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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. What is Ketoconazole specifically used for?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
HTN - CHF - calcium stone formation - nephrogenic DI.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Acetylcholine esterase

2. What is action of insulin in the liver - in muscle - and in adipose tissue?
Keratin containing tissues - e.g. - nails
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.
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Local anesthetic.

3. Name the common Nucleoside Reverse Transcriptase Inhibitors
- Corticosteroids - heparin
Decreases synthesis of Mycolic Acid
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
- Shifts the curve down - reduces Vmax

4. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
- Ethosuxamide - sulfonamides - lamotrigine
Blood
Pentavalent Antimony
Prevention of NSAID- induced peptic ulcers - maintains a PDA.

5. For Warfarin What is the Duration of action
Chronic (weeks or months)
fetal renal toxicity - hyperkalemia
Tricyclic antidepressant.
Delirium - Tremor - Nephrotoxicity

6. List the mechanism - clinical use - & toxicity of Tamoxifen.
torsade de pointes
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk

7. What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
Antileukotriene; blocks synthesis by lipoxygenase.
Alpha -1 antagonist
Diarrhea

8. How do you treat coma in the ER (4)?
Protamine sulfate
- Shifts the curve down - reduces Vmax
Paranteral (IV - SC)
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

9. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
- polymyxins
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Abortifacient.
Staphlococcus aureus

10. Antimicrobial prophylaxis for PCP
Blocks Influenza A and RubellA; causes problems with the cerebellA
TMP- SMZ (DOC) - aerosolized pentamidine
Ipratropium
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

11. Which drug(s) cause this reaction: Adrenocortical Insufficiency
Buy AT 30 - CELL at 50'
- Glucocorticoid withdrawal
Inhibits Viral DNA polymerase
Suramin

12. How do we stop angina?
With supplemental Folic Acid
Modification via Acetylation - Adenylation - or Phosphorylation
YES
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time

13. What are Fluoroquinolones indicated for? (3)
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
GET on the Metro
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

14. What is the category of drug names ending in - zosin (e.g. Prazosin)
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Blocks Norepi - but not Dopamine
Alpha -1 antagonist
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

15. Esmolol - short or long acting?
very short acting
DHPG (dihydroxy-2- propoxymethyl guanine)
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Primaquine

16. How is Trimethoprim used clinically?
Used in combination therapy with SMZ to sequentially block folate synthesis
Albuterol - tertbutaline
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Amphetamine and Ephedrine

17. What are the indications for using amphetamine?

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18. Acetazolamide - clinical uses?
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
AZT

19. List the specific antidote for this toxin: Opioids
Delirium - Tremor - Nephrotoxicity
- B51Naloxone / naltrexone (Narcan)
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Suramin

20. What are signs of Sildenafil (Viagra) toxicity?
Headache - flushing - dyspepsia - blue - green color vision.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
- polymyxins
PT

21. What is the clincial use for Misoprostol?
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Na/K ATPase

22. For Heparin What is the Mechanism of action
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
reversible SLE- like syndrome
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Activates antithrombin III

23. Antiarrhythmic class II- effects?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Chloramphenicol
AZT - to reduce risk of Fetal Transmission

24. What is a possible toxicity of Alpha - glucosidase inhibitors used in type -2 diabetes?
Yes - it does not cross the placenta.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
GI disturbances.
Beta1 more than B2

25. For Warfarin What is the Structure
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Small lipid - soluble molecule
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion

26. List the specific antidote for this toxin: Acetaminophen
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
- N- acetylcystine
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Amphotericin B - Nystatin - Fluconazole/azoles

27. How is Foscarnet used clinically?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
- Protamine
DOC in diagnosing and abolishing AV nodal arrhythmias
CMV Retinitis in IC pts When Ganciclovir fails

28. Which receptors does phenylephrine act upon?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Beta - lactam antibiotics

29. List the mechanism - clinical use - & toxicity of Busulfan.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
PT

30. What are Aminoglycosides synergistic with?
TMP- SMZ (DOC) - aerosolized pentamidine
- Chloramphenicol
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Beta - lactam antibiotics

31. What is the possible mechanism and effect of Metformin in treating diabetes?
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Leukotrienes increasing bronchial tone.
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

32. Aztreonam ________ to penicillinase
- Protamine
is resistant
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

33. Which drug(s) cause this reaction: Torsade de pointes (2)?
Staphlococcus aureus
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
- Vinca alkaloids(inhibit MT) - Paclitaxel

34. Which cancer drugs work at the level of proteins(2)?
- Vinca alkaloids(inhibit MT) - Paclitaxel
- Aminocaproic acid
Useful in muscle paralysis during surgery or mechanical ventilation.
- Daunorubicin & Doxorubicin

35. For Warfarin What is the Mechanism of action
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
Hydralazine and Minoxidil
carbonic anhydrase inhibitors - K+ sparing diuretics
Impairs the synthesis of vitamin K- dependent clotting factors

36. What is the mechanism of action of the Sulfonylureas?
Epinephrine
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Pretreat with antihistamines and a slow infusion rate

37. For Warfarin What is the Site of action
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Liver

38. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Resistant Gram - infections
DOC in diagnosing and abolishing AV nodal arrhythmias

39. What are the clinical indications for neostigmine?
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Inhibit viral DNA polymerase
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Digoxin=urinary Digitoxin=biliary

40. What are toxicities associated with Chloramphenicol?
Aplastic anemia (dose independent) - Gray Baby Syndrome
very short acting
AmOxicillin has greater Oral bioavailability
Gemfibrozil - Clofibrate

41. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
- Flumazenil
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.)
Captopril - Enalapril - Lisinopril
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.

42. Toxic side effects of the Azoles?
- Hydralazine - Procainamide - INH - phenytoin
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Ca2+ (Loops Lose calcium)
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

43. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Pyridoxine (B6) administration
Antileukotriene; blocks synthesis by lipoxygenase.
Delirium - Tremor - Nephrotoxicity

44. What is the memory key for Metronidazole's clinical uses?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Neomycin
GET on the Metro
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts

45. Antiarrhythmic class IC- toxicity?
proarrhythmic
- Clindamycin
GI side effects. (Indomethacin is less toxic - more commonly used.)
block Na+ channels in the cortical collecting tubule

46. Which diuretics increase urine NaCl?
Choline acetyltransferase
first dose orthostatic hypotension - dizziness - headache
all of them
is resistant

47. List the specific antidote for this toxin: Heparin
distal convoluted tubule (early)
Chronic (weeks or months)
- Protamine
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

48. For Warfarin What is the Onset of action
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.
Onchocerciasis ('river blindness'-- rIVER- mectin)
Hypersensitivity reactions
Slow - limited by half lives of clotting factors

49. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Doxycycline - because it is fecally eliminated
Cyclooxygenases (COX I - COX II).
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)

50. What is the MOA for the Tetracyclines?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Neomycin
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Inhibits Viral DNA polymerase

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USMLE Step 1 Pharmacology

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