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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 Methicillin - Nafcillin - and Dicloxacillin used for clinically?
Antifungal.
Benzathine penicillin G
Staphlococcus aureus
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

2. Antiarrhythmic class IB- toxicity?
local anesthetic. CNS stimulation or depression. CV depression.
- Antipsychotics
Quinidine - Amiodarone - Procainamide - Disopyramide
Nephrotoxicity

3. Name the Protease Inhibitors (4)
- Disulfram & also sulfonylureas - metronidazole
Antileukotriene; blocks leukotriene receptors.
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Saquinavir - Ritonavir - Indinavir - Nelfinavir

4. What is the memory key for Isoniazid (INH) toxicity?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
-100% oxygen - hyperbaric
INH: Injures Neurons and Hepatocytes
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

5. Classes of antihypertensive drugs?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
- N- acetylcystine
Succinylcholine

6. What is the memory key to remember Which pathway (extrinsic vs. intrinsic) and Which lab value Warfarin affects?
Nifedipine - Verapamil - Diltiazem
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Inhibits cell wall mucopeptide formation - Bactericidal
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

7. MOA for Penicillin (3 answers)?
scopolamine
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
- aminoglycosides - loop diuretics - cisplatin
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.

8. What is the mechanism of action of Omeprazole - Lansoprazole?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Sulfonamides - Trimethoprim
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

9. What is the category of drug names ending in - caine (e.g. Lidocaine)
Fast vs. Slow Acetylators
Local anesthetic.
Norepinephrine
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)

10. Which drug(s) cause this reaction: Tendonitis and rupture?
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
- Fluoroquinolones
Penicillin.

11. How does botulinum toxin result in respiratory arrest?
cyanide toxicity (releases CN)
Prevents the release of ACh - Which results in muscle paralysis.
severe hypertension - CHF
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

12. Why would dopamine be useful in treating shock?
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Rash - Pseudomembranous colitis
- Tricyclic antidepressants
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

13. What are common side effects of Amphotericin B?
Inhibit Ergosterol synthesis
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Same as penicillin. Act as narrow spectrum antibiotics
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias

14. What are the side effects of Rifampin?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Benzathine penicillin G
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Minor hepatotoxicity - Drug interactions (activates P450)

15. What organism is Imipenem/cilastatin the Drug of Choice for?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Enterobacter
Carbenicillin - Piperacillin - and Ticarcillin
Large anionic polymer - acidic

16. What is the mechanism of action of NSAIDs other than Aspirin?
first dose orthostatic hypotension - dizziness - headache
-100% oxygen - hyperbaric
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
- Isoniazid

17. Side effects of Isoniazid (INH)?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
TMP- SMZ (DOC) - aerosolized pentamidine
TCA
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

18. For Heparin What is the Onset of action
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Rapid (seconds)
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.

19. What is used to reverse the action of Heparin?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

20. MOA: Block peptidoglycan synthesis
Bacitracin - Vancomycin
cardiac depression - peripheral edema - flushing - dizziness - constipation
1. Antiandrogen 2. Nausea 3. Vomiting
Headache - flushing - dyspepsia - blue - green color vision.

21. Mannitol - clinical use?
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
AZT - to reduce risk of Fetal Transmission
Methylxanthine.
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time

22. What is Clindamycin used for clinically?
Binds to the Pyrophosphate Binding Site of the enzyme
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Modification via Acetylation

23. MOA: Block DNA topoisomerases
Neomycin
Erythromycin - Azithromycin - Clarithromycin
Quinolones
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

24. Amprotericin B ___________ the BBB
Does not cross
Beta -2 agonist.
Oxygen
Same as penicillin. Extended spectrum antibiotics

25. How are Interferons (INF) used clinically?

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26. List the mechanism - clinical use - & toxicity of Paclitaxel.
1. Renal damage 2. Aplastic anemia 3. GI distress
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Cell membrane Ca2+ channels of cardiac sarcomere
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

27. Which drug(s) cause this reaction: Focal to massive hepatic necrosis (4)?
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- Formaldehyde & formic acid - severe acidosis & retinal damage

28. Adverse effects of Captopril?
cholestyramine - colestipol
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Penicillin
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

29. Which drug(s) cause this reaction: Photosensitivity(3)?
Protease inhibitor.
- Tetracycline - amiodarone - sulfonamides
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.)
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

30. Which drug(s) cause this reaction: Hepatitis?
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
- Isoniazid
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
- Glucocorticoid withdrawal

31. What is the mechanism of action of Misoprostol?
- Methotrexate - 5 FU - 6 mercaptopurine
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Bleeding.
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

32. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
viral kinase
Interstitial nephritis
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

33. Foscarnet does not require activation by a...
viral kinase
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Praziquantel

34. What is the MOA for Vancomycin?
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Inhibits cell wall mucopeptide formation - Bactericidal
Rheumatoid and osteoarthritis.

35. Which cancer drugs work at the level of mRNA(2)?
- ED 50 is less than the Km (less than 50% of receptors)
Tendonitis and Tendon rupture
Staphlococcus aureus
- Steroids - Tamoxifen

36. What are five advantages of Oral Contraceptives (synthetic progestins - estrogen)?
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
Acetylcholinesterase; ACh is broken down into choline and acetate.
Sulfonamides - Trimethoprim
Inhibit Ergosterol synthesis

37. What is the mechanism of action of Warfarin (Coumadin)?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.

38. How do we stop angina?
- Clindamycin
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time

39. What is the loading dose formula?
Nephrotoxicity
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Pregnant women - Children; because animal studies show Damage to Cartilage
- Vitamin K & fresh frozen plasma

40. For Warfarin What is the Onset of action
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Lipoxygenase
Slow - limited by half lives of clotting factors

41. What are common toxicities associated with Macrolides? (4)
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Malaria (P. falciparum)
Acetylcholinesterase; ACh is broken down into choline and acetate.
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

42. What is the mechanism of action of Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

43. What are four conditions in Which H2 Blockers are used clinically?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
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.
Beta antagonist.

44. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Headache - flushing - dyspepsia - blue - green color vision.
Antileukotriene; blocks leukotriene receptors.
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

45. Adverse effects of Losartan?
hyperaldosteronism - K+ depletion - CHF
check PFTs - LFTs - and TFTs
fetal renal toxicity - hyperkalemia
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

46. What is the category of drug names ending in - tidine (e.g. Cimetidine)
Decreased uptake or Increased transport out of cell
Inhibits CMV DNA polymerase
H2 antagonist
Ceftriaxone

47. Which drug(s) cause this reaction: P450 induction(6)?
Acetylcholine esterase
Polymyxins
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

48. Name some common Tetracyclines (4)
Bleeding.
For serious - Gram + multidrug - resistant organisms
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Butyrophenone (neuroleptic).

49. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Disulfram & also sulfonylureas - metronidazole
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

50. Can Warfarin be used during pregnancy?
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
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.
propanolol - esmolol - metoprolol - atenolol - timolol
No - warfarin - unlike heparin - can cross the placenta.

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USMLE Step 1 Pharmacology

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