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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. Beta Blockers - CV toxicity?
Aminoglycosides
fetal renal toxicity - hyperkalemia
- Ammonium Chloride
bradycardia - AV block - CHF

2. What are three toxicities of Leuprolied?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Blocks Influenza A and RubellA; causes problems with the cerebellA
1. Antiandrogen 2. Nausea 3. Vomiting
Modification via Acetylation - Adenylation - or Phosphorylation

3. Name the common Nucleoside Reverse Transcriptase Inhibitors
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
YES

4. List the specific antidote for this toxin: TPA & Streptokinase
aPTT (intrinsic pathway)
- Aminocaproic acid
Protease Inhibitors and Reverse Transcriptase Inhibitors
- Formaldehyde & formic acid - severe acidosis & retinal damage

5. What organism is Imipenem/cilastatin the Drug of Choice for?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Enterobacter
- Protamine
GI upset - Superinfections - Skin rashes - Headache - Dizziness

6. What is the effect of the Glitazones in diabetes treatment?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Increase target cell response to insulin.

7. Which drug(s) cause this reaction: Tubulointerstitial Nephritis (5)?
Phosphorylation by a Viral Kinase
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

8. Ca2+ channel blockers - toxicity?
- Phenytoin
cardiac depression - peripheral edema - flushing - dizziness - constipation
decrease
Acetylcholine esterase

9. List the specific antidote for this toxin: Beta Blockers
Blood
- Glucagon
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

10. What are common side effects of RT Inhibitors?
Decreases synthesis of Mycolic Acid
- Aminocaproic acid
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.

11. Why would you use pralidoxime after exposure to an organophosphate?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- Normalize K+ - Lidocaine - & Anti - dig Mab
Pralidoxime regenerates active cholinesterase.
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

12. What process does Zafirlukast interfere with?
- Shifts the curve to the right - increases Km
Leukotrienes increasing bronchial tone.
physostigmine
- Formaldehyde & formic acid - severe acidosis & retinal damage

13. Name three calcium channel blockers?
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Nifedipine - Verapamil - Diltiazem
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Beta - lactamase cleavage of Beta - lactam ring

14. What is the mechanism of action of the thrombolytics?
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.)
Oral
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
proximal convoluted tubule

15. Why are the Sulfonylureas inactive in IDDM (type -1)?
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Because they require some residual islet function.
Blocks Influenza A and RubellA; causes problems with the cerebellA
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

16. What is the MOA for Trimethoprim (TMP)?
Pseudomonas species and Gram - rods
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

17. Adverse effects of Nifedipine - verapamil?
NO
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
dizziness - flushing - constipation (verapamil) - nausea
CMV Retinitis in IC pts When Ganciclovir fails

18. What drugs target anticholinesterase
Mebendazole/Thiabendazole - Pyrantel Pamoate
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Imipenem

19. Explain differences between full and partial agonists(2).
Phosphorylation by a Viral Kinase
- Act on same receptor - Full has greater efficacy
Paranteral (IV - SC)
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

20. Foscarnet does not require activation by a...
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
viral kinase
Pyridoxine (B6) administration

21. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
Liver
- Formaldehyde & formic acid - severe acidosis & retinal damage
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
- Atropine & pralidoxime

22. Hydralazine - clinical use?
Fast vs. Slow Acetylators
severe hypertension - CHF
Cardiac glycoside (inotropic agent).
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

23. Foscarnet toxicity?
Phosphorylation by a Viral Kinase
The PT.
Nephrotoxicity
Slow - limited by half lives of clotting factors

24. What is Fluconazole specifically used for?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
local anesthetic. CNS stimulation or depression. CV depression.

25. Amprotericin B ___________ the BBB
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Does not cross
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Hypersensitivity reactions

26. What are two toxicities of the Sulfonylureas?
Liver
Enterobacter
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.)
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

27. What is the chemical name for Ganciclovir?
Acetylcholine esterase
proximal convoluted tubule
DHPG (dihydroxy-2- propoxymethyl guanine)
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

28. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
TMP- SMZ (DOC) - aerosolized pentamidine
- Physostigmine salicylate

29. What is the clinical use of Mifepristone (RU486)?
Abortifacient.
Oxygen
not a sulfonamide - but action is the same as furosemide
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.

30. Adenosine - clinical use?
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Penicillin - V
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
DOC in diagnosing and abolishing AV nodal arrhythmias

31. Antimicrobial prophylaxis for a history of recurrent UTIs
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
bradycardia - AV block - CHF
TMP- SMZ

32. For Heparin What is the Lab value to monitor
aPTT (intrinsic pathway)
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
proximal convoluted tubule - thin descending limb - and collecting duct
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state

33. 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.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

34. What are Fluoroquinolones indicated for? (3)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Digoxin=urinary Digitoxin=biliary
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.
Norepinephrine (Alpha1 -2 and beta 1)

35. What is Clindamycin used for clinically?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Does not cross
- Cloazapine - carbamazapine - colchicine - PTU
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

36. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
- aminoglycosides - loop diuretics - cisplatin
Alpha -1 antagonist
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Chronic (weeks or months)

37. What is the MOA for Metronidazole?
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Forms toxic metabolites in the bacterial cell - Bactericidal

38. Which H2 Blocker has the most toxic effects and What are they?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
GI side effects. (Indomethacin is less toxic - more commonly used.)

39. For Heparin What is the Onset of action
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Rash - Pseudomembranous colitis
- Glucagon
Rapid (seconds)

40. Beta Blockers - site of action?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Beta adrenergic receptors and Ca2+ channels (stimulatory)
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
AZT - to reduce risk of Fetal Transmission

41. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
- Clindamycin
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
cortical collecting tubule

42. How is Amphotericin B administered for fungal meningitis?
Carbachol - pilocarpine - physostigmine - echothiophate
viral kinase
Intrathecally
Same as penicillin. Act as narrow spectrum antibiotics

43. What is the MOA for the Aminoglycosides?
Digoxin=urinary Digitoxin=biliary
GI disturbances.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Only in limited amounts

44. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Binds ergosterol - Disrupts fungal membranes
Blocks Influenza A and RubellA; causes problems with the cerebellA
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

45. Why does NE result in bradycardia?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
- Atropine & pralidoxime
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
- Methylene blue

46. Mannitol - site of action?
Inhibt Assembly of new virus by Blocking Protease Enzyme
Gram + cocci - Gram - rods - and Anerobes
Rifampin
proximal convoluted tubule - thin descending limb - and collecting duct

47. How is Chloramphenical used clinically?
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
- Aminocaproic acid
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
block Na+ channels in the cortical collecting tubule

48. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
G6PD deficient individuals
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Tendonitis and Tendon rupture
Neutropenia

49. What Sulfonamides are used for simple UTIs?
- EDTA - dimercaprol - succimer - & penicillamine
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Triple sulfas or SMZ
Pituitary hormone.

50. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
Dopamine
1. Antiandrogen 2. Nausea 3. Vomiting
scopolamine
Succinylcholine

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USMLE Step 1 Pharmacology

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