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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. What are Aminoglycosides used for clinically?
CL= (rate of elimination of drug/ Plasma drug conc.)
Bethanechol - Neostigmine - physostigmine
Severe Gram - rod infections.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.

2. MOA: Block nucleotide synthesis
Hydralazine and Minoxidil
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Sulfonamides - Trimethoprim

3. Explain potency in relation to full and partial agonists(2).
Acute (hours)
AluMINIMUM amount of feces.
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Megaloblastic anemia - Leukopenia - Granulocytopenia

4. What is the mechanism of action of Cyclosporine?
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.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
- Antipsychotics
Rash - Pseudomembranous colitis

5. Ca2+ channel blockers - mechanism?
penicillinase resistant
Increases coumadin metabolism
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

6. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Hypersensitivity reactions
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions

7. Procainamide - toxicity?
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Headache - flushing - dyspepsia - blue - green color vision.
reversible SLE- like syndrome
Rash - Pseudomembranous colitis

8. What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
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
RESPIre
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

9. Antimicrobial prophylaxis for Gonorrhea
for RSV
- EDTA - dimercaprol - succimer - & penicillamine
Yes
Ceftriaxone

10. What are four conditions in Which H2 Blockers are used clinically?
Digoxin=urinary Digitoxin=biliary
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

11. Steady state concentration is reached in __ number of half - lifes
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
- Shifts the curve down - reduces Vmax
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Chronic gout.

12. What are three types of antacids and the problems that can result from their overuse?
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Useful in muscle paralysis during surgery or mechanical ventilation.
GI disturbances.
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

13. List the mechanism - clinical use - & toxicity of 5 FU.
Mebendazole/Thiabendazole - Pyrantel Pamoate
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Rapid (seconds)
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

14. What is the MOA of Foscarnet?
toxic
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Inhibits Viral DNA polymerase
Oral treatment of superficial infections

15. What are three clinical uses of the NSAIDs?
Give an antichloinesterase - neostigmine - edrophonium - etc
Chronic gout.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Nifedipine - Verapamil - Diltiazem

16. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Acetylcholinesterase; ACh is broken down into choline and acetate.

17. What organisms does Griseofulvin target?
Aminoglycosides
Peptic ulcer disease.
Useful in muscle paralysis during surgery or mechanical ventilation.
Dermatophytes (tinea - ringworm)

18. What are toxicities associated with Chloramphenicol?
Praziquantel
Cilastatin
Aplastic anemia (dose independent) - Gray Baby Syndrome
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

19. Ethacrynic Acid - clinical use?
Cyclooxygenases (COX I - COX II).
Sulfonamides - Trimethoprim
- Disulfram & also sulfonylureas - metronidazole
Diuresis in pateints with sulfa allergy

20. K+- clinical use?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
depresses ectopic pacemakers - especially in digoxin toxicity
Neurotoxicity - Acute renal tubular necrosis

21. Name some common Tetracyclines (4)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Sotalol - Ibutilide - Bretylium - Amiodarone
Aminoglycosides
Decreases synthesis of Mycolic Acid

22. Name common Polymyxins
Ibuprofen - Naproxen - and Indomethacin
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Polymyxin B - Polymyxin E
Amphetamine and Ephedrine

23. What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Onchocerciasis ('river blindness'-- rIVER- mectin)
severe hypertension - CHF
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

24. Beta Blockers - site of action?
loop diuretics - spironolactone
- Quinidine - quinine
Headache - flushing - dyspepsia - blue - green color vision.
Beta adrenergic receptors and Ca2+ channels (stimulatory)

25. Which drug(s) cause this reaction: Gingival hyperplasia?
- Phenytoin
- Tetracycline
Acts as a wide spectrum carbapenem
aPTT (intrinsic pathway)

26. What are the clinical uses for Aztreonam?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Cyclooxygenases (COX I - COX II).
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

27. How are Sulfonamides employed clinically?
Gram + - Gram - - Norcardia - Chlamydia
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Small lipid - soluble molecule
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

28. Are penicillinase resistant
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
collecting ducts
Methicillin - Nafcillin - and Dicloxacillin
decrease conduction velocity - increase ERP - increase PR interval

29. 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.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
1. Antiandrogen 2. Nausea 3. Vomiting
torsade de pointes - excessive Beta block

30. Name three Antiarrhythmic drugs in class IV.
Verapamil - Diltiazem - Bepridil
Beta Blockers
Acetylcholinesterase; ACh is broken down into choline and acetate.
- Ammonium Chloride

31. What is the mechanism of action of the Sulfonylureas?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Pituitary hormone.
DHPG (dihydroxy-2- propoxymethyl guanine)

32. What type of gout is treated with Probenacid?
Chronic gout.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Premature infants - because they lack UDP- glucuronyl transferase
amphetamine and ephedrine

33. What is the MOA of Ganciclovir?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Inhibits CMV DNA polymerase
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
No - it inhibits the release of Nor Epi

34. ACE inhibitors - toxicity?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Vd= (Amt. of drug in body/ Plasma drug conc.)
Activates antithrombin III

35. Hydralazine - toxicity?
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
No - it inhibits the release of Nor Epi
Sulfonamides - Trimethoprim
compensatory tachycardia - fluid retention - lupus - like syndrome

36. What is the clinical use for Nystatin?
Local anesthetic.
Topical and Oral - for Oral Candidiasis (Thrush)
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.

37. How does a noncompetitive antagonist effect an agonist?
post MI and digitalis induced arrhythmias
- Shifts the curve down - reduces Vmax
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
GI side effects. (Indomethacin is less toxic - more commonly used.)

38. What is Fluconazole specifically used for?
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Same as penicillin. Extended spectrum antibiotics
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

39. Which drug(s) cause this reaction: Pseudomembranous colitis?
dizziness - flushing - constipation (verapamil) - nausea
- Clindamycin
bradycardia - AV block - CHF
Sildenafil fills the penis

40. Adverse effect of Nitroprusside?
cyanide toxicity (releases CN)
Potent immunosuppressive used in organ transplant recipients.
Lipoxygenase
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

41. What are the major toxic side effects of Imipenem/cilastatin?
GI distress - Skin rash - and Seizures at high plasma levels
- Formaldehyde & formic acid - severe acidosis & retinal damage
These B-2 agonists cause respiratory smooth muscle to relax.
Gram + - Gram - - Norcardia - Chlamydia

42. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
- Vinca alkaloids(inhibit MT) - Paclitaxel
Flecainide - Encainide - Propafenone
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas

43. Name four Antiarrhythmic drugs in class IA.
Digoxin=urinary Digitoxin=biliary
Quinidine - Amiodarone - Procainamide - Disopyramide
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Flecainide - Encainide - Propafenone

44. What is the category of drug names ending in - azine (e.g. Chlorpromazine)
Phenothiazine (neuroleptic - antiemetic).
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Staphlococcus aureus
check PFTs - LFTs - and TFTs

45. How would you reverse the effect of a neuromuscular blocking agent?
Antileukotriene; blocks synthesis by lipoxygenase.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Give an antichloinesterase - neostigmine - edrophonium - etc
Suramin

46. What is the clinical use for Sildenafil (Viagra)?
Inhibits Viral DNA polymerase
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Erectile dysfunction.

47. Adverse effects of Losartan?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
DOC in diagnosing and abolishing AV nodal arrhythmias
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
fetal renal toxicity - hyperkalemia

48. What is a Ribavirin toxicity?
Hemolytic anemia
VACUUM your Bed Room'
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

49. What additional side effects exist for Ampicillin?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
- Tetracycline - amiodarone - sulfonamides
Rash - Pseudomembranous colitis

50. What are three clinical uses of the Leuprolide?
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
pulmonary edema - dehydration

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USMLE Step 1 Pharmacology

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