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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 is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
Acetylcholine esterase
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
- Hydralazine - Procainamide - INH - phenytoin
Babiturate.

2. Which cancer drugs work at the level of proteins(2)?
physostigmine
Inhibt Assembly of new virus by Blocking Protease Enzyme
- Vinca alkaloids(inhibit MT) - Paclitaxel
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

3. Which drug(s) cause this reaction: Cardiac toxicity?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
- Daunorubicin & Doxorubicin
cholestyramine - colestipol
1. Antiandrogen 2. Nausea 3. Vomiting

4. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Reversible block of histamine H2 receptors
NO
Hypersensitivity reactions
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

5. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Mebendazole/Thiabendazole - Pyrantel Pamoate
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Penicillamine

6. Explain potency in relation to full and partial agonists(2).
Anaerobes
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Activates antithrombin III

7. Which drug(s) cause this reaction: Pseudomembranous colitis?
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
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.
Digitoxin 70% Digoxin 20-40%
- Clindamycin

8. Which drug(s) cause this reaction: P450 inhibition(6)?
Forms toxic metabolites in the bacterial cell - Bactericidal
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Abortifacient.

9. Which diuretics decrease urine Ca2+?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
thiazides - amiloride
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Digitoxin 168hrs Digoxin 40 hrs

10. What are three unwanted effects of Mifepristone?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Prevention of NSAID- induced peptic ulcers - maintains a PDA.

11. What is a prerequisite for Acyclovir activation?
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Ceftriaxone
Digitoxin 70% Digoxin 20-40%
It must be Phosphorylated by Viral Thymidine Kinase

12. What is the memory key involving the '4 R's of Rifampin?'
Increase target cell response to insulin.
- Disulfram & also sulfonylureas - metronidazole
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

13. Name three Antiarrhythmic drugs in class IV.
Verapamil - Diltiazem - Bepridil
Fast vs. Slow Acetylators
Suramin
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

14. What is the category of drug names ending in - ane (e.g. Halothane)
- ED 50 is less than the Km (less than 50% of receptors)
Pretreat with antihistamines and a slow infusion rate
Inhalational general anesthetic.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

15. What Sulfonamides are used for simple UTIs?
Norepinephrine (Alpha1 -2 and beta 1)
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Triple sulfas or SMZ

16. Which cancer drugs inhibit nucleotide synthesis(3)?
- Methotrexate - 5 FU - 6 mercaptopurine
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
- Penicillamine
Dopamine

17. Why would you give a drug like pancuronium or succinylcholine?
- Tetracycline
TCA
Useful in muscle paralysis during surgery or mechanical ventilation.
Foscarnet = pyroFosphate analog

18. What are three clinical uses of the NSAIDs?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Norepinephrine
TCA
Carbachol - pilocarpine - physostigmine - echothiophate

19. What is the category of drug names ending in - cillin (e.g. Methicillin)
Penicillin.
- Tamoxifen
Hypersensitivity reactions
Ipratropium

20. MOA: Block peptidoglycan synthesis
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Decreased uptake or Increased transport out of cell
- Shifts the curve down - reduces Vmax
Bacitracin - Vancomycin

21. What is the lab value used to monitor the effectiveness of Warfarin therapy?
TMP- SMZ (DOC) - aerosolized pentamidine
The PT.
Pentavalent Antimony
Large anionic polymer - acidic

22. What cholinomimetics might your pt be taking for his glaucoma
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Carbachol - pilocarpine - physostigmine - echothiophate

23. List the mechanism - clinical use - & toxicity of Doxorubicin.

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24. How do the Protease Inhibitors work?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Inhibt Assembly of new virus by Blocking Protease Enzyme
Nucleosides
Captopril - Enalapril - Lisinopril

25. Which drug(s) cause this reaction: Fanconi's syndrome?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Blood
Buy AT 30 - CELL at 50'
- Tetracycline

26. What are three common NSAIDS other than Aspirin?
Ibuprofen - Naproxen - and Indomethacin
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Sildenafil fills the penis

27. How are Interferons (INF) used clinically?

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28. Which of epi - norepi - or isoproterenol results in bradycardia?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Norepinephrine
Digoxin=urinary Digitoxin=biliary
Sildenafil fills the penis

29. What are the Anti - TB drugs?
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
- Flumazenil
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.

30. For Heparin What is the Mechanism of action
- Ethanol - dialysis - & fomepizole
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Activates antithrombin III
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

31. What are the side effects of Rifampin?
- Nitrate - hydroxocobalamin thiosulfate
Decreased uptake or Increased transport out of cell
- Act on same receptor - Full has greater efficacy
Minor hepatotoxicity - Drug interactions (activates P450)

32. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
decrease conduction velocity - increase ERP - increase PR interval
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

33. What are are the Sulfonylureas (general description) and What is their use?
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Pentavalent Antimony
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.
toxic

34. What is the major side effect for Ampicillin and Amoxicillin?
Pralidoxime regenerates active cholinesterase.
cardiac muscle: Verapamil>Diltiazem>Nifedipine
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Hypersensitivity reactions

35. Which diuretics increase urine Ca2+?
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Aminoglycosides
loop diuretics - spironolactone

36. What are the Macrolides used for clinically?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
No - it inhibits the release of Nor Epi
Decreases synthesis of Mycolic Acid
No - warfarin - unlike heparin - can cross the placenta.

37. Name three Antiarrhythmic drugs in class IB.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Lidocaine - Mexiletine - Tocainide
GI upset
DOC in diagnosing and abolishing AV nodal arrhythmias

38. Antiarrhythmic class IB- effects?
Epinephirine(Alpha1 -2 and Beta 1 -2)
Anaerobes
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
AZT - to reduce risk of Fetal Transmission

39. How does a noncompetitive antagonist effect an agonist?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Shifts the curve down - reduces Vmax
- Deferoxamine
- Glucocorticoid withdrawal

40. Adverse effects of Loop Diuretics?
Beta - lactamase cleavage of Beta - lactam ring
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
DOC in diagnosing and abolishing AV nodal arrhythmias
- Daunorubicin & Doxorubicin

41. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Pretreat with antihistamines and a slow infusion rate
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
- Quinidine - quinine

42. If a patient is given hexamethonium - What would happen to his/her heart rate?
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Chronic gout.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

43. For Warfarin What is the Duration of action
- Phenytoin
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Chronic (weeks or months)

44. Classes of antihypertensive drugs?
- Tetracycline - amiodarone - sulfonamides
AluMINIMUM amount of feces.
Delirium - Tremor - Nephrotoxicity
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

45. What are common toxic side effects of Sulfonamides? (5)
Potent immunosuppressive used in organ transplant recipients.
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Methicillin - Nafcillin - and Dicloxacillin

46. What is treated with Chloroquine - Quinine - Mefloquine?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Malaria (P. falciparum)
Tricyclic antidepressant.

47. What is the memory key for the effect of magnesium hydroxide overuse?
VACUUM your Bed Room'
Mg = Must go to the bathroom.
pulmonary edema - dehydration
sedation - sleep alterations

48. Digoxin v. Digitoxin: bioavailability?
Digitoxin>95% Digoxin 75%
Minor hepatotoxicity - Drug interactions (activates P450)
- Hydralazine - Procainamide - INH - phenytoin
Hydralazine and Minoxidil

49. How would you treat African Trypanosomiasis (sleeping sickness)?
Suramin
Gram + and Anerobes
1. Pioglitazone 2. Rosiglitazone.
Because they require some residual islet function.

50. What is the specific clinical use of Indomethacin in neonates?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
- Formaldehyde & formic acid - severe acidosis & retinal damage
Oral treatment of superficial infections
Indomethacin is used to close a patent ductus arteriosus.

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USMLE Step 1 Pharmacology

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