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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

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Answer 50 questions in 15 minutes.
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1. Antiarrhythmic class IB- effects?
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
- Shifts the curve down - reduces Vmax
Neomycin

2. Acetazolamide - clinical uses?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

3. List the specific antidote for this toxin: Salicylates
- Alkalinize urine & dialysis
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Methylxanthine.

4. What are Amantadine - associated side effects?
Peptic ulcer disease.
Ataxia - Dizziness - Slurred speech
Nitrates
- Vinca alkaloids(inhibit MT) - Paclitaxel

5. What is a common side effect of Misoprostol?
Cephalosporins
Diarrhea
loop diuretics - spironolactone
Acute (hours)

6. Toxicities associated with Acyclovir?
- Methotrexate - 5 FU - 6 mercaptopurine
YES
Nucleosides
Delirium - Tremor - Nephrotoxicity

7. Procainamide - toxicity?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Phosphorylation by a Viral Kinase
reversible SLE- like syndrome
Intrathecally

8. Common toxicities associated with Fluoroquinolones?
DHPG (dihydroxy-2- propoxymethyl guanine)
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- Fluoroquinolones
GI upset - Superinfections - Skin rashes - Headache - Dizziness

9. How is Amphotericin B used clinically?
Digoxin=urinary Digitoxin=biliary
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Butyrophenone (neuroleptic).

10. What is the category of drug names ending in - tidine (e.g. Cimetidine)
H2 antagonist
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

11. List the specific antidote for this toxin: Warfarin
- Niacin - Ca++ channel blockers - adenosine - vancomycin
- Vitamin K & fresh frozen plasma
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
- Acetaldehyde - Nausea - vomiting - headache - & hypotension

12. Beta Blockers - BP?
PT
decrease
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Foscarnet = pyroFosphate analog

13. Adverse effects of Nifedipine - verapamil?
dizziness - flushing - constipation (verapamil) - nausea
- Isoniazid
local anesthetic. CNS stimulation or depression. CV depression.
Rheumatoid and osteoarthritis.

14. How would you reverse the effect of a neuromuscular blocking agent?
Triple sulfas or SMZ
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Give an antichloinesterase - neostigmine - edrophonium - etc
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

15. Name three calcium channel blockers?
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
loop diuretics - spironolactone
Nifedipine - Verapamil - Diltiazem
CMV Retinitis in IC pts When Ganciclovir fails

16. For Warfarin What is the Site of action
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Liver
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

17. IV Penicillin
Beta - lactam antibiotics
Penicillin - G
Acute gout.
Give an antichloinesterase - neostigmine - edrophonium - etc

18. What are common toxicities related to Vancomycin therapy?

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19. Digitalis - site of action?
Small lipid - soluble molecule
Na/K ATPase
Gram + cocci - Gram - rods - and Anerobes
Phenothiazine (neuroleptic - antiemetic).

20. What is the clinical use for Sildenafil (Viagra)?
dizziness - flushing - constipation (verapamil) - nausea
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Erectile dysfunction.
Early myocardial infarction.

21. Antiarrhythmic class II- mechanism?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Hypersensitivity reactions
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Digoxin=urinary Digitoxin=biliary

22. List the specific antidote for this toxin: Carbon monoxide
-100% oxygen - hyperbaric
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
amphetamine and ephedrine
Chronic anticoagulation.

23. Antimicrobial prophylaxis for Gonorrhea
CMV - esp in Immunocompromised patients
sedation - positive Coombs' test
Ceftriaxone
cholestyramine - colestipol

24. What is action of insulin in the liver - in muscle - and in adipose tissue?
GI side effects. (Indomethacin is less toxic - more commonly used.)
dry mouth - sedation - severe rebound hypertension
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

25. MOA: Bactericidal antibiotics
Dermatophytes (tinea - ringworm)
Gemfibrozil - Clofibrate
distal convoluted tubule (early)
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

26. What are five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
Enterobacter
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
local anesthetic. CNS stimulation or depression. CV depression.

27. What are the major toxic side effects of the Cephalosporins?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Aminoglycosides
Indirect agonist - uptake inhibitor
Chronic gout.

28. What conditions are treated with Metronidazole?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
- Clindamycin
post MI and digitalis induced arrhythmias

29. Foscarnet toxicity?
block Na+ channels in the cortical collecting tubule
- Formaldehyde & formic acid - severe acidosis & retinal damage
Intrathecally
Nephrotoxicity

30. Adverse effects of Losartan?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
fetal renal toxicity - hyperkalemia
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Topical and Oral - for Oral Candidiasis (Thrush)

31. What is the chemical name for Ganciclovir?
- Penicillin
DHPG (dihydroxy-2- propoxymethyl guanine)
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
INH: Injures Neurons and Hepatocytes

32. List the specific antidote for this toxin: Tricyclic antidepressants
Binds ergosterol - Disrupts fungal membranes
Acts as a wide spectrum carbapenem
- NaHCO3
check PFTs - LFTs - and TFTs

33. Name some common Tetracyclines (4)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Protamine sulfate
Inhibit viral DNA polymerase

34. For Heparin What is the Route of administration
Paranteral (IV - SC)
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Erectile dysfunction.
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

35. Which diuretics cause alkalosis?
Mebendazole/Thiabendazole - Pyrantel Pamoate
These B-2 agonists cause respiratory smooth muscle to relax.
loop diuretics - thiazides
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

36. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
HTN - CHF - calcium stone formation - nephrogenic DI.
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Intrathecally
- polymyxins

37. Resistance mechanisms for Sulfonamides
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Treatment of infertility.
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
Digitoxin 168hrs Digoxin 40 hrs

38. What are the nondepolarizing neuromuscular blocking drugs?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Penicillin.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

39. What is the memory key for the action of Sildenafil (Viagra)?
Diarrhea
Sildenafil fills the penis
Acts as a wide spectrum carbapenem
- aminoglycosides - loop diuretics - cisplatin

40. How would you treat African Trypanosomiasis (sleeping sickness)?
Interstitial nephritis
decrease conduction velocity - increase ERP - increase PR interval
Suramin
- Alkalinize urine & dialysis

41. What is the category of drug names ending in - zosin (e.g. Prazosin)
- Shifts the curve down - reduces Vmax
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Alpha -1 antagonist
- Disulfram & also sulfonylureas - metronidazole

42. What is the MOA of Griseofulvin?
Diarrhea
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
- Shifts the curve to the right - increases Km
Interferes with microtubule function - disrupts mitosis - inhibits growth

43. Which drug(s) cause this reaction: Cough?
dry mouth - sedation - severe rebound hypertension
- aminoglycosides - loop diuretics - cisplatin
- ACE inhibitors (Losartan>no cough)
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

44. What are the four conditions in Which Omeprazole - Lansoprazole is used?
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Epinephirine(Alpha1 -2 and Beta 1 -2)
Digitoxin 168hrs Digoxin 40 hrs
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

45. Name three Antiarrhythmic drugs in class IC.
Flecainide - Encainide - Propafenone
Rifampin
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Pralidoxime regenerates active cholinesterase.

46. How do you calculate maintenance dose?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Penicillin.
Penicillin - V
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.

47. Why is Cilastatin administered with Imipenem?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Early myocardial infarction.
Gemfibrozil - Clofibrate

48. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
Hypersensitivity reactions
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
prevention of nodal arrhythmias (SVT)

49. Explain differences between full and partial agonists(2).
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- Act on same receptor - Full has greater efficacy
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

50. What is the MOA of Imipenem?
Butyrophenone (neuroleptic).
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.)
Pseudomonas species and Gram - rods
Acts as a wide spectrum carbapenem

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USMLE Step 1 Pharmacology

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