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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. How does NE modulate its own release? What other neurotransmitter has this same effect?
torsade de pointes
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

2. What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Botulinum
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

3. Toxic side effects of the Azoles?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

4. Aztreonam is not ________ with penicillins
cross - allergenic
atropine - homatropine - tropicamide
INH: Injures Neurons and Hepatocytes
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)

5. Isopoterenol was given to a patient with a developing AV block - why?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Stimulates beta adrenergic receptors
Vd= (Amt. of drug in body/ Plasma drug conc.)
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity

6. What are three clinical uses of the Leuprolide?
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

7. Ganciclovir associated toxicities?
TMP- SMZ (DOC) - aerosolized pentamidine
Imipenem
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

8. Name several common Macrolides (3)
Antibiotic - protein synthesis inhibitor.
post MI and digitalis induced arrhythmias
Erythromycin - Azithromycin - Clarithromycin
Yes

9. Which diuretics cause alkalosis?
Systemic mycoses
Ataxia - Dizziness - Slurred speech
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.
loop diuretics - thiazides

10. K+ sparing diuretics - toxicity?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
As an anticholinesterase it increases endogenous ACh and thus increases strength.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Acute (hours)

11. List the specific antidote for this toxin: Digitalis
reversible SLE- like syndrome
- Normalize K+ - Lidocaine - & Anti - dig Mab
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Chronic Hepatitis A and B - Kaposi's Sarcoma

12. What is a common side effect of Misoprostol?
Nephrotoxicity
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Small lipid - soluble molecule
Diarrhea

13. What is the mechanism of action of Heparin?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Ceftriaxone
Heparin catalyzes the activation of antithrombin III.
atropine - homatropine - tropicamide

14. Procainamide - toxicity?
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Neutropenia
reversible SLE- like syndrome

15. For Warfarin What is the Treatment for overdose
IV vitamin K and fresh frozen plasma
Amphetamine and Ephedrine
- Hydralazine - Procainamide - INH - phenytoin
ACE inhibitor.

16. What is the MOA of Ganciclovir?
Inhibits CMV DNA polymerase
Staphlococcus aureus
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
- Tamoxifen

17. Which drug(s) cause this reaction: Tardive dyskinesia?
Staphlococcus aureus
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
- Cloazapine - carbamazapine - colchicine - PTU
- Antipsychotics

18. What is the mechanism of action of the thrombolytics?
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.)
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
IV vitamin K and fresh frozen plasma
Indomethacin is used to close a patent ductus arteriosus.

19. If a patient is given hexamethonium - What would happen to his/her heart rate?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
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.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
No - hemicholinum block the uptake of Choline and thus Ach synthesis

20. What are the side effects of Rifampin?
Beta1 more than B2
Imipenem
TMP- SMZ
Minor hepatotoxicity - Drug interactions (activates P450)

21. List the specific antidote for this toxin: Iron
RESPIre
Succinylcholine
- Deferoxamine
Prophylaxis for Influenza A - Rubella; Parkinson's disease

22. MOA of Succinylcholine
Antileukotriene; blocks synthesis by lipoxygenase.
Hypersensitivity reactions
Prevents the release of Ca from SR of skeletal muscle
Rheumatoid and osteoarthritis.

23. List the mechanism - clinical use - & toxicity of Cisplatin.
Norepinephrine
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Increases coumadin metabolism

24. List the mechanism - clinical use - & toxicity of Bleomycin.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
collecting ducts
H2 antagonist
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

25. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
- Penicillamine
Scopolamine
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Primaquine

26. Ca2+ channel blockers - clinical use?
Does not cross
Aminoglycosides - Tetracyclines
hypertension - angina - arrhythmias
Na/K ATPase

27. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Norepinephrine (Alpha1 -2 and beta 1)
GET on the Metro
The PT.
Penicillin - G

28. What is the memory key for Metronidazole's clinical uses?
Rifampin (DOC) - minocycline
GET on the Metro
reversible SLE- like syndrome
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

29. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
torsade de pointes - excessive Beta block
Teratogenic - Carcinogenic - Confusion - Headaches
Pseudomonas species and Gram - rods
- Disulfram & also sulfonylureas - metronidazole

30. How would you reverse the effect of a neuromuscular blocking agent?
- Cloazapine - carbamazapine - colchicine - PTU
Give an antichloinesterase - neostigmine - edrophonium - etc
competitive inhibirot of aldosterone in the cortical collecting tubule
Blood

31. Common toxicities associated with Fluoroquinolones?
sedation - depression - nasal stuffiness - diarrhea
- Formaldehyde & formic acid - severe acidosis & retinal damage
Decreases synthesis of Mycolic Acid
GI upset - Superinfections - Skin rashes - Headache - Dizziness

32. Name the common Aminoglycosides (5)
Albuterol - tertbutaline
Enterobacter
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

33. For Heparin What is the Structure
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Digitoxin>95% Digoxin 75%
PT
Large anionic polymer - acidic

34. Common toxicities associated with Griseofulvin?
Teratogenic - Carcinogenic - Confusion - Headaches
Yes - it does not cross the placenta.
Dopamine; causes its release from intact nerve terminals
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)

35. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Ataxia - Dizziness - Slurred speech
Tendonitis and Tendon rupture
Epinephrine
Aplastic anemia (dose independent) - Gray Baby Syndrome

36. Beta Blockers - site of action?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Prevents the release of Ca from SR of skeletal muscle
Local anesthetic.

37. Antiarrhythmic class IB- clinical uses?
Decreases synthesis of Mycolic Acid
post MI and digitalis induced arrhythmias
cross - allergenic
- Vitamin K & fresh frozen plasma

38. What is Clindamycin used for clinically?
Inhalational general anesthetic.
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

39. How are Sulfonamides employed clinically?
Gram + - Gram - - Norcardia - Chlamydia
Chronic gout.
cardiac depression - peripheral edema - flushing - dizziness - constipation
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

40. What are the phases of succinylcholine neuromuscular blockade?
Non - Nucleosides
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
- Tetracycline - amiodarone - sulfonamides

41. What is the category of drug names ending in - oxin (e.g. Digoxin)
Cardiac glycoside (inotropic agent).
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Treatment of infertility.
Acetylcholinesterase; ACh is broken down into choline and acetate.

42. How is Amphotericin B used clinically?
Blocks Norepi - but not Dopamine
Ganciclovir is more toxic to host enzymes
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
- NaHCO3

43. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Antibiotic - protein synthesis inhibitor.

44. What are Amantadine - associated side effects?
Oxygen
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
It inhibits release of NE.
Ataxia - Dizziness - Slurred speech

45. How is Vancomycin used clinically?
Nucleosides
amphetamine and ephedrine
For serious - Gram + multidrug - resistant organisms
It affects beta receptors equally and is used in AV heart block (rare).

46. Which drug(s) cause this reaction: Cardiac toxicity?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
not a sulfonamide - but action is the same as furosemide
- Daunorubicin & Doxorubicin
AZT

47. How is Ganciclovir used clinically?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
CMV - esp in Immunocompromised patients
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

48. What is combination TMP- SMZ used to treat?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
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.
effective in torsade de pointes and digoxin toxicity
ACE inhibitor.

49. Why would you give a drug like pancuronium or succinylcholine?
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Useful in muscle paralysis during surgery or mechanical ventilation.
It acts presynaptically to increase NE release.
sedation - sleep alterations

50. Which drug(s) cause this reaction: Anaphylaxis?
- Penicillin
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Long.
cardiac depression - peripheral edema - flushing - dizziness - constipation

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USMLE Step 1 Pharmacology

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