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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)?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Decreased uptake or Increased transport out of cell
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Aplastic anemia (dose independent) - Gray Baby Syndrome

2. Ca2+ sensitizers'- site of action?
troponin - tropomyosin system
- Disulfram & also sulfonylureas - metronidazole
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Beta lactams - inhibit cell wall synthesis - Bactericidal

3. What is the category of drug names ending in - cillin (e.g. Methicillin)
Choline acetyltransferase
Penicillin.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

4. Antimicrobial prophylaxis for PCP
TMP- SMZ (DOC) - aerosolized pentamidine
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Amphetamine and Ephedrine

5. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Antileukotriene; blocks leukotriene receptors.
Digitoxin 70% Digoxin 20-40%
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Potent immunosuppressive used in organ transplant recipients.

6. Which drug(s) cause this reaction: Pseudomembranous colitis?
Early myocardial infarction.
- Oral Contraceptives
- Vinca alkaloids(inhibit MT) - Paclitaxel
- Clindamycin

7. Which drug(s) cause this reaction: Anaphylaxis?
Tricyclic antidepressant.
- Penicillin
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

8. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Headache - flushing - dyspepsia - blue - green color vision.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Tendonitis and Tendon rupture

9. Aztreonam is not ________ with penicillins
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
cross - allergenic
It affects beta receptors equally and is used in AV heart block (rare).

10. What is the category of drug names ending in - operidol (e.g. Haloperidol)
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Butyrophenone (neuroleptic).
Methylation of rRNA near Erythromycin's ribosome binding site
Alpha -1 antagonist

11. What microorganisms are Aminoglycosides ineffective against?
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Anaerobes
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

12. Name three Antiarrhythmic drugs in class IV.
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Verapamil - Diltiazem - Bepridil
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
- Antipsychotics

13. Antimicrobial prophylaxis for a history of recurrent UTIs
Cell membrane Ca2+ channels of cardiac sarcomere
Modification via Acetylation
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
TMP- SMZ

14. Why would dopamine be useful in treating shock?
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
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.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Long.

15. What are the clinical indications for Azole therapy?
Systemic mycoses
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Reversible block of histamine H2 receptors
Mebendazole/Thiabendazole - Pyrantel Pamoate

16. List the specific antidote for this toxin: Beta Blockers
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
INH: Injures Neurons and Hepatocytes
- Glucagon
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

17. What are three possible complications of Heparin therapy?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Carbenicillin - Piperacillin - and Ticarcillin
- B51Naloxone / naltrexone (Narcan)

18. Which cancer drugs work at the level of mRNA(2)?
Antifungal.
- Steroids - Tamoxifen
Blocks Influenza A and RubellA; causes problems with the cerebellA
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity

19. Resistance mechanisms for Macrolides

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20. Which drug(s) cause this reaction: Photosensitivity(3)?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
ACE inhibitor.
- Tetracycline - amiodarone - sulfonamides

21. For Heparin What is the Lab value to monitor
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
aPTT (intrinsic pathway)
CMV - esp in Immunocompromised patients
Local anesthetic.

22. Loop diuretics (furosemide)- site of action?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
thick ascending limb
Leukotrienes increasing bronchial tone.
BM suppression (neutropenia - anemia) - Peripheral neuropathy

23. Side effects of Isoniazid (INH)?
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
competitive inhibirot of aldosterone in the cortical collecting tubule
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
anticholinesterase glaucoma

24. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
With an amino acid change of D- ala D- ala to D- ala D- lac
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Epinephirine(Alpha1 -2 and Beta 1 -2)

25. Sotalol - toxicity?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
torsade de pointes - excessive Beta block
Triple sulfas or SMZ

26. What is the MOA of Ganciclovir?
1. Weight gain 2. Hepatotoxicity (troglitazone)
Inhibits CMV DNA polymerase
- Oral Contraceptives
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

27. What is the memory key for the effect of magnesium hydroxide overuse?
toxic
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Mg = Must go to the bathroom.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

28. What reversal agent could a Anes give to reverse the effects of Atropine
Increase target cell response to insulin.
Suramin
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Bethanechol - Neostigmine - physostigmine

29. Can Warfarin be used during pregnancy?
Beta lactams - inhibit cell wall synthesis - Bactericidal
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
No - warfarin - unlike heparin - can cross the placenta.
Butyrophenone (neuroleptic).

30. Cocaine shares is mechanism of action with What antidepressant
TCA
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

31. A 57 yo heart failure pt develops cardiac decompensation - What drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
AZT
- Isoniazid
Erythromycin - Azithromycin - Clarithromycin
Dopamine

32. Adverse effects of Minoxidil?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.

33. Hydralazine - toxicity?
Yes - it does not cross the placenta.
- Normalize K+ - Lidocaine - & Anti - dig Mab
Megaloblastic anemia - Leukopenia - Granulocytopenia
compensatory tachycardia - fluid retention - lupus - like syndrome

34. What is Imipenem always administered with?
Pituitary hormone.
Cilastatin
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.
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

35. What is are two clinical uses of Cyclosporine?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
YES
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.
DHPG (dihydroxy-2- propoxymethyl guanine)

36. Name several common Macrolides (3)
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
TMP- SMZ (DOC) - aerosolized pentamidine
Erythromycin - Azithromycin - Clarithromycin
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

37. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
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)
atropine - homatropine - tropicamide
Benzodiazepine.

38. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Binding to the presynaptic alpha 2 release modulating receptors
Digoxin=urinary Digitoxin=biliary
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

39. What are the four conditions in Which Omeprazole - Lansoprazole is used?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
compensatory tachycardia - fluid retention - lupus - like syndrome
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

40. What are three clinical uses of the Leuprolide?
Same as penicillin. Extended spectrum antibiotics
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

41. What is the mechanism of action of the thrombolytics?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Oral treatment of superficial infections
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.)
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

42. What is the formula for Clearance (CL)
CL= (rate of elimination of drug/ Plasma drug conc.)
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Nucleosides
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

43. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Alpha -1 antagonist
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Same as penicillin. Extended spectrum antibiotics
Inhalational general anesthetic.

44. What are two types of drugs that interfere with the action of Sucralfate and why?
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
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Cilastatin

45. Why is pyridostigmine effective in the treatment of myasthenia gravis?
- Lithium
Malaria (P. falciparum)
As an anticholinesterase it increases endogenous ACh and thus increases strength.
- Aminocaproic acid

46. What are four clinical uses of glucocorticoids?

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47. Guanethidine enhances the release of Norepi?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
cyanide toxicity (releases CN)
No - it inhibits the release of Nor Epi
Same as penicillin. Extended spectrum antibiotics

48. What class of drug is echothiophate? What is its indication?
Verapamil - Diltiazem - Bepridil
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
anticholinesterase glaucoma

49. Adverse effects of Clonidine?
dry mouth - sedation - severe rebound hypertension
- Quinidine - quinine
RESPIre
- Isoniazid

50. What drug is used to diagnose myasthenia gravis?
Alpha -1 antagonist
Sildenafil fills the penis
edrophonium (extremely short acting anticholinesterase)
Scopolamine