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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. Which cancer drugs inhibit nucleotide synthesis(3)?
- Cloazapine - carbamazapine - colchicine - PTU
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
- Methotrexate - 5 FU - 6 mercaptopurine
Impairs the synthesis of vitamin K- dependent clotting factors

2. List the mechanism - clinical use - & toxicity of Etoposide.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride

3. Resistance mechanisms for Tetracycline
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
post MI and digitalis induced arrhythmias
Decreased uptake or Increased transport out of cell
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

4. Mannitol - clinical use?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides

5. Toxicities associated with Acyclovir?
Delirium - Tremor - Nephrotoxicity
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Lidocaine - Mexiletine - Tocainide
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

6. Which drug(s) cause this reaction: Osteoporosis (2)?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Neutropenia
- Corticosteroids - heparin
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

7. What is a common side effect of Misoprostol?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Diarrhea
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
- Aminocaproic acid

8. Adverse effects of Nifedipine - verapamil?
The only local anesthetic with vasoconstrictive properties.
dizziness - flushing - constipation (verapamil) - nausea
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Neomycin

9. MOA for Penicillin (3 answers)?
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
- Steroids - Tamoxifen
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
CL= (rate of elimination of drug/ Plasma drug conc.)

10. What are common toxicities associated with Macrolides? (4)
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Ataxia - Dizziness - Slurred speech
CMV Retinitis in IC pts When Ganciclovir fails
Digitoxin 70% Digoxin 20-40%

11. Triamterene and amiloride - mechanism?
DOC in diagnosing and abolishing AV nodal arrhythmias
block Na+ channels in the cortical collecting tubule
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

12. ACE inhibitors - clinical use?
hypertension - CHF - diabetic renal disease
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time

13. Name some common Tetracyclines (4)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
No - it inhibits the release of Nor Epi
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

14. List the mechanism - clinical use - & toxicity of Cisplatin.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

15. How is Acyclovir used clinically?
Oxygen
cholestyramine - colestipol
AZT
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts

16. What is the effect of epinephrine infusion on bp and pulse pressure?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers

17. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
Cardiac glycoside (inotropic agent).
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

18. What are the clinical indications for neostigmine?
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Alpha -1 antagonist
- Haloperidol - chlorpromazine - reserpine - MPTP
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.

19. Name the common Fluoroquinolones (6)
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.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Chronic gout.
Cephalosporins

20. What is a prerequisite for Acyclovir activation?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
- Act on same receptor - Full has greater efficacy
It must be Phosphorylated by Viral Thymidine Kinase
bradycardia - AV block - CHF

21. Name two bile acid resins.
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Norepinephrine (Alpha1 -2 and beta 1)
Decreased uptake or Increased transport out of cell
cholestyramine - colestipol

22. Ibutilide - toxicity?
Indomethacin is used to close a patent ductus arteriosus.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
torsade de pointes

23. Name four HMG- CoA reductase inhibitors.
Quinolones
Nephrotoxicity
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

24. What is the effect of guanethidine on adrenergic NE release?
Constant FRACTION eliminated per unit time.(exponential)
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
It inhibits release of NE.

25. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Praziquantel
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Same as penicillin. Extended spectrum antibiotics
RESPIre

26. Name three calcium channel blockers?
Nifedipine - Verapamil - Diltiazem
NO
Clavulanic acid
H2 antagonist

27. Explain pH dependent urinary drug elimination?
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- Methotrexate - 5 FU - 6 mercaptopurine

28. Which drug(s) cause this reaction: Gray baby syndrome?
- Chloramphenicol
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

29. MOA: Block mRNA synthesis
Rifampin
Digitoxin>95% Digoxin 75%
Chronic (weeks or months)
- Tetracycline

30. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Gram + - Gram - - Norcardia - Chlamydia
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas

31. What is a possible result of overdose of Acetaminophen?
Amphetamine and Ephedrine
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

32. What type of gout is treated with Probenacid?
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Chronic gout.
anuria - CHF
Gram + and Anerobes

33. What is an additional side effect of Methicillin?
The only local anesthetic with vasoconstrictive properties.
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
reversible SLE- like syndrome
Interstitial nephritis

34. What are common toxicities related to Vancomycin therapy?

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35. What additional side effects exist for Ampicillin?
Rash - Pseudomembranous colitis
blocks SR Ca2+ channels
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

36. What are five advantages of Oral Contraceptives (synthetic progestins - estrogen)?
- Haloperidol - chlorpromazine - reserpine - MPTP
edrophonium (extremely short acting anticholinesterase)
- Antipsychotics
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses

37. What are five possible toxic effects of Aspirin therapy?

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38. What is the loading dose formula?
Tendonitis and Tendon rupture
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Albuterol - tertbutaline
decrease conduction velocity - increase ERP - increase PR interval

39. How does angiotensin II affect NE release?
- Daunorubicin & Doxorubicin
Ipratropium
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
It acts presynaptically to increase NE release.

40. How is Trimethoprim used clinically?
proximal convoluted tubule
Yes
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Used in combination therapy with SMZ to sequentially block folate synthesis

41. What are three complications of Warfarin usage?
Enterobacter
Short.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions

42. Why does atropine dilate the pupil?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
decrease
Pseudomonas species and Gram - rods
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

43. Are not penicillinase resistant
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Carbenicillin - Piperacillin - and Ticarcillin
Vd= (Amt. of drug in body/ Plasma drug conc.)
- Alkalate DNA - Brain tumors - CNS toxicity

44. Verapamil has similar action to?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Beta Blockers
Long.
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity

45. What is a Ribavirin toxicity?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
- Ammonium Chloride
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Hemolytic anemia

46. List the mechanism - clinical use - & toxicity of Prednisone.

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47. What process does Zafirlukast interfere with?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Leukotrienes increasing bronchial tone.
Primaquine
effective in torsade de pointes and digoxin toxicity

48. Antiarrhythmic class IA effects?
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Na/K ATPase
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

49. What class of drug is echothiophate? What is its indication?
new arrhythmias - hypotension
Large anionic polymer - acidic
Phosphorylation by a Viral Kinase
anticholinesterase glaucoma

50. What is the mechanism of action of Misoprostol?
- Ammonium Chloride
Inhibits CMV DNA polymerase
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
GI side effects. (Indomethacin is less toxic - more commonly used.)

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USMLE Step 1 Pharmacology

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