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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
dry mouth - sedation - severe rebound hypertension

2. For Warfarin What is the Lab value to monitor
Digitoxin 70% Digoxin 20-40%
Carbachol - pilocarpine - physostigmine - echothiophate
PT
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression

3. What is the MOA for Nystatin?
Binds ergosterol - Disrupts fungal membranes
Treatment of infertility.
Ipratropium
- Glucagon

4. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
Headache - flushing - dyspepsia - blue - green color vision.
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)

5. Antimicrobial prophylaxis for a history of recurrent UTIs
Onchocerciasis ('river blindness'-- rIVER- mectin)
TMP- SMZ
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

6. K+ sparing diuretics - site of action?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
cortical collecting tubule
Rash - Pseudomembranous colitis

7. What is the formula for Volume of distribution (Vd)
GI disturbances.
sedation - positive Coombs' test
Vd= (Amt. of drug in body/ Plasma drug conc.)
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

8. What is the MOA of Polymyxins?
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
- Cloazapine - carbamazapine - colchicine - PTU
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
- Ethosuxamide - sulfonamides - lamotrigine

9. What are the indications for using amphetamine?

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10. When is Rifampin not used in combination with other drugs?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Headache - flushing - dyspepsia - blue - green color vision.
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

11. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
Amphetamine and Ephedrine
- Vitamin K & fresh frozen plasma
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Chronic anticoagulation.

12. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
Activates antithrombin III
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
sedation - depression - nasal stuffiness - diarrhea
- Ethosuxamide - sulfonamides - lamotrigine

13. What are signs of Sildenafil (Viagra) toxicity?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Headache - flushing - dyspepsia - blue - green color vision.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species

14. For Heparin What is the Treatment for overdose
Protamine sulfate
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- Vitamin K & fresh frozen plasma
for RSV

15. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Neomycin
Primaquine
Foscarnet = pyroFosphate analog
Na/K ATPase

16. Acetazolamide - mechanism?
Staphlococcus aureus
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
With supplemental Folic Acid
Decreased uptake or Increased transport out of cell

17. What is the MOA for Clindamycin?
Albuterol - tertbutaline
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

18. What are common toxicities associated with Macrolides? (4)
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
reversible SLE- like syndrome
very short acting
Babiturate.

19. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)
Norepinephrine (Alpha1 -2 and beta 1)
Carbenicillin - Piperacillin - and Ticarcillin
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

20. Why is pyridostigmine effective in the treatment of myasthenia gravis?
Diarrhea
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Nucleosides
Same as penicillin. Act as narrow spectrum antibiotics

21. What is Metronidazole used for clinically?
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Tricyclic antidepressant.
It affects beta receptors equally and is used in AV heart block (rare).
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

22. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
Choline acetyltransferase
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Epinephirine(Alpha1 -2 and Beta 1 -2)

23. What drugs target anticholinesterase
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Tricyclic antidepressant.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

24. What is the mechanism of action of Omeprazole - Lansoprazole?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Hypersensitivity reactions
Prevents the release of Ca from SR of skeletal muscle

25. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
Botulinum
Edrophonium
- Lithium
Albuterol - tertbutaline

26. What are two processes Corticosteroids inhibit leading to decreased inflammation?
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
Nifedipine - Verapamil - Diltiazem
cortical collecting tubule
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

27. What are four Sulfonylureas?
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

28. Decrease Digoxin dose in renal failure?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
YES

29. What is the clincial use for Misoprostol?
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
No - warfarin - unlike heparin - can cross the placenta.
Prevention of NSAID- induced peptic ulcers - maintains a PDA.

30. Triamterene and amiloride - mechanism?
block Na+ channels in the cortical collecting tubule
fetal renal toxicity - hyperkalemia
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
all of them

31. What is the MOA for Ampicillin and Amoxicillin?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Same as penicillin. Extended spectrum antibiotics
No - warfarin - unlike heparin - can cross the placenta.
Prevents the release of Ca from SR of skeletal muscle

32. Furosemide increases the excretion of What ion?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
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.
Ca2+ (Loops Lose calcium)
edrophonium (extremely short acting anticholinesterase)

33. What is the MOA of Ganciclovir?
Inhibits CMV DNA polymerase
Inhibt Assembly of new virus by Blocking Protease Enzyme
sedation - positive Coombs' test
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.

34. What is the mechanism of action of Sildenafil (Viagra)?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Hypersensitivity reactions
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

35. Verapamil has similar action to?
Beta Blockers
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
depresses ectopic pacemakers - especially in digoxin toxicity
- Shifts the curve down - reduces Vmax

36. Antimicrobial prophylaxis for PCP
TMP- SMZ (DOC) - aerosolized pentamidine
Pentamidine
- Antipsychotics
The only local anesthetic with vasoconstrictive properties.

37. How do we stop angina?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
For serious - Gram + multidrug - resistant organisms
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

38. What is the category of drug names ending in - oxin (e.g. Digoxin)
Cardiac glycoside (inotropic agent).
Protease Inhibitors and Reverse Transcriptase Inhibitors
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
post MI and digitalis induced arrhythmias

39. What process does Zafirlukast interfere with?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Leukotrienes increasing bronchial tone.
Benzodiazepine.
- Flumazenil

40. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
- Chlorpromazine - thioridazine - haloperidol
Aminoglycosides
Babiturate.
- Formaldehyde & formic acid - severe acidosis & retinal damage

41. What is the definition of zero - order kinetics? Example?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Lidocaine - Mexiletine - Tocainide
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
- B51Naloxone / naltrexone (Narcan)

42. Furosemide - toxicity? (OH DANG)
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
G6PD deficient individuals
- ACE inhibitors (Losartan>no cough)

43. Which cancer drugs work at the level of mRNA(2)?
Ceftriaxone
- Steroids - Tamoxifen
cardiac depression - peripheral edema - flushing - dizziness - constipation
Pseudomonas species and Gram - rods

44. Ca2+ channel blockers - mechanism?
Penicillin - V
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Disulfiram - like reaction with EtOH - Headache
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

45. Which diuretics increase urine Ca2+?
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.
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
loop diuretics - spironolactone
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

46. Which drug(s) cause this reaction: Cinchonism (2)?
GI upset
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Increases coumadin metabolism
- Quinidine - quinine

47. Which H2 Blocker has the most toxic effects and What are they?
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.
Acetylcholinesterase; ACh is broken down into choline and acetate.
- Dimercaprol - succimer
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

48. K+- clinical use?
depresses ectopic pacemakers - especially in digoxin toxicity
sedation - depression - nasal stuffiness - diarrhea
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
decrease

49. What microorganisms are clinical indications for Tetracycline therapy?

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50. What is the MOA for Metronidazole?
Acute (hours)
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Forms toxic metabolites in the bacterial cell - Bactericidal
Methylxanthine.