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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 is the MOA for Methicillin - Nafcillin - and Dicloxacillin?
Same as penicillin. Act as narrow spectrum antibiotics
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
No
- Aminocaproic acid

2. What is the most common cause of Pt noncompliance with Macrolides?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
GI discomfort
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

3. List the specific antidote for this toxin: Methemoglobin
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.)
- Methylene blue
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Norepinephrine (Alpha1 -2 and beta 1)

4. What are the clinical uses for Aztreonam?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Tricyclic antidepressant.
Phosphorylation by a Viral Kinase
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species

5. K+ sparing diuretics - toxicity?
Inhibition of 50S peptidyl transferase - Bacteriostatic
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Aminoglycosides
Epinephirine(Alpha1 -2 and Beta 1 -2)

6. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
It acts presynaptically to increase NE release.
scopolamine
Acts as a wide spectrum carbapenem
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

7. What are five toxicities associated with Tacrolimus (FK506)?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
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.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

8. What drug is given for Pneumocystis carinii prophylaxis?
Nitrates
Pentamidine
Acetylcholinesterase; ACh is broken down into choline and acetate.
Rifampin (DOC) - minocycline

9. What are two clinical uses of Azathioprine?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Slow - limited by half lives of clotting factors
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

10. What is the category of drug names ending in - terol (e.g. Albuterol)
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Hypersensitivity reactions
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 -2 agonist.

11. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
Ipratropium
- aminoglycosides - loop diuretics - cisplatin
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome

12. What are common serious side effects of Aminoglycosides and What are these associated with?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
IV vitamin K and fresh frozen plasma
Prevents the release of Ca from SR of skeletal muscle
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

13. What type of gout is treated with Colchicine?
VACUUM your Bed Room'
Pregnant women - Children; because animal studies show Damage to Cartilage
Acute gout.
- Quinidine - quinine

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

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15. MOA: Block DNA topoisomerases
Prevents the release of ACh - Which results in muscle paralysis.
Chronic (weeks or months)
Triple sulfas or SMZ
Quinolones

16. Name two LPL stimulators.
Gemfibrozil - Clofibrate
Benzodiazepine.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

17. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Choline acetyltransferase
Hemolytic anemia
post MI and digitalis induced arrhythmias
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

18. What is the category of drug names ending in - navir (e.g. Saquinavir)
Resistant Gram - infections
Indirect agonist - uptake inhibitor
Only in limited amounts
Protease inhibitor.

19. List the mechanism - clinical use - & toxicity of Bleomycin.
Malaria (P. falciparum)
Oral
not a sulfonamide - but action is the same as furosemide
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

20. What is the category of drug names ending in - olol (e.g. Propranolol)
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Long.
Disulfiram - like reaction with EtOH - Headache
Beta antagonist.

21. List the specific antidote for this toxin: Opioids
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Same as penicillin. Extended spectrum antibiotics
- B51Naloxone / naltrexone (Narcan)
- Halothane - Valproic acid - acetaminophen - Amantia phalloides

22. What is the category of drug names ending in - ipramine (e.g. Imipramine)
Tricyclic antidepressant.
VACUUM your Bed Room'
thick ascending limb
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

23. Name four Antiarrhythmic drugs in class III.
Sotalol - Ibutilide - Bretylium - Amiodarone
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Pentamidine

24. What are two Glitazones?
1. Pioglitazone 2. Rosiglitazone.
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Protamine sulfate
Yes - it does not cross the placenta.

25. Which drug(s) cause this reaction: Cardiac toxicity?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
- Daunorubicin & Doxorubicin
sedation - depression - nasal stuffiness - diarrhea
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

26. What is the major toxic side effect of Penicillin?
Hypersensitivity reactions
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

27. What are three toxicities of Leuprolied?
cyanide toxicity (releases CN)
- Penicillin
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
1. Antiandrogen 2. Nausea 3. Vomiting

28. Adverse effects of Guanethidine?
GI upset
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
thiazides - amiloride
Resistant Gram - infections

29. List the mechanism - clinical use - & toxicity of Nitrosureas.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Amphetamine and Ephedrine
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
- Alkalate DNA - Brain tumors - CNS toxicity

30. What is the clinical use of Tacrolimus (FK506)?
Potent immunosuppressive used in organ transplant recipients.
- Chloramphenicol
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Carbenicillin - Piperacillin - and Ticarcillin

31. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
AmOxicillin has greater Oral bioavailability
AZT - to reduce risk of Fetal Transmission

32. Common side effects associated with Clindamycin include?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
- ED 50 is less than the Km (less than 50% of receptors)
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Pituitary hormone.

33. What is the category of drug names ending in - cycline (e.g. Tetracycline)
- Antipsychotics
Antibiotic - protein synthesis inhibitor.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Those patients who are taking nitrates.

34. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Paranteral (IV - SC)
Rare.
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
- Alkalinize urine & dialysis

35. What is the mechanism of action of the glucocorticoids?
Modification via Acetylation
CL= (rate of elimination of drug/ Plasma drug conc.)
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

36. Antiarrhythmic class II- toxicity?
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

37. For Warfarin What is the Onset of action
Slow - limited by half lives of clotting factors
Potent immunosuppressive used in organ transplant recipients.
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Buy AT 30 - CELL at 50'

38. What can result due to antacid overuse?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Reversible block of histamine H2 receptors
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Keratin containing tissues - e.g. - nails

39. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Activates antithrombin III
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Binding to the presynaptic alpha 2 release modulating receptors
Epinephrine

40. What is the category of drug names ending in - cillin (e.g. Methicillin)
Rapid (seconds)
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Penicillin.

41. Antiarrhythmic class IV- clinical use?
- Alkalinize urine & dialysis
Teratogenic - Carcinogenic - Confusion - Headaches
prevention of nodal arrhythmias (SVT)
Penicillin.

42. Which drug(s) cause this reaction: Gingival hyperplasia?
Clavulanic acid
- Phenytoin
Acute gout.
anuria - CHF

43. K+ sparing diuretics - site of action?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
cortical collecting tubule

44. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
- Glucagon
Inhibt Assembly of new virus by Blocking Protease Enzyme
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

45. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Increases coumadin metabolism
Inhibits CMV DNA polymerase
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Binding to the presynaptic alpha 2 release modulating receptors

46. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
These B-2 agonists cause respiratory smooth muscle to relax.
Ipratropium
Resistant Gram - infections

47. What is the category of drug names ending in - operidol (e.g. Haloperidol)
Butyrophenone (neuroleptic).
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Chronic (weeks or months)

48. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride

49. Does Heparin have a long - medium - or short half life?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Short.
Phosphorylation by a Viral Kinase
Blocks Norepi - but not Dopamine

50. Furosemide - clinical use?
Digitoxin>95% Digoxin 75%
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Nitrates