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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. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Pyridoxine (B6) administration
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- ACE inhibitors (Losartan>no cough)
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

2. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
Lidocaine - Mexiletine - Tocainide
for RSV
1. Antiandrogen 2. Nausea 3. Vomiting
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil

3. Loop diuretics (furosemide)- site of action?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
thick ascending limb
is resistant
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

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

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5. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
Beta - lactamase cleavage of Beta - lactam ring
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
- Phenytoin
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

6. What is the MOA for the Aminoglycosides?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

7. How are Sulfonamides employed clinically?
Gram + - Gram - - Norcardia - Chlamydia
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Malaria (P. falciparum)

8. Acetazolamide - mechanism?
Does not cross
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

9. What are common toxicities associated with Tetracyclines?

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10. What is the MOA for Trimethoprim (TMP)?
Verapamil - Diltiazem - Bepridil
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Amphetamine and Ephedrine
- Steroids - Tamoxifen

11. What are four conditions in Which H2 Blockers are used clinically?
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. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
- Tamoxifen

12. What is the category of drug names ending in - zosin (e.g. Prazosin)
- Antipsychotics
Alpha -1 antagonist
- Ammonium Chloride
Fast vs. Slow Acetylators

13. Adverse effects of Reserpine?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
sedation - depression - nasal stuffiness - diarrhea
Potent immunosuppressive used in organ transplant recipients.
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

14. Cautions When using Amiodarone?
check PFTs - LFTs - and TFTs
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Neutropenia
Long.

15. What antimuscarinic drug is useful for the tx of asthma
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Ipratropium
AV nodal cells
for RSV

16. Triamterene and amiloride - mechanism?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
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.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
block Na+ channels in the cortical collecting tubule

17. Which drug(s) cause this reaction: Hot flashes?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
- Tamoxifen
Early myocardial infarction.
Chronic Hepatitis A and B - Kaposi's Sarcoma

18. What drug is given for Pneumocystis carinii prophylaxis?
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Used in combination therapy with SMZ to sequentially block folate synthesis
- Chloramphenicol
Pentamidine

19. What process does Zafirlukast interfere with?
Leukotrienes increasing bronchial tone.
Prevents the release of Ca from SR of skeletal muscle
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
prevention of nodal arrhythmias (SVT)

20. Adverse effects of Hydralazine?
- Penicillamine
Cell membrane Ca2+ channels of cardiac sarcomere
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

21. Name three K+ sparing diuretics?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Spironolactone - Triamterene - Amiloride (the K+ STAys)
- ED 50 is less than the Km (less than 50% of receptors)
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased

22. Ryanodine - site of action?
- Glucagon
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
blocks SR Ca2+ channels
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic

23. Digitalis - site of action?
Buy AT 30 - CELL at 50'
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Na/K ATPase
Prevents the release of ACh - Which results in muscle paralysis.

24. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
Quinidine - Amiodarone - Procainamide - Disopyramide
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
ACIDazolamide' causes acidosis
Na/K ATPase

25. Adverse effects of Methyldopa?

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26. Name five Antiarrhythmic drugs in class II?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
propanolol - esmolol - metoprolol - atenolol - timolol
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

27. Which drug(s) cause this reaction: Aplastic anemia (5)?
- Tetracycline
- Steroids - Tamoxifen
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
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.)

28. Beta Blockers - BP?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
decrease
dry mouth - sedation - severe rebound hypertension

29. For Warfarin What is the Route of administration
Oral
PT
Modification via Acetylation - Adenylation - or Phosphorylation
Dopamine; causes its release from intact nerve terminals

30. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Tendonitis and Tendon rupture
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Dermatophytes (tinea - ringworm)

31. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
Cephalosporins
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

32. Name three Antiarrhythmic drugs in class IV.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Verapamil - Diltiazem - Bepridil
HTN - CHF - calcium stone formation - nephrogenic DI.
- Oral Contraceptives

33. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Norepinephrine (Alpha1 -2 and beta 1)
- Tricyclic antidepressants
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Beta -2 agonist.

34. Hydrochlorothiazide - mechanism?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
thick ascending limb
hyperaldosteronism - K+ depletion - CHF
Erythromycin - Azithromycin - Clarithromycin

35. Which diuretics increase urine Ca2+?
loop diuretics - spironolactone
- Physostigmine salicylate
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Mebendazole/Thiabendazole - Pyrantel Pamoate

36. Name the Protease Inhibitors (4)
- Quinidine - quinine
TCA
atropine - homatropine - tropicamide
Saquinavir - Ritonavir - Indinavir - Nelfinavir

37. What is the mechanism of action of Allopurinol used to treat chronic gout?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
cross - allergenic
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Bethanechol - Neostigmine - physostigmine

38. Explain potency in relation to full and partial agonists(2).
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
BM suppression (neutropenia - anemia) - Peripheral neuropathy

39. What are three clinical uses of the NSAIDs?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Acute (hours)
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

40. Which H2 Blocker has the most toxic effects and What are they?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
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.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

41. Cocaine shares is mechanism of action with What antidepressant
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
TCA
AmOxicillin has greater Oral bioavailability

42. How is Chloramphenical used clinically?
Nifedipine - Verapamil - Diltiazem
Activates antithrombin III
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Botulinum

43. What is the MOA for the Azoles?
Clavulanic acid
Inhibit Ergosterol synthesis
Minor hepatotoxicity - Drug interactions (activates P450)
- Ethanol - dialysis - & fomepizole

44. Which drug(s) cause this reaction: Photosensitivity(3)?
- Tetracycline - amiodarone - sulfonamides
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Leukotrienes increasing bronchial tone.

45. Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
Polymyxin B - Polymyxin E
- Bleomycin - amiodarone - busulfan
proximal convoluted tubule
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

46. What are two conditions in Which COX-2 inhibitors might be used?
Rheumatoid and osteoarthritis.
Benzathine penicillin G
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Indomethacin is used to close a patent ductus arteriosus.

47. Antimicrobial prophylaxis for Meningococcal infection
decrease conduction velocity - increase ERP - increase PR interval
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.
Potent immunosuppressive used in organ transplant recipients.
Rifampin (DOC) - minocycline

48. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
Pseudomonas species and Gram - rods
Benzodiazepine.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

49. What are common side effects of Amphotericin B?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
- Penicillin
Local anesthetic.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias

50. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
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.
- Haloperidol - chlorpromazine - reserpine - MPTP
edrophonium (extremely short acting anticholinesterase)

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USMLE Step 1 Pharmacology

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