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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. Furosemide - clinical use?
Treatment of infertility.
Penicillin - G
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased

2. Name three calcium channel blockers?
Phenothiazine (neuroleptic - antiemetic).
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Nifedipine - Verapamil - Diltiazem

3. What is the mechanism of action of the Sulfonylureas?
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
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
1. Renal damage 2. Aplastic anemia 3. GI distress
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.

4. Which diuretics increase urine NaCl?
all of them
viral kinase
Polymyxins
Epinephrine

5. Hydrochlorothiazide - clinical use?
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
HTN - CHF - calcium stone formation - nephrogenic DI.
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Cilastatin

6. MOA: Block mRNA synthesis
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Penicillin - G
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Rifampin

7. What are four unwanted effects of Clomiphene use?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Beta lactams - inhibit cell wall synthesis - Bactericidal
Slow - limited by half lives of clotting factors
propanolol - esmolol - metoprolol - atenolol - timolol

8. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
- Lithium
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Amphetamine and Ephedrine

9. Can Warfarin be used during pregnancy?
No - warfarin - unlike heparin - can cross the placenta.
Resistant Gram - infections
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

10. Describe Phase I metabolism in liver(3)?
Hypersensitivity reactions
AZT
Penicillin.
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

11. What is the category of drug names ending in - azine (e.g. Chlorpromazine)
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Sotalol - Ibutilide - Bretylium - Amiodarone
Phenothiazine (neuroleptic - antiemetic).
Dopamine; causes its release from intact nerve terminals

12. Which cancer drugs work at the level of mRNA(2)?
sedation - positive Coombs' test
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Resistant Gram - infections
- Steroids - Tamoxifen

13. Name three K+ sparing diuretics?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Sotalol - Ibutilide - Bretylium - Amiodarone
- Act on same receptor - Full has greater efficacy

14. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Foscarnet = pyroFosphate analog
very short acting
Primaquine
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

15. What is the MOA for Ampicillin and Amoxicillin?
Same as penicillin. Extended spectrum antibiotics
The PTT.
Nephrotoxicity
Tricyclic antidepressant.

16. What are two Alpha - glucosidase inhibitors?
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Quinidine - Amiodarone - Procainamide - Disopyramide
1. Acarbose 2. Miglitol
Acute gout.

17. What parasites are treated with Pyrantel Pamoate (more specific)?
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

18. What is the mechanism of action of Colchicine used to treat acute gout?
1. Weight gain 2. Hepatotoxicity (troglitazone)
Stimulates beta adrenergic receptors
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Quinidine - Amiodarone - Procainamide - Disopyramide

19. Name two bile acid resins.
- Haloperidol - chlorpromazine - reserpine - MPTP
It must be Phosphorylated by Viral Thymidine Kinase
cholestyramine - colestipol
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

20. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Onchocerciasis ('river blindness'-- rIVER- mectin)
loop diuretics - spironolactone
NO
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

21. Name five Antiarrhythmic drugs in class II?
propanolol - esmolol - metoprolol - atenolol - timolol
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Verapamil - Diltiazem - Bepridil
- Haloperidol - chlorpromazine - reserpine - MPTP

22. Name two classes of drugs for HIV therapy
Protease Inhibitors and Reverse Transcriptase Inhibitors
Blood
Beta lactams - inhibit cell wall synthesis - Bactericidal
Chronic gout.

23. What is the category of drug names ending in - pril (e.g. Captopril)
- Oral Contraceptives
TMP- SMZ
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
ACE inhibitor.

24. What are two clinical uses of Azathioprine?
Pituitary hormone.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Erectile dysfunction.

25. List the specific antidote for this toxin: TPA & Streptokinase
- Aminocaproic acid
DOC in diagnosing and abolishing AV nodal arrhythmias
No - warfarin - unlike heparin - can cross the placenta.
Topical and Oral - for Oral Candidiasis (Thrush)

26. What is the MOA for the Azoles?
Inhibit Ergosterol synthesis
Chronic gout.
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

27. For Heparin What is the Onset of action
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Rapid (seconds)

28. Furosemide - toxicity? (OH DANG)
- N- acetylcystine
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
These B-2 agonists cause respiratory smooth muscle to relax.

29. What type of gout is treated with Probenacid?
Nucleosides
collecting ducts
Neomycin
Chronic gout.

30. What is the MOA of Amantadine?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Quinolones
Does not cross

31. Antiarrhythmic class IV- clinical use?
Minor hepatotoxicity - Drug interactions (activates P450)
- Ammonium Chloride
prevention of nodal arrhythmias (SVT)
Modification via Acetylation - Adenylation - or Phosphorylation

32. Which diuretics increase urine K+?
Verapamil - Diltiazem - Bepridil
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Rifampin

33. How do we stop angina?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
1. Weight gain 2. Hepatotoxicity (troglitazone)

34. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Tendonitis and Tendon rupture
- NaHCO3
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

35. For Heparin What is the Site of action
Blood
ACIDazolamide' causes acidosis
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
pulmonary edema - dehydration

36. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
Phenothiazine (neuroleptic - antiemetic).
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
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.)
BM suppression (neutropenia - anemia) - Peripheral neuropathy

37. A common side effects of Interferon (INF) treatment is?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Neutropenia
- Flumazenil
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

38. How is Vancomycin used clinically?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Ammonium Chloride
For serious - Gram + multidrug - resistant organisms
Stimulates beta adrenergic receptors

39. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
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.)
Diuresis in pateints with sulfa allergy
- ACE inhibitors (Losartan>no cough)
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

40. What are two types of drugs that interfere with the action of Sucralfate and why?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Dopamine; causes its release from intact nerve terminals
Beta antagonist.

41. What is the mechanism of action of Cyclosporine?
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
Inhibt Assembly of new virus by Blocking Protease Enzyme
YES
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

42. What is the mechanism of Tacrolimus (FK506)?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
It must be Phosphorylated by Viral Thymidine Kinase

43. What antimuscarinic drug is useful for the tx of asthma
Headache - flushing - dyspepsia - blue - green color vision.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Intrathecally
Ipratropium

44. Which diuretics cause alkalosis?
Rifampin
Activates antithrombin III
loop diuretics - thiazides
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

45. What are four clinical uses of glucocorticoids?

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

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47. What is the clincial use for Misoprostol?
Mebendazole/Thiabendazole - Pyrantel Pamoate
Albuterol - tertbutaline
It affects beta receptors equally and is used in AV heart block (rare).
Prevention of NSAID- induced peptic ulcers - maintains a PDA.

48. Adverse effects of Guanethidine?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

49. Why is there a drop in systolic - mean - and diastolic bp with infusion of isoproterenol?
Constant FRACTION eliminated per unit time.(exponential)
Pentavalent Antimony
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

50. Adverse effects of Minoxidil?
Hemolytic anemia
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis