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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. Which drug(s) cause this reaction: Fanconi's syndrome?
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
- Tetracycline
Reversible block of histamine H2 receptors

2. What conditions would you use dantrolene?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Neomycin
Binding to the presynaptic alpha 2 release modulating receptors
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

3. How do Sulfonamides act on bacteria?
Modification via Acetylation
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
AluMINIMUM amount of feces.
Mebendazole/Thiabendazole - Pyrantel Pamoate

4. What is a common side effect of Misoprostol?
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
scopolamine
Diarrhea

5. Isopoterenol was given to a patient with a developing AV block - why?
- Tetracycline
Hypersensitivity reactions
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Stimulates beta adrenergic receptors

6. What effect would atropine have on the preganglionic sympathetic activation of sweat glands? Would this person sweat?
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
very short acting
sedation - depression - nasal stuffiness - diarrhea
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

7. Common toxicities associated with Fluoroquinolones?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Antifungal.
GI upset - Superinfections - Skin rashes - Headache - Dizziness

8. What are Fluoroquinolones indicated for? (3)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
TCA
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
- aminoglycosides - loop diuretics - cisplatin

9. What is the category of drug names ending in - olol (e.g. Propranolol)
Beta antagonist.
scopolamine
bradycardia - AV block - CHF
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

10. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Long.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Gram + - Gram - - Norcardia - Chlamydia

11. What type of gout is treated with Allopurinol?
- Methylene blue
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Chronic gout.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.

12. List the specific antidote for this toxin: Acetaminophen
- N- acetylcystine
The PTT.
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

13. List some specifics of lead poisoning(4)?
Diarrhea
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Rifampin
Same as penicillin. Act as narrow spectrum antibiotics

14. Which drug(s) cause this reaction: Aplastic anemia (5)?
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
distal convoluted tubule (early)
Oxygen
Keratin containing tissues - e.g. - nails

15. What anticholinesterase crosses the blood - brain - barrier?
physostigmine
not a sulfonamide - but action is the same as furosemide
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
loop diuretics - thiazides

16. Mannitol - toxicity?
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
check PFTs - LFTs - and TFTs
Local anesthetic.
pulmonary edema - dehydration

17. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
Succinylcholine
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
It acts presynaptically to increase NE release.

18. What is the MOA of the RT Inhibitors?
Succinylcholine
- NaHCO3
Same as penicillin. Extended spectrum antibiotics
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA

19. What are signs of Sildenafil (Viagra) toxicity?
Headache - flushing - dyspepsia - blue - green color vision.
Hypersensitivity reactions
Chronic gout.
Captopril - Enalapril - Lisinopril

20. What is the MOA for the Cephalosporins?
- Flumazenil
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Beta lactams - inhibit cell wall synthesis - Bactericidal
carbonic anhydrase inhibitors - K+ sparing diuretics

21. What are three possible complications of Heparin therapy?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Reversible block of histamine H2 receptors
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Chronic (weeks or months)

22. The MOA for Chloramphenicol is?
TMP- SMZ (DOC) - aerosolized pentamidine
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Inhibition of 50S peptidyl transferase - Bacteriostatic
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.

23. How are the HIV drugs used clinically?

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24. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Gemfibrozil - Clofibrate
- Chlorpromazine - thioridazine - haloperidol
Binding to the presynaptic alpha 2 release modulating receptors

25. Hydralazine - clinical use?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
severe hypertension - CHF
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
- Lithium

26. What is the mecanism of action of Sucralfate?
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
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.
block Na+ channels in the cortical collecting tubule
Cyclooxygenases (COX I - COX II).

27. ___________ are Teratogenic
Pituitary hormone.
Aminoglycosides
NO
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

28. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
HTN - CHF - calcium stone formation - nephrogenic DI.
AmOxicillin has greater Oral bioavailability

29. Ca2+ channel blockers - site of action?
prevention of nodal arrhythmias (SVT)
Cell membrane Ca2+ channels of cardiac sarcomere
Chronic gout.
dry mouth - sedation - severe rebound hypertension

30. Nifedipine has similar action to?
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
Nitrates
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
- Phenytoin

31. What is the mechanism of action of Colchicine used to treat acute gout?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
- Bleomycin - amiodarone - busulfan
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Nifedipine - Verapamil - Diltiazem

32. What are two toxicities of the Sulfonylureas?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
cholestyramine - colestipol
With an amino acid change of D- ala D- ala to D- ala D- lac
These B-2 agonists cause respiratory smooth muscle to relax.

33. List the specific antidote for this toxin: Amphetamine
Methylxanthine.
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
- Ammonium Chloride

34. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Pretreat with antihistamines and a slow infusion rate
- Act on same receptor - Full has greater efficacy
Intrathecally
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

35. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Tendonitis and Tendon rupture
Sotalol - Ibutilide - Bretylium - Amiodarone

36. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
TCA
Leukotrienes increasing bronchial tone.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
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.)

37. ACE inhibitors - clinical use?
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
hypertension - CHF - diabetic renal disease
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

38. Beta Blockers - CV toxicity?
TMP- SMZ
Vd= (Amt. of drug in body/ Plasma drug conc.)
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
bradycardia - AV block - CHF

39. What is Nifurtimox administered for?

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40. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
atropine - homatropine - tropicamide
Modification via Acetylation - Adenylation - or Phosphorylation
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

41. Why are the Sulfonylureas inactive in IDDM (type -1)?
- EDTA - dimercaprol - succimer - & penicillamine
- Alkalinize urine & dialysis
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Because they require some residual islet function.

42. What is the mechanism of action of Mifepristone (RU486)?
thick ascending limb
- Ethosuxamide - sulfonamides - lamotrigine
Competitive inibitor of progestins at progesterone receptors.
CMV - esp in Immunocompromised patients

43. What are the major toxic side effects of the Cephalosporins?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- Atropine & pralidoxime
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
hyperaldosteronism - K+ depletion - CHF

44. A 57 yo heart failure pt develops cardiac decompensation - What drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Dopamine
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction

45. Adverse effects of Nifedipine - verapamil?
dizziness - flushing - constipation (verapamil) - nausea
YES
- Clindamycin
Protease inhibitor.

46. How do spare receptors effect the Km?
- polymyxins
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.
- ED 50 is less than the Km (less than 50% of receptors)
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

47. What is the chemical name for Ganciclovir?
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.
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
DHPG (dihydroxy-2- propoxymethyl guanine)

48. What is the memory key for the effect of aluminum hydroxide overuse?
NO
AluMINIMUM amount of feces.
Gram + - Gram - - Norcardia - Chlamydia
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis

49. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Dopamine; causes its release from intact nerve terminals
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Nephrotoxicity

50. How does resistance to Vancomycin occur?
- Corticosteroids - heparin
The only local anesthetic with vasoconstrictive properties.
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
With an amino acid change of D- ala D- ala to D- ala D- lac