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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. Acetazolamide causes?

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2. What side effect of using atropine to induce pupillary dilation would you expect?
CMV - esp in Immunocompromised patients
The only local anesthetic with vasoconstrictive properties.
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

3. Antimicrobial prophylaxis for Meningococcal infection
Rifampin (DOC) - minocycline
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Increases coumadin metabolism

4. Which drug(s) cause this reaction: Anaphylaxis?
Hypersensitivity reactions
- Penicillin
- Nitrate - hydroxocobalamin thiosulfate
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

5. Does Heparin have a long - medium - or short half life?
bradycardia - AV block - CHF
Short.
Nifedipine - Verapamil - Diltiazem
for RSV

6. Antiarrhythmic class II- effects?
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

7. What microorganisms is Aztreonam not effective against?
Rheumatoid and osteoarthritis.
Gram + and Anerobes
Norepinephrine
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

8. In coma situations you rule out What (7)?

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9. What is the clinical use for Warfarin?
Chronic anticoagulation.
Modification via Acetylation - Adenylation - or Phosphorylation
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
- Formaldehyde & formic acid - severe acidosis & retinal damage

10. How can the t1/2 of INH be altered?
-100% oxygen - hyperbaric
Fast vs. Slow Acetylators
cholestyramine - colestipol
Activates antithrombin III

11. What is an additional side effect of Methicillin?
decrease conduction velocity - increase ERP - increase PR interval
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Sulfonamides - Trimethoprim
Interstitial nephritis

12. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Acetylcholinesterase; ACh is broken down into choline and acetate.
Because they require some residual islet function.
Pseudomembranous colitis (C. difficile) - fever - diarrhea
cholestyramine - colestipol

13. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Pituitary hormone.
1. Pioglitazone 2. Rosiglitazone.
Digitoxin>95% Digoxin 75%
Binding to the presynaptic alpha 2 release modulating receptors

14. What is the category and mechanism of action of Zileuton in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
Praziquantel
It must be Phosphorylated by Viral Thymidine Kinase
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

15. What process does Zafirlukast interfere with?
Digoxin=urinary Digitoxin=biliary
Mg = Must go to the bathroom.
Leukotrienes increasing bronchial tone.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

16. What populations are Floroquinolones contraindicated in? Why?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Methicillin - Nafcillin - and Dicloxacillin
INH: Injures Neurons and Hepatocytes
Pregnant women - Children; because animal studies show Damage to Cartilage

17. Digoxin v. Digitoxin: bioavailability?
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
- Antipsychotics
Digitoxin>95% Digoxin 75%
Because they require some residual islet function.

18. For Heparin What is the Ability to inhibit coagulation in vitro
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Haloperidol - chlorpromazine - reserpine - MPTP
pulmonary edema - dehydration
Yes

19. Ganciclovir associated toxicities?
thiazides - amiloride
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Benzodiazepine.
cortical collecting tubule

20. Digoxin v. Digitoxin: excretion?
Digoxin=urinary Digitoxin=biliary
Indomethacin is used to close a patent ductus arteriosus.
Give an antichloinesterase - neostigmine - edrophonium - etc
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

21. For Heparin What is the Duration of action
YES
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
for RSV
Acute (hours)

22. Loop diuretics (furosemide)- site of action?
Fast vs. Slow Acetylators
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
thick ascending limb

23. Can Heparin be used during pregnancy?
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Yes - it does not cross the placenta.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Doxycycline - because it is fecally eliminated

24. What is the mechanism of action of NSAIDs other than Aspirin?
- Isoniazid
Keratin containing tissues - e.g. - nails
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Interstitial nephritis

25. List the specific antidote for this toxin: Digitalis
Severe Gram - rod infections.
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Acute gout.
- Normalize K+ - Lidocaine - & Anti - dig Mab

26. Which individuals are predisposed to Sulfonamide - induced hemolysis?
G6PD deficient individuals
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Epinephirine(Alpha1 -2 and Beta 1 -2)
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

27. What reversal agent could a Anes give to reverse the effects of Atropine
Bethanechol - Neostigmine - physostigmine
Phenothiazine (neuroleptic - antiemetic).
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
- Oral Contraceptives

28. List the mechanism - clinical use - & toxicity of Paclitaxel.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Topical and Oral - for Oral Candidiasis (Thrush)
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

29. What is the chemical name for Ganciclovir?
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
anticholinesterase glaucoma
Imipenem
DHPG (dihydroxy-2- propoxymethyl guanine)

30. Which drug(s) cause this reaction: Fanconi's syndrome?
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
- Tetracycline
CMV - esp in Immunocompromised patients
Sulfonamides - Trimethoprim

31. How do we stop angina?
AluMINIMUM amount of feces.
loop diuretics - spironolactone
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

32. What is the only depolarizing neuromuscular blocking agent?
Succinylcholine
Penicillin - V
Impairs the synthesis of vitamin K- dependent clotting factors
blocks SR Ca2+ channels

33. Explain pH dependent urinary drug elimination?
TCA
Severe Gram - rod infections.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

34. What are are the Sulfonylureas (general description) and What is their use?
Pentamidine
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Non - Nucleosides
cardiac muscle: Verapamil>Diltiazem>Nifedipine

35. What is the MOA of Aztreonam?
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
atropine - homatropine - tropicamide
Butyrophenone (neuroleptic).

36. List the mechanism - clinical use - & toxicity of Etoposide.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Aminoglycosides
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

37. What is the mechanism of action of Sildenafil (Viagra)?
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
Cyclooxygenases (COX I - COX II).
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

38. What is Niclosamide used for?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
GI distress - Skin rash - and Seizures at high plasma levels

39. For Heparin What is the Treatment for overdose
Protamine sulfate
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Pregnant women - Children; because animal studies show Damage to Cartilage

40. What are three possible complications of Heparin therapy?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Penicillin.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
loop diuretics - spironolactone

41. Reserpine will block the syntheis of this drug and but not its precursor.
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Benzathine penicillin G
Blocks Norepi - but not Dopamine
Digitoxin>95% Digoxin 75%

42. What conditions would you use dantrolene?
Ipratropium
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

43. Describe Phase II metabolism in liver(3)?
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Succinylcholine
prevention of nodal arrhythmias (SVT)
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

44. Classes of antihypertensive drugs?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

45. What are five toxicities associated with Tacrolimus (FK506)?
Anaerobes
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Nitrates
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

46. Adverse effects of Captopril?
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

47. Why is pyridostigmine effective in the treatment of myasthenia gravis?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
aPTT (intrinsic pathway)
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

48. What physiological effects was the Anes using Atropine to tx
Vd= (Amt. of drug in body/ Plasma drug conc.)
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Amphetamine and Ephedrine

49. Adverse effects of Nifedipine - verapamil?
dizziness - flushing - constipation (verapamil) - nausea
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

50. 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.
- Dimercaprol - succimer
edrophonium (extremely short acting anticholinesterase)
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

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USMLE Step 1 Pharmacology

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