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0 - USMLE Step 1 > Pharmacology > Flashcards

Pharmacology Flashcards

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USMLE® Step 1 flashcards
1
Q

Which type of diuretic can be useful in preventing the formation of calcium stones by causing increased Ca2+ reabsorption?

A

Thiazides —> decrease urine Ca2+ excretion

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2
Q

Which drug can be used to decrease the risk of uric acid kidney stones?

A

Acetazolamide

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3
Q

The SERM, Tamoxifen, is a prodrug used in breast cancer treatment that metabolized by what CYP and to what active metabolite?

A

CYP2D —> active metabolite, endoxifen

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4
Q

Which 3 drugs can be used for venous thromboembolism and atrial fibrillation in pt’s with heparin-induced thrombocytopenia?

A
  • Bivalirudin
  • Argatroban
  • Dabigatran

*Direct thrombin inhibitors; used when heparin is BAD for the pt

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5
Q

What is the MOA of cyclosporine?

A

Binds cyclophilin in lymphocytes and inhibits calcineurin –> ↓ IL-2

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6
Q

What is the MOA of Tacrolimus?

A

Binds FK506-binding protein and Inhibits IL-2 through a calcineurin-dependent mechanism

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7
Q

What are the most common mechanisms of aminoglycoside resistance?

A

Antibiotic-modifying enzymes adding chemical groups i.e., acetyl ,adenyl, phosphate

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8
Q

What is the MOA and use for Flutamide?

A
  • Nonsteroid anti-androgen that competitively inhibits testosterone receptors
  • Used in tx of prostate cancer –> improves sx’s of bone pain and urinary obstruction
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9
Q

List the 4 preferred agents used for bipolar maintenance tx?

A
  • Lithium
  • Anticonvulsants: Valproate and Lamotrigine
  • Quetiapine (2nd gen. antipsychotic)
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10
Q

List 5 medication classes which prolong the QT and can induce torsades.

A
  • Macrolides
  • Fluoroquinolones
  • Anti-psychotics: haloperidol and risperidone
  • Antiemetics: ondansetron and metoclopramide
  • Azoles
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11
Q

What is phenylephrine and what is its effect on peripheral vascular resistance, systolic BP, pulse pressure, and HR?

A
  • Selective alpha-1 AR agonist
  • ↑ PVR and ↑ systolic BP
  • ↓ pulse pressure and ↓ HR
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12
Q

What is the most frequently used agent for the chemoprophylaxis of meningococcal disease?

A

Rifampin

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13
Q

Which 3 classes of drugs act on the ciliary epithelium to decrease aqueous humor secretion and can be used for glaucoma?

A
  • Non-selective beta-blockers: Timolol
  • Alpha-2 AR agonists
  • Carbonic anhydrase inhibitors: Acetazolamide
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14
Q

What is the MOA of administering Amyl Nitrite to pt with Cyanide poisoning?

A
  • Oxidizes Fe2+ –> Fe3+ generating methemoglobin
  • Methemoglobin has a high affinity for cyanide, freeing it from cytochrome oxidase and limiting its toxic effects
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15
Q

What are 2 monoclonal antibodies against PD-1 and which is against PD-L1?

A
  • Pembrolizumab and Nivolumab are against PD-1
  • Atezolizumab is against PD-L1

*Used for advanced melanoma, some lung cancer, and RCC

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16
Q

How can mycobacteria develop resistance to both isoniazid and ethambutol?

A
  • Isoniazid: decreased activity of bacterial catalase-peroxidase
  • Ethambutol: increased activity of enzymes involved in cell wall polysaccharide synthesis
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17
Q

Digoxin slows ventricular rate during AF primarily by causing what?

A
  • Increased parasympathetic tone –> inhibition of the AV nodal conduction
  • Used in HF due to positive inotropic effect; accomplished through inhibition of Na/K-ATPase pump
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18
Q

What is the MOA of the stimulant drugs (methylphenidate and amphetamines) used to treat ADHD?

A

Blocking NE and dopamine re-uptake at synapses in the prefrontal cortex

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19
Q

Clozapine is a 2nd-gen. antipsychotic that is used for what?

A

Treatment-_refractory_ Schizophrenia

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20
Q

Which 2 second-gen. antipsychotics carry the greatest risk of metabolic syndrome and require pt’s to undergo routine monitoring of weigh, waist circumference, BP, fasting glucose and lipid profiles?

A

Olanzapine and Clozapine

21
Q

Which laboratory test should be obtained before starting patient on Metformin?

A
  • Serum creatinine level to evaluate to estimate GFR and evaluate kidney function
  • Patients with recent IV contrast administration may have suppressed renal function
22
Q

Which 2 medications require routine thyroid function tests?

A

Lithium and Amiodarone

23
Q

Which 2 antiseizure meds work by blocking Na+ channels?

A

Phenytoin and Carbamazepine

24
Q

What is the 1st line tx for absence seizures and what is the MOA?

A
  • Ethosuximide
  • Blocks T-type Ca2+ channels in thalamic neurons
25
Q

Which antiseizure med works by blocking Na+ channels and increasing GABA levels?

A

Valproic acid

26
Q

What are 2 important AE’s associated with Carbamazepine?

A
  • Bone marrow suppression –> anemia, agranulocytosis, and thrombocytopenia
  • SIADH —> hyponatremia
27
Q

What is th drug of choice for tx of Bulimia Nervosa?

A

Fluoxetine (SSRI)

28
Q

Why are ACEI’s and ARBs containdicated during pregnancy?

A
  • Leads to low levels of angiotensin II, which is necessary for fetal renal development
  • This leads to Potter sequence due to oligohydramnios –> pulmonary hypoplasia and skeletal defects
29
Q

What are 4 characteristics of a drug which would cause it to be trapped in the plasma compartment resulting in a low Vd (3-5L)?

A
  • High molecular weight
  • High plasma protein binding
  • High charge
  • Hydrophilicity
30
Q

What can be a potential limiting factor when starting a patient on an ACE inhibitor?

A
  • First-dose HYPOtension
  • Most likely in pt’s w/ high renin activity, such as those w/ volume depletion (i.e., from diuretic use) or heart failure
31
Q

What are the 2 positive effects of using the PDE-3 enzyme inhibitor, Milrinone for heart failure?

A
  • In cardiomyocytes, intracellular Ca2+ is increased –> increases contractility (positive inotropy), improving SV and cardiac output
  • In vascular smooth m., increases uptake of Ca2+ by the SR = relaxation and vasodilation = decreases preload and afterload
32
Q

What are the drugs of choice for treating heparin-induced thrombocytopenia (HIT)?

A

Direct thrombin inhibitors = Hirudin, Lepirudin, and Argatroban

33
Q

Which 2 drugs are commonly used to tx spasticity secondary to both brain and spinal cord disease, including MS; what are their MOA’s?

A
  • Baclofen: an agonist at the GABA-B receptor
  • Tizanidine: an agonist at the alpha-2 AR
34
Q

Which 3 anticonvulsants can be used as mood stabilizers in tx of bipolar disorder?

A
  • Valproate
  • Lamotrigine
  • Carbamazepine
35
Q

Which AE’s are associated with the first-line tx for CMV colitis and retinitis, Gangciclovir?

A

Neutropenia, thrombocytopenia, and anemia

36
Q

What is the MOA of the non-benzodiazepine hypnotic agents, Zolpidem, Zaleplon, and Eszopiclone?

A

Agonist at GABAA receptor at the benzodiazepine receptor site

37
Q

What is the MOA of Cromolyn and Nedocromil?

A

Inhibit mast cell degranulation and prevent release of preformed mediators

38
Q

Methylation is an important drug biotransformation method to consider when prescribing drugs such as?

A

Azathioprine and 6-mercaptopurine

39
Q

Which drug is as effective as aspirin for prevention of cardiovascular events and should be used in pt’s with an aspirin allergey; what’s the MOA?

A

Clopidogrel: irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface and prevents aggregation

40
Q

Which 5 drugs are commonly implicated in drug-induced lupus?

A
  • Hyrdralazine
  • Procainamide
  • Isoniazid
  • Minocycline
  • Quinidine
41
Q

Why do ACE inhibitors cause an increase in creatinine levels within the first few days of starting tx; who might this cause serious problems in?

A
  • Due to decreased angiotensin II –> decreased efferent arteriole constriction
  • Pt’s with bilateral renal artery stenosis (heavily dependent on angiotensin II to maintain GFR) can experience a precipitous fall in GFR and develop acute renal failure
42
Q

After stabilization, long term use of which medications have been shown to improve survival in pt’s with heart failure due to LV systolic dysfunction (decompensated HF)?

A
  • Beta-blockers i.e., Carvedilol or Metoprolol
  • ACE inhibitors
  • ARBs
  • Aldosterone antagonists: Spironolactone and Eplerenone
43
Q

What are the 3 aromatase inhibitors which can be used to slow the progression of ER-positive tumors?

A
  • Anastrozole
  • Letrozole
  • Exemestane
44
Q

Sinus bradycardia is the most common arrhythmia in those with inferior wall MI, which drug should be given IV to correct this?

A

Atopine: counteracts the enhanced vagal tone to increase HR

45
Q

How can mu-opioid agonists such as morphine cause biliary colic?

A

Cause contraction of the SMOOTH M. cells in the sphincter of Oddi, leading to spasm and increase in common bile duct pressures

46
Q

Which agents used for skeletal muscle relaxation during surgery are pt’s with Myasthenia Gravis extremely sensitive to and which are they often resistant to?

A
  • Extremely sensitive to NON-depolarizing agents: Vecuronium or Rocuronium = competitive antagonist at nAChRs
  • Often resistant to depolarizing agents –> Succinylcholine = competitive agonist at nAChRs
47
Q

What are the 4 broad spectrum anti-seizure drugs which can be used as first-line tx of generalized tonic-clonic and myoclonic seizures?

A
  • Valproic acid: block Na+ channels and increases GABA
  • Levetiracetam: modulates GABA and glutamate release
  • Topiramate and Lamotrigine: increases Na+ channel inactivation
48
Q

What is the MOA of Cilostazol and Dipyridamole and what are they used for; what are the AE’s?

A
  • Reduce platelet activation by inhibiting platelet PDE, which normally breaks down cAMP and also act as direct arterial vasodilators
  • Used to decrease claudication sx’s in pt’s with peripheral artery disease
  • AE’s: facial flushing and abdominal pain
49
Q

Which drug classes are effective in tx OCD?

A
  • SSRIs = tx of choice
  • TCA’s use clomipramine for cases unresponsive to SSRIs

0 - USMLE Step 1 (22 decks)

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