic agent).
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Dopamine
No

37. Resistance mechanisms for Macrolides

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38. Name four Antiarrhythmic drugs in class IA.
Quinidine - Amiodarone - Procainamide - Disopyramide
Mg = Must go to the bathroom.
Because they require some residual islet function.
With an amino acid change of D- ala D- ala to D- ala D- lac

39. Which diuretics cause acidosis?
It affects beta receptors equally and is used in AV heart block (rare).
- B51Naloxone / naltrexone (Narcan)
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
carbonic anhydrase inhibitors - K+ sparing diuretics

40. Why would dopamine be useful in treating shock?
No - it inhibits the release of Nor Epi
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Chronic Hepatitis A and B - Kaposi's Sarcoma
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

41. Can Heparin be used during pregnancy?
decrease conduction velocity - increase ERP - increase PR interval
Give an antichloinesterase - neostigmine - edrophonium - etc
Yes - it does not cross the placenta.
Neurotoxicity - Acute renal tubular necrosis

42. Name four Antiarrhythmic drugs in class III.
distal convoluted tubule (early)
loop diuretics - spironolactone
physostigmine
Sotalol - Ibutilide - Bretylium - Amiodarone

43. What are three clinical uses of the Leuprolide?
Cilastatin
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
1. Weight gain 2. Hepatotoxicity (troglitazone)
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

44. Where does Griseofulvin deposit?
Keratin containing tissues - e.g. - nails
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
cholestyramine - colestipol

45. What is the MOA for Trimethoprim (TMP)?
Norepinephrine (Alpha1 -2 and beta 1)
Activates antithrombin III
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.)
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

46. List the specific antidote for this toxin: Amphetamine
Amphetamine and Ephedrine
proximal convoluted tubule
- Ammonium Chloride
Activates antithrombin III

47. Cocaine shares is mechanism of action with What antidepressant
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
TCA
Onchocerciasis ('river blindness'-- rIVER- mectin)
TMP- SMZ

48. What is the memory key for Metronidazole's clinical uses?
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
GET on the Metro
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

49. Name four HMG- CoA reductase inhibitors.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Impairs the synthesis of vitamin K- dependent clotting factors
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
- Tetracycline - amiodarone - sulfonamides

50. What is the mechanism of action of Warfarin (Coumadin)?
Megaloblastic anemia - Leukopenia - Granulocytopenia
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.
Beta lactams - inhibit cell wall synthesis - Bactericidal
1. Renal damage 2. Aplastic anemia 3. GI distress