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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. Acetazolamide - clinical uses?
Hypersensitivity reactions
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Epinephirine(Alpha1 -2 and Beta 1 -2)

2. Does Heparin have a long - medium - or short half life?
Increases coumadin metabolism
Long.
Short.
Inhibits CMV DNA polymerase

3. Why would you use pralidoxime after exposure to an organophosphate?
- Aminocaproic acid
Nevirapine - Delavirdine
Pralidoxime regenerates active cholinesterase.
DOC in diagnosing and abolishing AV nodal arrhythmias

4. What are common side effects of RT Inhibitors?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
H2 antagonist

5. How are the HIV drugs used clinically?

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6. What are three types of antacids and the problems that can result from their overuse?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

7. Digoxin v. Digitoxin: protein binding?
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
Digitoxin 70% Digoxin 20-40%
Ceftriaxone
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

8. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
With an amino acid change of D- ala D- ala to D- ala D- lac

9. What are the clinical uses for Aztreonam?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Interstitial nephritis
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

10. How does NE modulate its own release? What other neurotransmitter has this same effect?
Those patients who are taking nitrates.
torsade de pointes - excessive Beta block
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Beta antagonist.

11. What is the category of drug names ending in - navir (e.g. Saquinavir)
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
The PT.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Protease inhibitor.

12. For Warfarin What is the Lab value to monitor
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.
Acetylcholine esterase
Cilastatin
PT

13. Which cancer drugs inhibit nucleotide synthesis(3)?
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Beta antagonist.
- Methotrexate - 5 FU - 6 mercaptopurine
Premature infants - because they lack UDP- glucuronyl transferase

14. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Cyclooxygenases (COX I - COX II).
Prophylaxis for Influenza A - Rubella; Parkinson's disease
bradycardia - AV block - CHF

15. What is the mechanism of action of the thrombolytics?
Pyridoxine (B6) administration
Directly of indirectly aid conversion of plasminogen to plasmin Which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin - bound plasminogen to plasmin.)
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
- Penicillamine

16. MOA: Block protein synthesis at 30s subunit
Antileukotriene; blocks synthesis by lipoxygenase.
- Alkalinize urine & dialysis
Aminoglycosides - Tetracyclines
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

17. Which drug(s) cause this reaction: Fanconi's syndrome?
dry mouth - sedation - severe rebound hypertension
Rare.
Nevirapine - Delavirdine
- Tetracycline

18. Which diuretics increase urine NaCl?
all of them
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

19. What is a mnemonic to remember Amantadine's function?
Keratin containing tissues - e.g. - nails
PT
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Blocks Influenza A and RubellA; causes problems with the cerebellA

20. What is the mecanism of action of Sucralfate?
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
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.
These B-2 agonists cause respiratory smooth muscle to relax.
Triple sulfas or SMZ

21. Mg+- clinical use?
effective in torsade de pointes and digoxin toxicity
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

22. List the mechanism - clinical use - & toxicity of Etoposide.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
TMP- SMZ (DOC) - aerosolized pentamidine
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

23. What are three possible complications of Heparin therapy?
blocks SR Ca2+ channels
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Ibuprofen - Naproxen - and Indomethacin
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

24. What is the memory key for the effect of aluminum hydroxide overuse?
- Penicillamine
- Haloperidol - chlorpromazine - reserpine - MPTP
BM suppression (neutropenia - anemia) - Peripheral neuropathy
AluMINIMUM amount of feces.

25. What is the receptor affinity and clinical use of isoproterenol?
Buy AT 30 - CELL at 50'
Small lipid - soluble molecule
It affects beta receptors equally and is used in AV heart block (rare).
Dermatophytes (tinea - ringworm)

26. Which drug(s) cause this reaction: G6PD hemolysis(8)?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Impairs the synthesis of vitamin K- dependent clotting factors
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

27. For Warfarin What is the Mechanism of action
Impairs the synthesis of vitamin K- dependent clotting factors
Imipenem
Vd= (Amt. of drug in body/ Plasma drug conc.)
- Tricyclic antidepressants

28. Which drug(s) cause this reaction: P450 inhibition(6)?
physostigmine
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
GI side effects. (Indomethacin is less toxic - more commonly used.)
Norepinephrine

29. Antiarrhythmic class IB- effects?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Quinidine - Amiodarone - Procainamide - Disopyramide
Ca2+ (Loops Lose calcium)

30. Adverse effects of Captopril?
Nitrates
Decreases synthesis of Mycolic Acid
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

31. How is Amphotericin B administered for fungal meningitis?
cross - allergenic
Intrathecally
effective in torsade de pointes and digoxin toxicity
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

32. Name two classes of drugs for HIV therapy
Protease Inhibitors and Reverse Transcriptase Inhibitors
- Formaldehyde & formic acid - severe acidosis & retinal damage
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Nifedipine - Verapamil - Diltiazem

33. Adverse effects of Nifedipine - verapamil?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Antileukotriene; blocks synthesis by lipoxygenase.
dizziness - flushing - constipation (verapamil) - nausea
AZT - to reduce risk of Fetal Transmission

34. What antimuscarinic agent is used in asthma and COPD?
- Ethosuxamide - sulfonamides - lamotrigine
Ipratropium
pulmonary edema - dehydration
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

35. What is the MOA for Acyclovir?
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.
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
troponin - tropomyosin system
Inhibit viral DNA polymerase

36. What anticholinesterase crosses the blood - brain - barrier?
Acute gout.
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
physostigmine
No

37. How does Ganciclovir's toxicity relate to that of Acyclovir?
- Glucagon
Nifedipine - Verapamil - Diltiazem
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Ganciclovir is more toxic to host enzymes

38. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Acetylcholinesterase; ACh is broken down into choline and acetate.
Ibuprofen - Naproxen - and Indomethacin
Clavulanic acid
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.

39. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
Beta Blockers
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
- Haloperidol - chlorpromazine - reserpine - MPTP

40. What is the category of drug names ending in - tropin (e.g. Somatotropin)
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
-100% oxygen - hyperbaric
Pituitary hormone.

41. What is the category of drug names ending in - zosin (e.g. Prazosin)
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Alpha -1 antagonist
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.

42. Common toxicities associated with Griseofulvin?
Teratogenic - Carcinogenic - Confusion - Headaches
DOC in diagnosing and abolishing AV nodal arrhythmias
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

43. What is Metronidazole used for clinically?
Methylation of rRNA near Erythromycin's ribosome binding site
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Cell membrane Ca2+ channels of cardiac sarcomere

44. What do Aminoglycosides require for uptake?
Digoxin=urinary Digitoxin=biliary
Oxygen
Onchocerciasis ('river blindness'-- rIVER- mectin)
Chronic gout.

45. What type of neurological blockade would hexamethonium create?
Carbenicillin - Piperacillin - and Ticarcillin
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
hypertension - angina - arrhythmias
1. Antiandrogen 2. Nausea 3. Vomiting

46. Name four Antiarrhythmic drugs in class IA.
Polymyxin B - Polymyxin E
Increase target cell response to insulin.
Quinidine - Amiodarone - Procainamide - Disopyramide
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

47. Amiodarone - toxicity?
Local anesthetic.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Methylxanthine.

48. Foscarnet toxicity?
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Nephrotoxicity
AZT
- Corticosteroids - heparin

49. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Phosphorylation by a Viral Kinase
- Aminocaproic acid
Tricyclic antidepressant.
Intrathecally

50. Why is reserpine effective in treating HTN?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
local anesthetic. CNS stimulation or depression. CV depression.
Pretreat with antihistamines and a slow infusion rate