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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 category of drug names ending in - pril (e.g. Captopril)
- Clindamycin
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
ACE inhibitor.
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities

2. What is the major toxic side effect of Penicillin?
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
cross - allergenic
cyanide toxicity (releases CN)
Hypersensitivity reactions

3. Ibutilide - toxicity?
AV nodal cells
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
torsade de pointes

4. What are three clinical uses of the NSAIDs?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
The only local anesthetic with vasoconstrictive properties.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

5. How does resistance to Vancomycin occur?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
With an amino acid change of D- ala D- ala to D- ala D- lac
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

6. What is the memory key to remember Which pathway (extrinsic vs. intrinsic) and Which lab value Warfarin affects?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
carbonic anhydrase inhibitors - K+ sparing diuretics
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
- Penicillin

7. Antiarrhythmic class IV- primary site of action?
- Chloramphenicol
severe hypertension - CHF
- Tricyclic antidepressants
AV nodal cells

8. Antiarrhythmic class IB- effects?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Nephrotoxicity
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

9. How do we stop angina?
GI side effects. (Indomethacin is less toxic - more commonly used.)
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
-100% oxygen - hyperbaric
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

10. What are two indirect acting adrenergic agonists?
Give an antichloinesterase - neostigmine - edrophonium - etc
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
amphetamine and ephedrine

11. How is Ganciclovir used clinically?
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
CMV - esp in Immunocompromised patients
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

12. Sotalol - toxicity?
Epinephirine(Alpha1 -2 and Beta 1 -2)
- Lithium
torsade de pointes - excessive Beta block
Inhibits DNA dependent RNA polymerase

13. Which drug(s) cause this reaction: Fanconi's syndrome?
troponin - tropomyosin system
- Tetracycline
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

14. What are common toxicities associated with Tetracyclines?

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15. Antiarrhythmic class II- toxicity?
Na/K ATPase
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

16. What process does Zafirlukast interfere with?
Leukotrienes increasing bronchial tone.
Staphlococcus aureus
Antileukotriene; blocks leukotriene receptors.
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion

17. List the mechanism - clinical use - & toxicity of Doxorubicin.

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18. What is the category and mechanism of action of Zileuton in Asthma treatment?
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Antileukotriene; blocks synthesis by lipoxygenase.
Useful in muscle paralysis during surgery or mechanical ventilation.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

19. What is the MOA for Rifampin?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Oxygen
Neutropenia
Inhibits DNA dependent RNA polymerase

20. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
- Clindamycin
DHPG (dihydroxy-2- propoxymethyl guanine)
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
It affects beta receptors equally and is used in AV heart block (rare).

21. Furosemide increases the excretion of What ion?
Beta antagonist.
Ca2+ (Loops Lose calcium)
Rapid (seconds)
Increases coumadin metabolism

22. MOA: Disrupt bacterial/fungal cell membranes
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Hydralazine - Procainamide - INH - phenytoin
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Polymyxins

23. Which diuretics increase urine Ca2+?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Reversible block of histamine H2 receptors
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
loop diuretics - spironolactone

24. What is the mechanism of Tacrolimus (FK506)?
Acute (hours)
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Phosphorylation by a Viral Kinase
Modification via Acetylation

25. What is the clinical use for Sildenafil (Viagra)?
Diuresis in pateints with sulfa allergy
Erectile dysfunction.
new arrhythmias - hypotension
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

26. List the specific antidote for this toxin: Copper
- Penicillamine
Methylxanthine.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Antifungal.

27. Why is Cilastatin administered with Imipenem?
- Corticosteroids - heparin
- Glucagon
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

28. Describe first - order kinetics?
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Constant FRACTION eliminated per unit time.(exponential)
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

29. What neurotransmitter does Amantadine affect? How does it influence this NT?
Diarrhea
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Dopamine; causes its release from intact nerve terminals

30. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
Succinylcholine
The PTT.
INH: Injures Neurons and Hepatocytes
Blocks Influenza A and RubellA; causes problems with the cerebellA

31. Adverse effects of Methyldopa?

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32. Which Aminoglycoside is used for Bowel Surgery ?
Acute gout.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Neomycin
Succinylcholine

33. What antimuscarinic agent is used in asthma and COPD?
Mebendazole/Thiabendazole - Pyrantel Pamoate
Inhibit viral DNA polymerase
Ipratropium
- Chloramphenicol

34. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
- Flumazenil
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Praziquantel
Hypersensitivity reactions

35. What are Amantadine - associated side effects?
Rifampin (DOC) - minocycline
Indirect agonist - uptake inhibitor
Ataxia - Dizziness - Slurred speech
Methylxanthine.

36. Which of epi - norepi - or isoproterenol results in bradycardia?
Norepinephrine
1. Pioglitazone 2. Rosiglitazone.
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
Beta antagonist.

37. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Primaquine
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

38. What is the possible mechanism and effect of Metformin in treating diabetes?
Inhibit Ergosterol synthesis
Penicillin - G
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

39. List the mechanism - clinical use - & toxicity of Tamoxifen.
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
- Formaldehyde & formic acid - severe acidosis & retinal damage
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk

40. What is the MOA of Isoniazid (INH)?
AZT
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Decreases synthesis of Mycolic Acid
- Shifts the curve down - reduces Vmax

41. What are four Sulfonylureas?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
fetal renal toxicity - hyperkalemia
torsade de pointes
Captopril - Enalapril - Lisinopril

42. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
Norepinephrine
Teratogenic - Carcinogenic - Confusion - Headaches
AmOxicillin has greater Oral bioavailability
Inhibits Viral DNA polymerase

43. Which drug(s) cause this reaction: Diabetes insipidus?
Inhibt Assembly of new virus by Blocking Protease Enzyme
Aminoglycosides
- Lithium
hypertension - angina - arrhythmias

44. What is the MOA for Nystatin?
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Binds ergosterol - Disrupts fungal membranes
- Chlorpromazine - thioridazine - haloperidol
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

45. Foscarnet toxicity?
viral kinase
GI disturbances.
Nephrotoxicity
Because they require some residual islet function.

46. ADH antagonists - site of action?
Albuterol - tertbutaline
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
collecting ducts
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

47. K+- clinical use?
Long.
depresses ectopic pacemakers - especially in digoxin toxicity
proarrhythmic
Inhibits reabsorption of uric acid.

48. What is the MOA for Acyclovir?
Inhibit viral DNA polymerase
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
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.)
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

49. Which drug(s) cause this reaction: Hepatitis?
Bethanechol - Neostigmine - physostigmine
- Isoniazid
Cell membrane Ca2+ channels of cardiac sarcomere
Oral treatment of superficial infections

50. What is the mechanism of Leuprolide?
Dopamine
troponin - tropomyosin system
loop diuretics - spironolactone
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