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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

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1. MOA: Block protein synthesis at 30s subunit
cross - allergenic
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Aminoglycosides - Tetracyclines
Carbachol - pilocarpine - physostigmine - echothiophate

2. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Keratin containing tissues - e.g. - nails
Clavulanic acid
Nitrates
depresses ectopic pacemakers - especially in digoxin toxicity

3. Ca2+ channel blockers - toxicity?
YES
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
cardiac depression - peripheral edema - flushing - dizziness - constipation

4. Why would dopamine be useful in treating shock?
Constant FRACTION eliminated per unit time.(exponential)
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.
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion

5. Adverse effects of Reserpine?
Praziquantel
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
sedation - depression - nasal stuffiness - diarrhea
- Methylene blue

6. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
dry mouth - sedation - severe rebound hypertension
first dose orthostatic hypotension - dizziness - headache
- Bleomycin - amiodarone - busulfan
Succinylcholine

7. What is the MOA for the Fluoroquinolones?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Methylxanthine.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Beta adrenergic receptors and Ca2+ channels (stimulatory)

8. How can the t1/2 of INH be altered?
Fast vs. Slow Acetylators
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
toxic
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

9. What is the lab value used to monitor the effectiveness of Warfarin therapy?
Indomethacin is used to close a patent ductus arteriosus.
The PT.
Chronic gout.
No - hemicholinum block the uptake of Choline and thus Ach synthesis

10. K+ sparing diuretics - site of action?
cortical collecting tubule
pulmonary edema - dehydration
Paranteral (IV - SC)
Hemolytic anemia

11. What is the MOA for Nystatin?
TCA
Nucleosides
Polymyxin B - Polymyxin E
Binds ergosterol - Disrupts fungal membranes

12. What enzyme does Zileuton inhibit?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
is resistant
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.
Lipoxygenase

13. Cautions When using Amiodarone?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
- Disulfram & also sulfonylureas - metronidazole
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
check PFTs - LFTs - and TFTs

14. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Decreases synthesis of Mycolic Acid
Benzodiazepine.
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

15. What is the category of drug names ending in - oxin (e.g. Digoxin)
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Cardiac glycoside (inotropic agent).
proarrhythmic
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

16. What anticholinesterase crosses the blood - brain - barrier?
Gram + - Gram - - Norcardia - Chlamydia
Phosphorylation by a Viral Kinase
Flecainide - Encainide - Propafenone
physostigmine

17. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
Oral treatment of superficial infections
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

18. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Chronic gout.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Penicillin - G
Hypersensitivity reactions

19. A 57 yo heart failure pt develops cardiac decompensation - What drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
Vd= (Amt. of drug in body/ Plasma drug conc.)
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Dopamine

20. What are three possible complications of Heparin therapy?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
- Physostigmine salicylate
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic

21. For Warfarin What is the Onset of action
Acute gout.
Slow - limited by half lives of clotting factors
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
- Methotrexate - 5 FU - 6 mercaptopurine

22. List the specific antidote for this toxin: Acetaminophen
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Onchocerciasis ('river blindness'-- rIVER- mectin)
- N- acetylcystine

23. Thiazides - site of action?
distal convoluted tubule (early)
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

24. What is the MOA for Amphotericin B?
NO
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Prevents the release of ACh - Which results in muscle paralysis.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

25. For Heparin What is the Site of action
Blood
Choline acetyltransferase
Phenothiazine (neuroleptic - antiemetic).
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

26. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
- Isoniazid
1. Weight gain 2. Hepatotoxicity (troglitazone)
Blood
Hydralazine and Minoxidil

27. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
ACE inhibitor.
cardiac muscle: Verapamil>Diltiazem>Nifedipine

28. Name the common Fluoroquinolones (6)
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
- Protamine
Vd= (Amt. of drug in body/ Plasma drug conc.)

29. What is treated with Chloroquine - Quinine - Mefloquine?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Saquinavir - Ritonavir - Indinavir - Nelfinavir
- Shifts the curve down - reduces Vmax
Malaria (P. falciparum)

30. What microorganisms is Aztreonam not effective against?
Gram + and Anerobes
Hypersensitivity reactions
Local anesthetic.
Disulfiram - like reaction with EtOH - Headache

31. Adverse effects of Hydralazine?
Anaerobes
- Act on same receptor - Full has greater efficacy
Suramin
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

32. Which cancer drugs work at the level of proteins(2)?
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Aminoglycosides
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- Vinca alkaloids(inhibit MT) - Paclitaxel

33. Which drug(s) cause this reaction: Tendonitis and rupture?
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Beta adrenergic receptors and Ca2+ channels (stimulatory)
- Fluoroquinolones

34. Ibutilide - toxicity?
GI side effects. (Indomethacin is less toxic - more commonly used.)
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
torsade de pointes
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.

35. What are toxicities associated with Chloramphenicol?
Only in limited amounts
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Does not cross
Aplastic anemia (dose independent) - Gray Baby Syndrome

36. Sotalol - toxicity?
- Nitrate - hydroxocobalamin thiosulfate
torsade de pointes - excessive Beta block
Inhibt Assembly of new virus by Blocking Protease Enzyme
Edrophonium

37. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Tricyclic antidepressant.
Rare.
Antifungal.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

38. What drugs target anticholinesterase
Due to the presence of a bulkier R group
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Onchocerciasis ('river blindness'-- rIVER- mectin)
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

39. What are the clinical uses for Aztreonam?
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)
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions

40. Adverse effect of Nitroprusside?
cyanide toxicity (releases CN)
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
AZT
Nephrotoxicity

41. List the mechanism - clinical use - & toxicity of Nitrosureas.
Choline acetyltransferase
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
- Alkalate DNA - Brain tumors - CNS toxicity

42. Name three K+ sparing diuretics?
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Choline acetyltransferase

43. Which drug(s) cause this reaction: Hot flashes?
- Tamoxifen
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
GI side effects. (Indomethacin is less toxic - more commonly used.)
AV nodal cells

44. Which drug(s) cause this reaction: SLE- like syndrome?
- Hydralazine - Procainamide - INH - phenytoin
- Corticosteroids - heparin
Binds to the Pyrophosphate Binding Site of the enzyme
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

45. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
- Oxalic acid - Acidosis & nephrotoxicity
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Only in limited amounts

46. Furosemide - toxicity? (OH DANG)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
ACIDazolamide' causes acidosis
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

47. What is the mechanism of action of the glucocorticoids?
Interstitial nephritis
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
ACE inhibitor.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias

48. Acetazolamide - clinical uses?
Potent immunosuppressive used in organ transplant recipients.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Inhibits reabsorption of uric acid.

49. Explain potency in relation to full and partial agonists(2).
The PT.
Nucleosides
Ganciclovir is more toxic to host enzymes
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

50. MOA: Bactericidal antibiotics
Intrathecally
YES
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Disulfiram - like reaction with EtOH - Headache

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USMLE Step 1 Pharmacology

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