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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 drug(s) cause this reaction: G6PD hemolysis(8)?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Sulfonamides - Trimethoprim
post MI and digitalis induced arrhythmias
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol

2. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Fast vs. Slow Acetylators
Same as penicillin. Extended spectrum antibiotics
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

3. What is the category of drug names ending in - olol (e.g. Propranolol)
AluMINIMUM amount of feces.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Beta antagonist.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow

4. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
No - warfarin - unlike heparin - can cross the placenta.

5. Does Warfarin have a long - medium - or short half life?
Long.
Ataxia - Dizziness - Slurred speech
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Norepinephrine

6. How is Ribavirin used clinically?
Aminoglycosides
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
for RSV
carbonic anhydrase inhibitors - K+ sparing diuretics

7. What is the category of drug names ending in - cillin (e.g. Methicillin)
cross - allergenic
Short.
Penicillin.
Only in limited amounts

8. What are four clinical uses of glucocorticoids?

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9. What is a prerequisite for Acyclovir activation?
Dermatophytes (tinea - ringworm)
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
It must be Phosphorylated by Viral Thymidine Kinase
post MI and digitalis induced arrhythmias

10. Adverse effects of Guanethidine?
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Onchocerciasis ('river blindness'-- rIVER- mectin)
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
- B51Naloxone / naltrexone (Narcan)

11. Antiarrhythmic class II- toxicity?
Aminoglycosides
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Early myocardial infarction.

12. Name several common Macrolides (3)
physostigmine
Erythromycin - Azithromycin - Clarithromycin
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Teratogenic - Carcinogenic - Confusion - Headaches

13. How are Sulfonamides employed clinically?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Gram + - Gram - - Norcardia - Chlamydia
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Early myocardial infarction.

14. What is the mechanism of action of the Sulfonylureas?
Aminoglycosides
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

15. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
GI upset
Edrophonium
Modification via Acetylation - Adenylation - or Phosphorylation

16. What is Metronidazole combined with for 'triple therapy'? Against What organism?
Decreases synthesis of Mycolic Acid
Liver
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

17. What are four unwanted effects of Clomiphene use?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
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.)
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
sedation - sleep alterations

18. What are two types of drugs that interfere with the action of Sucralfate and why?
Ganciclovir is more toxic to host enzymes
Acute (hours)
It must be Phosphorylated by Viral Thymidine Kinase
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.

19. What is the effect of epinephrine infusion on bp and pulse pressure?
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Gram + cocci - Gram - rods - and Anerobes

20. Which cancer drugs effect nuclear DNA (4)?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Severe Gram - rod infections.

21. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
Alpha -1 antagonist
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Cephalosporins
NO

22. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
TMP- SMZ
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

23. What is the most common cause of Pt noncompliance with Macrolides?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
GI discomfort
- Disulfram & also sulfonylureas - metronidazole

24. Hydralazine - toxicity?
compensatory tachycardia - fluid retention - lupus - like syndrome
Methicillin - Nafcillin - and Dicloxacillin
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

25. What are the clinical uses for 3rd Generation Cephalosporins?
DHPG (dihydroxy-2- propoxymethyl guanine)
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

26. What is Fluconazole specifically used for?
Antileukotriene; blocks leukotriene receptors.
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Diarrhea

27. What are common toxicities related to Vancomycin therapy?

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28. For Heparin What is the Lab value to monitor
Chronic gout.
As an anticholinesterase it increases endogenous ACh and thus increases strength.
aPTT (intrinsic pathway)
- Flumazenil

29. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
hypertension - angina - arrhythmias
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Rare.

30. What are two processes Corticosteroids inhibit leading to decreased inflammation?
Beta -2 agonist.
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Foscarnet = pyroFosphate analog
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

31. What is the mechanism of Leuprolide?
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
- Physostigmine salicylate
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Useful in muscle paralysis during surgery or mechanical ventilation.

32. Does Heparin have a long - medium - or short half life?
Short.
- Normalize K+ - Lidocaine - & Anti - dig Mab
new arrhythmias - hypotension
proximal convoluted tubule - thin descending limb - and collecting duct

33. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
Staphlococcus aureus
- N- acetylcystine
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Polymyxin B - Polymyxin E

34. Nifedipine has similar action to?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Antileukotriene; blocks synthesis by lipoxygenase.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Nitrates

35. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
- Ethosuxamide - sulfonamides - lamotrigine
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
thiazides - amiloride

36. What is the memory key for the action of Sildenafil (Viagra)?
With supplemental Folic Acid
TCA
Methylxanthine.
Sildenafil fills the penis

37. What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
The PT.

38. Digoxin v. Digitoxin: excretion?
Digoxin=urinary Digitoxin=biliary
Indomethacin is used to close a patent ductus arteriosus.
Megaloblastic anemia - Leukopenia - Granulocytopenia
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

39. Digitalis - site of action?
Carbenicillin - Piperacillin - and Ticarcillin
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Na/K ATPase

40. Why is pyridostigmine effective in the treatment of myasthenia gravis?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Buy AT 30 - CELL at 50'

41. What is the lab value used to monitor the effectiveness of Warfarin therapy?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
The PT.
block Na+ channels in the cortical collecting tubule
It acts presynaptically to increase NE release.

42. What parasites are treated with Pyrantel Pamoate (more specific)?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Stimulates beta adrenergic receptors
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

43. What is the memory key to remember Which pathway (extrinsic vs. intrinsic) and Which lab value Warfarin affects?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
- ACE inhibitors (Losartan>no cough)

44. MOA for Penicillin (3 answers)?
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Beta antagonist.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
- Glucocorticoid withdrawal

45. List the specific antidote for this toxin: Beta Blockers
Pseudomembranous colitis (C. difficile) - fever - diarrhea
It inhibits release of NE.
- Glucagon
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

46. Toxicities associated with Acyclovir?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Delirium - Tremor - Nephrotoxicity
- Act on same receptor - Full has greater efficacy
Benzathine penicillin G

47. Antimicrobial prophylaxis for Meningococcal infection
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Rifampin (DOC) - minocycline
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Neutropenia

48. What is a common side effect of Misoprostol?
Diarrhea
Vd= (Amt. of drug in body/ Plasma drug conc.)
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

49. What is the clinical use for Clomiphene?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Treatment of infertility.

50. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Beta antagonist.
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Methylxanthine.

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USMLE Step 1 Pharmacology

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