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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. Antimicrobial prophylaxis for Gonorrhea
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Neomycin
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Ceftriaxone

2. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Rare.
Tricyclic antidepressant.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

3. What is an occasional side effect of Aztreonam?
1. Renal damage 2. Aplastic anemia 3. GI distress
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
GI upset
Digitoxin 168hrs Digoxin 40 hrs

4. MOA: Bactericidal antibiotics
Same as penicillin. Extended spectrum antibiotics
reversible SLE- like syndrome
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Decreases synthesis of Mycolic Acid

5. Which RT inhibitors cause a Rash?
Non - Nucleosides
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

6. What are four Sulfonylureas?
troponin - tropomyosin system
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

7. Resistance mechanisms for Cephalosporins/Penicillins
Beta - lactamase cleavage of Beta - lactam ring
Digitoxin 168hrs Digoxin 40 hrs
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Inhibit Ergosterol synthesis

8. What is the memory key for organisms treated with Tetracyclines?

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9. How does NE modulate its own release? What other neurotransmitter has this same effect?
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
not a sulfonamide - but action is the same as furosemide

10. Describe the MOA of Interferons (INF)
Forms toxic metabolites in the bacterial cell - Bactericidal
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Butyrophenone (neuroleptic).
Gemfibrozil - Clofibrate

11. Ca2+ channel blockers - clinical use?
hypertension - angina - arrhythmias
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.

12. What do Aminoglycosides require for uptake?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
dry mouth - sedation - severe rebound hypertension
Oxygen
Norepinephrine (Alpha1 -2 and beta 1)

13. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Antileukotriene; blocks leukotriene receptors.
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.)
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

14. Adverse effects of Captopril?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Cloazapine - carbamazapine - colchicine - PTU
No - hemicholinum block the uptake of Choline and thus Ach synthesis

15. Which diuretics increase urine Ca2+?
RESPIre
loop diuretics - spironolactone
decrease
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.

16. List the specific antidote for this toxin: Warfarin
- Vitamin K & fresh frozen plasma
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
carbonic anhydrase inhibitors - K+ sparing diuretics

17. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
For serious - Gram + multidrug - resistant organisms
Mebendazole/Thiabendazole - Pyrantel Pamoate
Norepinephrine
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

18. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
- ACE inhibitors (Losartan>no cough)
Ipratropium
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.)
Indomethacin is used to close a patent ductus arteriosus.

19. Classes of antihypertensive drugs?
severe hypertension - CHF
Modification via Acetylation - Adenylation - or Phosphorylation
Gram + cocci - Gram - rods - and Anerobes
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

20. What are three toxicities of Propylthiouracil?
Chronic Hepatitis A and B - Kaposi's Sarcoma
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
With an amino acid change of D- ala D- ala to D- ala D- lac
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

21. Which diuretics increase urine K+?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

22. Hydrochlorothiazide - clinical use?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
HTN - CHF - calcium stone formation - nephrogenic DI.
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
- Fluoroquinolones

23. If a patient is given hexamethonium - What would happen to his/her heart rate?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
BM suppression (neutropenia - anemia) - Peripheral neuropathy
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.

24. What is the mechanism of action of Omeprazole - Lansoprazole?
PT
Large anionic polymer - acidic
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

25. IV Penicillin
- Steroids - Tamoxifen
Lidocaine - Mexiletine - Tocainide
With an amino acid change of D- ala D- ala to D- ala D- lac
Penicillin - G

26. Adverse effects of Minoxidil?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
GI distress - Skin rash - and Seizures at high plasma levels
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

27. What is the category - desired effect - and adverse effect of Isoproterenol in the treatment of Asthma?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
For serious - Gram + multidrug - resistant organisms

28. What additional side effects exist for Ampicillin?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
edrophonium (extremely short acting anticholinesterase)
Rash - Pseudomembranous colitis

29. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Inhibit viral DNA polymerase
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Pyridoxine (B6) administration

30. Adverse effects of Hydralazine?
Chronic (weeks or months)
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
hypertension - angina - arrhythmias
- Tetracycline - amiodarone - sulfonamides

31. List the specific antidote for this toxin: Iron
Hypersensitivity reactions
- Deferoxamine
Rifampin
Digoxin=urinary Digitoxin=biliary

32. What is the MOA of the RT Inhibitors?
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Teratogenic - Carcinogenic - Confusion - Headaches

33. How are Sulfonamides employed clinically?
AZT
Gram + - Gram - - Norcardia - Chlamydia
Epinephirine(Alpha1 -2 and Beta 1 -2)
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

34. What is the category of drug names ending in - caine (e.g. Lidocaine)
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Ceftriaxone
Local anesthetic.
Treatment of infertility.

35. List the specific antidote for this toxin: Cyanide
- Nitrate - hydroxocobalamin thiosulfate
1. Renal damage 2. Aplastic anemia 3. GI distress
reversible SLE- like syndrome
Beta Blockers

36. What are three clinical uses of the Leuprolide?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Local anesthetic.
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

37. For Heparin What is the Treatment for overdose
Protamine sulfate
Penicillin - V
not a sulfonamide - but action is the same as furosemide
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome

38. How is Ribavirin used clinically?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Protease Inhibitors and Reverse Transcriptase Inhibitors
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)
for RSV

39. What is the MOA for the Cephalosporins?
Chronic gout.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Beta lactams - inhibit cell wall synthesis - Bactericidal
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

40. Adverse effects of Losartan?
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
new arrhythmias - hypotension
fetal renal toxicity - hyperkalemia
Epinephrine

41. What is the MOA for Ampicillin and Amoxicillin?
Same as penicillin. Extended spectrum antibiotics
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Beta -2 agonist.
Delirium - Tremor - Nephrotoxicity

42. Ibutilide - toxicity?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
It acts presynaptically to increase NE release.
Rifampin (DOC) - minocycline
torsade de pointes

43. Antiarrhythmic class IA effects?
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
hyperaldosteronism - K+ depletion - CHF
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

44. Antiarrhythmic class II- effects?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
decrease
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
- Methotrexate - 5 FU - 6 mercaptopurine

45. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
Scopolamine
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
anticholinesterase glaucoma

46. Describe Phase II metabolism in liver(3)?
-100% oxygen - hyperbaric
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Inhalational general anesthetic.
AV nodal cells

47. Ethacrynic Acid - mechanism?
not a sulfonamide - but action is the same as furosemide
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Inhibits reabsorption of uric acid.
Due to the presence of a bulkier R group

48. How would you reverse the effect of a neuromuscular blocking agent?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Give an antichloinesterase - neostigmine - edrophonium - etc
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Antibiotic - protein synthesis inhibitor.

49. Name four Antiarrhythmic drugs in class III.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Sotalol - Ibutilide - Bretylium - Amiodarone
- Vinca alkaloids(inhibit MT) - Paclitaxel
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.

50. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Antibiotic - protein synthesis inhibitor.
Inhibt Assembly of new virus by Blocking Protease Enzyme
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.