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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. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Inhibits Viral DNA polymerase
Carbenicillin - Piperacillin - and Ticarcillin
Pretreat with antihistamines and a slow infusion rate

2. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Clavulanic acid
Rifampin (DOC) - minocycline
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Modification via Acetylation

3. What is Metronidazole combined with for 'triple therapy'? Against What organism?
- Physostigmine salicylate
Digoxin=urinary Digitoxin=biliary
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Ceftriaxone

4. What is the mechanism of action of NSAIDs other than Aspirin?
aPTT (intrinsic pathway)
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
- Formaldehyde & formic acid - severe acidosis & retinal damage
Polymyxin B - Polymyxin E

5. What is the mechanism of action of the Alpha - glucosidase inhibitors?
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
- aminoglycosides - loop diuretics - cisplatin

6. What is the MOA of Foscarnet?
Polymyxin B - Polymyxin E
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Inhibits Viral DNA polymerase
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

7. What is the memory key for Metronidazole's clinical uses?
GET on the Metro
amphetamine and ephedrine
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- Formaldehyde & formic acid - severe acidosis & retinal damage

8. What is the effect of guanethidine on adrenergic NE release?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Early myocardial infarction.
It inhibits release of NE.
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

9. What is the MOA of the RT Inhibitors?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
- Glucagon

10. Ganciclovir associated toxicities?
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
- Chlorpromazine - thioridazine - haloperidol
depresses ectopic pacemakers - especially in digoxin toxicity
It acts presynaptically to increase NE release.

11. Which RT inhibitors cause Lactic Acidosis?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Nucleosides
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

12. What are four unwanted effects of Clomiphene use?
collecting ducts
Erythromycin - Azithromycin - Clarithromycin
- Vinca alkaloids(inhibit MT) - Paclitaxel
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

13. What is the specific clinical use of Indomethacin in neonates?
Indomethacin is used to close a patent ductus arteriosus.
Choline acetyltransferase
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Same as penicillin. Extended spectrum antibiotics

14. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
distal convoluted tubule (early)
Choline acetyltransferase
Hydralazine and Minoxidil

15. Which drug(s) cause this reaction: Hot flashes?
- Tamoxifen
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Prevents the release of ACh - Which results in muscle paralysis.
- Phenytoin

16. What enzyme is responsible for the degredation of Ach
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Acetylcholine esterase
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.

17. Antiarrhythmic class IB- effects?
Tendonitis and Tendon rupture
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Edrophonium
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

18. What are the clinical indications for Azole therapy?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Indirect agonist - uptake inhibitor
Systemic mycoses
Binds to the Pyrophosphate Binding Site of the enzyme

19. Name three calcium channel blockers?
Antifungal.
1. Renal damage 2. Aplastic anemia 3. GI distress
Slow - limited by half lives of clotting factors
Nifedipine - Verapamil - Diltiazem

20. What are the clinical uses for Ticlopidine - Clopidogrel?
- Fluoroquinolones
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Reversible block of histamine H2 receptors
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

21. What is the memory aid for subunit distribution of ribosomal inhibitors?

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22. Acetazolamide - toxicity?
Megaloblastic anemia - Leukopenia - Granulocytopenia
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Binding to the presynaptic alpha 2 release modulating receptors

23. List the specific antidote for this toxin: Digitalis
No
- Normalize K+ - Lidocaine - & Anti - dig Mab
No - hemicholinum block the uptake of Choline and thus Ach synthesis
effective in torsade de pointes and digoxin toxicity

24. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
These B-2 agonists cause respiratory smooth muscle to relax.
- Cloazapine - carbamazapine - colchicine - PTU
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Activates antithrombin III

25. Resistance mechanisms for Aminoglycosides
Inhalational general anesthetic.
Used in combination therapy with SMZ to sequentially block folate synthesis
Neutropenia
Modification via Acetylation - Adenylation - or Phosphorylation

26. What physiological effects was the Anes using Atropine to tx
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
- Vinca alkaloids(inhibit MT) - Paclitaxel
H2 antagonist
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

27. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Non - Nucleosides
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

28. What is the MOA for Nystatin?
Diuresis in pateints with sulfa allergy
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Binds ergosterol - Disrupts fungal membranes
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

29. Antimicrobial prophylaxis for Gonorrhea
Ceftriaxone
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
sedation - positive Coombs' test
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

30. Name the Protease Inhibitors (4)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
dizziness - flushing - constipation (verapamil) - nausea
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Beta Blockers

31. Foscarnet toxicity?
Nephrotoxicity
- Methotrexate - 5 FU - 6 mercaptopurine
very short acting
Anaerobes

32. What are two toxicities associated with Cyclosporine?
- NaHCO3
TMP- SMZ (DOC) - aerosolized pentamidine
Foscarnet = pyroFosphate analog
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

33. Adverse effects of beta - blockers?
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
The PT.
- Physostigmine salicylate
Foscarnet = pyroFosphate analog

34. ADH antagonists - site of action?
collecting ducts
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Benzodiazepine.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow

35. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Rifampin
Premature infants - because they lack UDP- glucuronyl transferase
Pretreat with antihistamines and a slow infusion rate

36. Which of these three drugs will cause a reflex bradycardia in your pt (Norepi - Epi - or Isoporterenol)
block Na+ channels in the cortical collecting tubule
Norepinephrine
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

37. How does botulinum toxin result in respiratory arrest?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Erythromycin - Azithromycin - Clarithromycin
Prevents the release of ACh - Which results in muscle paralysis.
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.

38. What is the effect of the Glitazones in diabetes treatment?
- Shifts the curve down - reduces Vmax
Interferes with microtubule function - disrupts mitosis - inhibits growth
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Increase target cell response to insulin.

39. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Clavulanic acid
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
depresses ectopic pacemakers - especially in digoxin toxicity

40. List the mechanism - clinical use - & toxicity of Cisplatin.
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Modification via Acetylation - Adenylation - or Phosphorylation
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
The only local anesthetic with vasoconstrictive properties.

41. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
- Oxalic acid - Acidosis & nephrotoxicity
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Penicillin.

42. How is Amantadine used clinically?

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43. For Heparin What is the Lab value to monitor
Sulfonamides - Trimethoprim
aPTT (intrinsic pathway)
Neurotoxicity - Acute renal tubular necrosis
Onchocerciasis ('river blindness'-- rIVER- mectin)

44. What are three types of antacids and the problems that can result from their overuse?
Interstitial nephritis
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

45. How do we stop angina?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Minor hepatotoxicity - Drug interactions (activates P450)
TCA

46. Name three K+ sparing diuretics?
- Alkalate DNA - Brain tumors - CNS toxicity
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Spironolactone - Triamterene - Amiloride (the K+ STAys)
For serious - Gram + multidrug - resistant organisms

47. Foscarnet does not require activation by a...
viral kinase
Acute (hours)
Carbenicillin - Piperacillin - and Ticarcillin
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

48. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
- Shifts the curve to the right - increases Km
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
- Vitamin K & fresh frozen plasma
No - hemicholinum block the uptake of Choline and thus Ach synthesis

49. Common toxicities associated with Fluoroquinolones?
- Flumazenil
Binds to the Pyrophosphate Binding Site of the enzyme
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

50. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
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.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
- B51Naloxone / naltrexone (Narcan)