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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. Name common Polymyxins
Tetracycline - Doxycycline - Demeclocycline - Minocycline
check PFTs - LFTs - and TFTs
Penicillin.
Polymyxin B - Polymyxin E

2. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Benzodiazepine.
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

3. What is the category of drug names ending in - azine (e.g. Chlorpromazine)
Succinylcholine
Phenothiazine (neuroleptic - antiemetic).
first dose orthostatic hypotension - dizziness - headache
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

4. Nifedipine has similar action to?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
cyanide toxicity (releases CN)
Nitrates
post MI and digitalis induced arrhythmias

5. List the specific antidote for this toxin: TPA & Streptokinase
- Aminocaproic acid
Inhibits cell wall mucopeptide formation - Bactericidal
Benzathine penicillin G
Pseudomonas species and Gram - rods

6. What is the mechanism of action of Aspirin?
Dopamine
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

7. What are two clinical uses of Azathioprine?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
sedation - depression - nasal stuffiness - diarrhea

8. What are the clinical uses for Ticlopidine - Clopidogrel?
These B-2 agonists cause respiratory smooth muscle to relax.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

9. Loop diuretics (furosemide)- site of action?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
INH: Injures Neurons and Hepatocytes
thick ascending limb
Imipenem

10. What is the MOA for Amphotericin B?
Penicillin.
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.

11. What organism is Imipenem/cilastatin the Drug of Choice for?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Enterobacter
G6PD deficient individuals
Paranteral (IV - SC)

12. What are common toxicities associated with Macrolides? (4)
Rash - Pseudomembranous colitis
Bleeding.
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Beta Blockers

13. Which drug(s) cause this reaction: Hepatitis?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Used in combination therapy with SMZ to sequentially block folate synthesis
- Isoniazid

14. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
proarrhythmic
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Disulfiram - like reaction with EtOH - Headache

15. What is the clinical use for Heparin?
- EDTA - dimercaprol - succimer - & penicillamine
- Normalize K+ - Lidocaine - & Anti - dig Mab
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

16. MOA: Block mRNA synthesis
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Rifampin
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

17. List the mechanism - clinical use - & toxicity of Busulfan.
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Antileukotriene; blocks leukotriene receptors.

18. How is Ganciclovir activated?
Carbenicillin - Piperacillin - and Ticarcillin
Phosphorylation by a Viral Kinase
Pentavalent Antimony
Indomethacin is used to close a patent ductus arteriosus.

19. Do Tetracyclines penetrate the CNS?
Only in limited amounts
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Penicillin - G
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

20. What is the mechanism of action of Sildenafil (Viagra)?
CMV - esp in Immunocompromised patients
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
AV nodal cells
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

21. K+ sparing diuretics - site of action?
loop diuretics - thiazides
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
cortical collecting tubule

22. Does Warfarin have a long - medium - or short half life?
- Ammonium Chloride
Long.
Slow - limited by half lives of clotting factors
Prophylaxis for Influenza A - Rubella; Parkinson's disease

23. What is a common side effect of Misoprostol?
Diarrhea
Rifampin (DOC) - minocycline
Staphlococcus aureus
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'

24. How does a noncompetitive antagonist effect an agonist?
Reversible block of histamine H2 receptors
Benzathine penicillin G
- Shifts the curve down - reduces Vmax
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

25. Which drug(s) cause this reaction: G6PD hemolysis(8)?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
toxic
1. Weight gain 2. Hepatotoxicity (troglitazone)

26. What beta 2 agonist will help your 21yo Astma pt?
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
- Daunorubicin & Doxorubicin
Albuterol - tertbutaline

27. How is Trimethoprim used clinically?
fetal renal toxicity - hyperkalemia
- Atropine & pralidoxime
Used in combination therapy with SMZ to sequentially block folate synthesis
Ca2+ (Loops Lose calcium)

28. Name some common Sulfonamides (4)
Reversible block of histamine H2 receptors
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

29. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Penicillin.
- Chlorpromazine - thioridazine - haloperidol
Tetracycline - Doxycycline - Demeclocycline - Minocycline
dizziness - flushing - constipation (verapamil) - nausea

30. What are the clinical uses for 1st Generation Cephalosporins?
Chronic Hepatitis A and B - Kaposi's Sarcoma
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
- Ethanol - dialysis - & fomepizole
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)

31. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Those patients who are taking nitrates.

32. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Babiturate.
Same as penicillin. Extended spectrum antibiotics
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

33. Which cancer drugs effect nuclear DNA (4)?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Vitamin K & fresh frozen plasma
Short.

34. What is the memory key for the effect of aluminum hydroxide overuse?
Aminoglycosides - Tetracyclines
- Tamoxifen
AluMINIMUM amount of feces.
TCA

35. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
- aminoglycosides - loop diuretics - cisplatin
Succinylcholine

36. What is the effect of TCA's on the adrenergic nerve?
Gemfibrozil - Clofibrate
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

37. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Antifungal.
Nevirapine - Delavirdine
Pentavalent Antimony
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

38. How would hemicholinium treatment affect cholinergic neurons?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
for RSV
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Tricyclic antidepressant.

39. Mannitol - site of action?
proximal convoluted tubule - thin descending limb - and collecting duct
Cardiac glycoside (inotropic agent).
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

40. What drug is given for Pneumocystis carinii prophylaxis?
Pentamidine
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Mg = Must go to the bathroom.
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol

41. Which drug(s) cause this reaction: Pseudomembranous colitis?
- Clindamycin
Indirect agonist - uptake inhibitor
No - hemicholinum block the uptake of Choline and thus Ach synthesis
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

42. What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
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
Beta -2 agonist.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.

43. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
DHPG (dihydroxy-2- propoxymethyl guanine)
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Digitoxin>95% Digoxin 75%

44. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
- Oxalic acid - Acidosis & nephrotoxicity
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Beta1 more than B2

45. For Warfarin What is the Treatment for overdose
IV vitamin K and fresh frozen plasma
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Captopril - Enalapril - Lisinopril

46. List the specific antidote for this toxin: Amphetamine
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
not a sulfonamide - but action is the same as furosemide
- Ammonium Chloride

47. Digoxin v. Digitoxin: bioavailability?
Foscarnet = pyroFosphate analog
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Digitoxin>95% Digoxin 75%
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

48. What conditions are treated with Metronidazole?
Succinylcholine
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
distal convoluted tubule (early)

49. Guanethidine enhances the release of Norepi?
No - it inhibits the release of Nor Epi
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

50. Adenosine - clinical use?
Decreased uptake or Increased transport out of cell
DOC in diagnosing and abolishing AV nodal arrhythmias
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
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.

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USMLE Step 1 Pharmacology

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