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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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1. What is Clindamycin used for clinically?
- Lithium
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Pentamidine
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

2. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
edrophonium (extremely short acting anticholinesterase)
first dose orthostatic hypotension - dizziness - headache
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Pseudomonas species and Gram - rods

3. Beta Blockers - site of action?
effective in torsade de pointes and digoxin toxicity
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Amphetamine and Ephedrine
- Alkalate DNA - Brain tumors - CNS toxicity

4. How does angiotensin II affect NE release?
It acts presynaptically to increase NE release.
Polymyxin B - Polymyxin E
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Pseudomonas species and Gram - rods

5. Ryanodine - site of action?
- EDTA - dimercaprol - succimer - & penicillamine
blocks SR Ca2+ channels
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

6. What is combination TMP- SMZ used to treat?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
- Vinca alkaloids(inhibit MT) - Paclitaxel
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

7. What is the category of drug names ending in - zosin (e.g. Prazosin)
Early myocardial infarction.
Alpha -1 antagonist
Short.
Albuterol - tertbutaline

8. What Sulfonamides are used for simple UTIs?
Binding to the presynaptic alpha 2 release modulating receptors
Increase target cell response to insulin.
Triple sulfas or SMZ
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

9. What is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
Aplastic anemia (dose independent) - Gray Baby Syndrome
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

10. What are four H2 Blockers?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Beta - lactamase cleavage of Beta - lactam ring
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Inhibition of 50S peptidyl transferase - Bacteriostatic

11. What neurotransmitter does Amantadine affect? How does it influence this NT?
- Normalize K+ - Lidocaine - & Anti - dig Mab
Abortifacient.
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Dopamine; causes its release from intact nerve terminals

12. What are four clinical uses of glucocorticoids?

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13. Which diuretics increase urine K+?
Inhalational general anesthetic.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
- Tetracycline

14. Adverse effects of Prazosin?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.
first dose orthostatic hypotension - dizziness - headache
- Chloramphenicol

15. What is Metronidazole used for clinically?
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Ibuprofen - Naproxen - and Indomethacin
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

16. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
Hemolytic anemia
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Epinephirine(Alpha1 -2 and Beta 1 -2)
decrease

17. What are two clinical uses of Azathioprine?
Ibuprofen - Naproxen - and Indomethacin
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Scopolamine

18. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
Na/K ATPase
- polymyxins
Pseudomonas species and Gram - rods
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

19. What is the clinical use of Mifepristone (RU486)?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Abortifacient.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Epinephrine

20. What is the major toxic side effect of Penicillin?
amphetamine and ephedrine
Hypersensitivity reactions
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Choline acetyltransferase

21. What type of gout is treated with Allopurinol?
Chronic gout.
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
torsade de pointes
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

22. Why would you give a drug like pancuronium or succinylcholine?
Useful in muscle paralysis during surgery or mechanical ventilation.
GI discomfort
reversible SLE- like syndrome
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

23. What are the major structural differences between Penicillin and Cephalosporin?
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)
- Formaldehyde & formic acid - severe acidosis & retinal damage
TCA
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.

24. What is Niclosamide used for?
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Nevirapine - Delavirdine

25. What is the clinical use for Heparin?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
hypertension - CHF - diabetic renal disease
anuria - CHF

26. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Ibuprofen - Naproxen - and Indomethacin
Clavulanic acid
Severe Gram - rod infections.
effective in torsade de pointes and digoxin toxicity

27. How is Rifampin used clinically?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Long.
aPTT (intrinsic pathway)
RESPIre

28. MOA: Block DNA topoisomerases
Quinolones
Early myocardial infarction.
The PTT.
Sotalol - Ibutilide - Bretylium - Amiodarone

29. Beta Blockers - BP?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Early myocardial infarction.
decrease

30. What is the definition of zero - order kinetics? Example?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
AmOxicillin has greater Oral bioavailability
Hypersensitivity reactions
Sotalol - Ibutilide - Bretylium - Amiodarone

31. Explain potency in relation to full and partial agonists(2).
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Nephrotoxicity
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Suramin

32. Digoxin v. Digitoxin: excretion?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
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.
Digoxin=urinary Digitoxin=biliary
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.

33. K+ sparing diuretics - site of action?
cortical collecting tubule
Diarrhea
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

34. ACE inhibitors - toxicity?
local anesthetic. CNS stimulation or depression. CV depression.
torsade de pointes - excessive Beta block
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion

35. What are common side effects of Protease Inhibitors?
Indirect agonist - uptake inhibitor
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

36. What conditions would you use dantrolene?
Blood
Hypersensitivity reactions
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
With an amino acid change of D- ala D- ala to D- ala D- lac

37. How would you reverse the effect of a neuromuscular blocking agent?
Decreases synthesis of Mycolic Acid
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
troponin - tropomyosin system
Give an antichloinesterase - neostigmine - edrophonium - etc

38. What antimuscarinic drug is useful for the tx of asthma
Ipratropium
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
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.
-100% oxygen - hyperbaric

39. What is the memory key for the effect of aluminum hydroxide overuse?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
AluMINIMUM amount of feces.
Succinylcholine
Paranteral (IV - SC)

40. What are two toxicities of the Sulfonylureas?
- Steroids - Tamoxifen
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Ibuprofen - Naproxen - and Indomethacin
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

41. What is the MOA for the Macrolides?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
ACIDazolamide' causes acidosis
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

42. What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
Sildenafil fills the penis
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
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
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas

43. Verapamil has similar action to?
Blood
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
- NaHCO3
Beta Blockers

44. Furosemide - clinical use?
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Acts as a wide spectrum carbapenem
Bacitracin - Vancomycin
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

45. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Binding to the presynaptic alpha 2 release modulating receptors
- Normalize K+ - Lidocaine - & Anti - dig Mab
Pregnant women - Children; because animal studies show Damage to Cartilage
Vd= (Amt. of drug in body/ Plasma drug conc.)

46. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
sedation - depression - nasal stuffiness - diarrhea
- Chlorpromazine - thioridazine - haloperidol
Malaria (P. falciparum)
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

47. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
Bethanechol - Neostigmine - physostigmine
atropine - homatropine - tropicamide
Same as penicillin. Act as narrow spectrum antibiotics
Succinylcholine

48. List the mechanism - clinical use - & toxicity of Nitrosureas.
Increase target cell response to insulin.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
- Alkalate DNA - Brain tumors - CNS toxicity
Short.

49. How does Ganciclovir's toxicity relate to that of Acyclovir?
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Ganciclovir is more toxic to host enzymes
Inhibits Viral DNA polymerase
INH: Injures Neurons and Hepatocytes

50. Resistance mechanisms for Cephalosporins/Penicillins
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Decreases synthesis of Mycolic Acid
Beta - lactamase cleavage of Beta - lactam ring
Those patients who are taking nitrates.