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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 type of patient should not take Misoprostol and why?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Polymyxins
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
- Steroids - Tamoxifen

2. Why would dopamine be useful in treating shock?
- Ethanol - dialysis - & fomepizole
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

3. Are penicillinase resistant
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Methicillin - Nafcillin - and Dicloxacillin
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Slow - limited by half lives of clotting factors

4. What process does Zafirlukast interfere with?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Leukotrienes increasing bronchial tone.
- polymyxins

5. Hydralazine - toxicity?
Chronic anticoagulation.
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
compensatory tachycardia - fluid retention - lupus - like syndrome
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

6. Name three Antiarrhythmic drugs in class IV.
Verapamil - Diltiazem - Bepridil
Those patients who are taking nitrates.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
- Tetracycline - amiodarone - sulfonamides

7. What is the effect of norepinephrine on bp and pulse pressure?
anticholinesterase glaucoma
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

8. How is Amphotericin B administered for fungal meningitis?
Polymyxins
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Methylxanthine.
Intrathecally

9. Ca2+ channel blockers - toxicity?
cardiac depression - peripheral edema - flushing - dizziness - constipation
Peptic ulcer disease.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Sildenafil fills the penis

10. What are Aminoglycosides used for clinically?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Severe Gram - rod infections.
Indirect agonist - uptake inhibitor

11. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
bradycardia - AV block - CHF
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Erythromycin - Azithromycin - Clarithromycin

12. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Praziquantel
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

13. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Babiturate.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Cloazapine - carbamazapine - colchicine - PTU
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

14. What is the mechanism of Leuprolide?
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
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
- Physostigmine salicylate
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

15. K+ sparing diuretics - clinical use?
post MI and digitalis induced arrhythmias
hyperaldosteronism - K+ depletion - CHF
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
- Cloazapine - carbamazapine - colchicine - PTU

16. What is the clincial use for Misoprostol?
Epinephrine
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
AluMINIMUM amount of feces.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

17. What is the formula for Clearance (CL)
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
aPTT (intrinsic pathway)
CL= (rate of elimination of drug/ Plasma drug conc.)
- Glucocorticoid withdrawal

18. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
- Cloazapine - carbamazapine - colchicine - PTU
Aminoglycosides - Tetracyclines
- Ethosuxamide - sulfonamides - lamotrigine
fetal renal toxicity - hyperkalemia

19. What are two indirect acting adrenergic agonists?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Impairs the synthesis of vitamin K- dependent clotting factors
amphetamine and ephedrine

20. Are not penicillinase resistant
CL= (rate of elimination of drug/ Plasma drug conc.)
Captopril - Enalapril - Lisinopril
toxic
Carbenicillin - Piperacillin - and Ticarcillin

21. List the specific antidote for this toxin: TPA & Streptokinase
Dermatophytes (tinea - ringworm)
cortical collecting tubule
- Aminocaproic acid
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

22. What is the MOA of Polymyxins?
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
decrease

23. Foscarnet does not require activation by a...
viral kinase
Pyridoxine (B6) administration
reversible SLE- like syndrome
Beta lactams - inhibit cell wall synthesis - Bactericidal

24. Can Warfarin be used during pregnancy?
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
No - warfarin - unlike heparin - can cross the placenta.

25. What is a prerequisite for Acyclovir activation?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
It must be Phosphorylated by Viral Thymidine Kinase
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Epinephirine(Alpha1 -2 and Beta 1 -2)

26. What are toxicities associated with Chloramphenicol?
Penicillin - G
Aplastic anemia (dose independent) - Gray Baby Syndrome
Antifungal.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

27. What microorganisms is Aztreonam not effective against?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Praziquantel
Verapamil - Diltiazem - Bepridil
Gram + and Anerobes

28. Which diuretics decrease urine Ca2+?
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
Premature infants - because they lack UDP- glucuronyl transferase
thiazides - amiloride
Potent immunosuppressive used in organ transplant recipients.

29. 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
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Diarrhea
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction

30. Antimicrobial prophylaxis for a history of recurrent UTIs
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Tricyclic antidepressant.
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
TMP- SMZ

31. Resistance mechanisms for Vancomycin
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Digoxin=urinary Digitoxin=biliary
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Those patients who are taking nitrates.

32. What drug is used during the pregnancy of an HIV+ mother? - Why?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Sotalol - Ibutilide - Bretylium - Amiodarone
AZT - to reduce risk of Fetal Transmission
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

33. For Heparin What is the Route of administration
CMV - esp in Immunocompromised patients
Buy AT 30 - CELL at 50'
Diuresis in pateints with sulfa allergy
Paranteral (IV - SC)

34. Which Tetracycline is used in patients with renal failure? / Why?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Only in limited amounts
Doxycycline - because it is fecally eliminated
- Tamoxifen

35. What is the MOA of Isoniazid (INH)?
Succinylcholine
Decreases synthesis of Mycolic Acid
Pralidoxime regenerates active cholinesterase.
Praziquantel

36. Which RT inhibitors cause Lactic Acidosis?
Nucleosides
Epinephrine
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

37. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
- Formaldehyde & formic acid - severe acidosis & retinal damage
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Same as penicillin. Extended spectrum antibiotics
- NaHCO3

38. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Rifampin
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

39. What is the possible mechanism and effect of Metformin in treating diabetes?
torsade de pointes - excessive Beta block
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
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
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

40. What is the category of drug names ending in - zosin (e.g. Prazosin)
Verapamil - Diltiazem - Bepridil
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.
Alpha -1 antagonist
Hypersensitivity reactions

41. List the specific antidote for this toxin: Heparin
- Oxalic acid - Acidosis & nephrotoxicity
Prophylaxis for Influenza A - Rubella; Parkinson's disease
- Protamine
The PT.

42. What physiological effects was the Anes using Atropine to tx
Bethanechol - Neostigmine - physostigmine
Dopamine; causes its release from intact nerve terminals
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)

43. What is the category of drug names ending in - oxin (e.g. Digoxin)
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Cardiac glycoside (inotropic agent).
Chronic Hepatitis A and B - Kaposi's Sarcoma
Hypersensitivity reactions

44. Spironolactone - mechanism?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
TMP- SMZ (DOC) - aerosolized pentamidine
competitive inhibirot of aldosterone in the cortical collecting tubule
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

45. Acetazolamide - site of action?
Dermatophytes (tinea - ringworm)
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
proximal convoluted tubule
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

46. What are two mechanisms of action of Propythiouracil?
Mg = Must go to the bathroom.
Methicillin - Nafcillin - and Dicloxacillin
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

47. List the mechanism - clinical use - & toxicity of Nitrosureas.
Ipratropium
- Ammonium Chloride
- Alkalate DNA - Brain tumors - CNS toxicity
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

48. Which RT inhibitors cause a Rash?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Ca2+ (Loops Lose calcium)
Nevirapine - Delavirdine
Non - Nucleosides

49. What are the clinical uses for 2nd Generation Cephalosporins?
Neurotoxicity - Acute renal tubular necrosis
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
The PT.
Inhibt Assembly of new virus by Blocking Protease Enzyme

50. MOA: Block mRNA synthesis
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Rifampin
These B-2 agonists cause respiratory smooth muscle to relax.

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USMLE Step 1 Pharmacology

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