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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

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1. What is the formula for Clearance (CL)
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
CL= (rate of elimination of drug/ Plasma drug conc.)
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
troponin - tropomyosin system

2. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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3. What is the mechanism of action of the H2 Blockers?
- N- acetylcystine
Reversible block of histamine H2 receptors
Paranteral (IV - SC)
- Antipsychotics

4. Adenosine - clinical use?
- Tetracycline
hyperaldosteronism - K+ depletion - CHF
anticholinesterase glaucoma
DOC in diagnosing and abolishing AV nodal arrhythmias

5. What are the side effects of Rifampin?
Minor hepatotoxicity - Drug interactions (activates P450)
prevention of nodal arrhythmias (SVT)
Due to the presence of a bulkier R group
GI upset

6. Furosemide increases the excretion of What ion?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
- Tetracycline
Those patients who are taking nitrates.
Ca2+ (Loops Lose calcium)

7. Antiarrhythmic class IV- toxicity?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Amphotericin B - Nystatin - Fluconazole/azoles
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

8. What is the MOA for the Tetracyclines?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Forms toxic metabolites in the bacterial cell - Bactericidal

9. List the specific antidote for this toxin: Cyanide
Inhibt Assembly of new virus by Blocking Protease Enzyme
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.
- Nitrate - hydroxocobalamin thiosulfate
Fast vs. Slow Acetylators

10. What is the clinical use for Nystatin?
Norepinephrine
Rash - Pseudomembranous colitis
Topical and Oral - for Oral Candidiasis (Thrush)
Headache - flushing - dyspepsia - blue - green color vision.

11. List the specific antidote for this toxin: Warfarin
decrease
- Vitamin K & fresh frozen plasma
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
- Quinidine - quinine

12. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Antifungal.
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Neomycin
cardiac muscle: Verapamil>Diltiazem>Nifedipine

13. When is Rifampin not used in combination with other drugs?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
cortical collecting tubule

14. Why would you give a drug like pancuronium or succinylcholine?
Rare.
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
effective in torsade de pointes and digoxin toxicity
Useful in muscle paralysis during surgery or mechanical ventilation.

15. List the specific antidote for this toxin: Salicylates
Neutropenia
Inhibition of 50S peptidyl transferase - Bacteriostatic
- Alkalinize urine & dialysis
Carbenicillin - Piperacillin - and Ticarcillin

16. What are four H2 Blockers?
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
sedation - sleep alterations
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

17. What is the MOA of Aztreonam?
atropine - homatropine - tropicamide
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
- Protamine
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

18. What are toxic side effects for Metronidazole?
fetal renal toxicity - hyperkalemia
- Tricyclic antidepressants
Disulfiram - like reaction with EtOH - Headache
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

19. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Rare.
Indomethacin is used to close a patent ductus arteriosus.
Used in combination therapy with SMZ to sequentially block folate synthesis
Succinylcholine

20. Antiarrhythmic class IB- effects?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Treatment of infertility.
troponin - tropomyosin system
amphetamine and ephedrine

21. Why are Methicillin - Nafcillin - and Dicloxacillin penicillinase resistant?
Sildenafil fills the penis
Ceftriaxone
Intrathecally
Due to the presence of a bulkier R group

22. Which drug(s) cause this reaction: Gray baby syndrome?
Doxycycline - because it is fecally eliminated
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Leukotrienes increasing bronchial tone.
- Chloramphenicol

23. Resistance mechanisms for Aminoglycosides
Modification via Acetylation - Adenylation - or Phosphorylation
GI distress - Skin rash - and Seizures at high plasma levels
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Resistant Gram - infections

24. How does Ganciclovir's toxicity relate to that of Acyclovir?
With an amino acid change of D- ala D- ala to D- ala D- lac
AV nodal cells
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Ganciclovir is more toxic to host enzymes

25. What is the category and mechanism of action of Zileuton in Asthma treatment?
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.
Antileukotriene; blocks synthesis by lipoxygenase.
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
AmOxicillin has greater Oral bioavailability

26. What is the memory key for Metronidazole's clinical uses?
Epinephirine(Alpha1 -2 and Beta 1 -2)
Antileukotriene; blocks leukotriene receptors.
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
GET on the Metro

27. Which drug(s) cause this reaction: Cardiac toxicity?
Protamine sulfate
Cyclooxygenases (COX I - COX II).
Binds ergosterol - Disrupts fungal membranes
- Daunorubicin & Doxorubicin

28. Ryanodine - site of action?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
NO
blocks SR Ca2+ channels
Verapamil - Diltiazem - Bepridil

29. What are the clinical indications for Azole therapy?
Cephalosporins
Systemic mycoses
Forms toxic metabolites in the bacterial cell - Bactericidal
Inhibits cell wall mucopeptide formation - Bactericidal

30. Why does atropine dilate the pupil?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Oral
sedation - positive Coombs' test
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

31. What are common side effects of RT Inhibitors?
Phenothiazine (neuroleptic - antiemetic).
It inhibits release of NE.
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
BM suppression (neutropenia - anemia) - Peripheral neuropathy

32. MOA: Disrupt fungal cell membranes
Amphotericin B - Nystatin - Fluconazole/azoles
Nephrotoxicity
cross - allergenic
new arrhythmias - hypotension

33. Which drug(s) cause this reaction: Hot flashes?
Lidocaine - Mexiletine - Tocainide
- Tamoxifen
Resistant Gram - infections
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

34. Antiarrhythmic class IA effects?
Pentavalent Antimony
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Phenothiazine (neuroleptic - antiemetic).

35. Resistance mechanisms for Cephalosporins/Penicillins
effective in torsade de pointes and digoxin toxicity
DOC in diagnosing and abolishing AV nodal arrhythmias
Beta - lactamase cleavage of Beta - lactam ring
Indirect agonist - uptake inhibitor

36. Which drug(s) cause this reaction: Fanconi's syndrome?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
- Tetracycline
Botulinum
Amphetamine and Ephedrine

37. Which drug(s) cause this reaction: Agranulocytosis (3)?
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
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.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
- Cloazapine - carbamazapine - colchicine - PTU

38. How is Ganciclovir activated?
- NaHCO3
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Phosphorylation by a Viral Kinase
pulmonary edema - dehydration

39. What is the clinical use of Mifepristone (RU486)?
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Abortifacient.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
CMV - esp in Immunocompromised patients

40. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Ipratropium
Pretreat with antihistamines and a slow infusion rate
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.

41. What is combination TMP- SMZ used to treat?
PT
Dopamine; causes its release from intact nerve terminals
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

42. What is the category of drug names ending in - terol (e.g. Albuterol)
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
thick ascending limb
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.
Beta -2 agonist.

43. What is the MOA for Trimethoprim (TMP)?
Nitrates
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
- Chloramphenicol
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

44. How can the t1/2 of INH be altered?
sedation - depression - nasal stuffiness - diarrhea
check PFTs - LFTs - and TFTs
Fast vs. Slow Acetylators
Sildenafil fills the penis

45. Adverse effects of Nifedipine - verapamil?
dizziness - flushing - constipation (verapamil) - nausea
Neomycin
- Dimercaprol - succimer
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

46. What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
The only local anesthetic with vasoconstrictive properties.
Acetylcholinesterase; ACh is broken down into choline and acetate.
- Steroids - Tamoxifen

47. What microorganisms are clinical indications for Tetracycline therapy?

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48. Describe Phase I metabolism in liver(3)?
Same as penicillin. Extended spectrum antibiotics
Malaria (P. falciparum)
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
penicillinase resistant

49. Adverse effects of Clonidine?
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
dry mouth - sedation - severe rebound hypertension

50. For Warfarin What is the Duration of action
very short acting
- Vinca alkaloids(inhibit MT) - Paclitaxel
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Chronic (weeks or months)

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USMLE Step 1 Pharmacology

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