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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. 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
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Dopamine
- Atropine & pralidoxime
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.

2. Secretion of What drug is inhibited by Probenacid used to treat chronic gout?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Hypersensitivity reactions
Penicillin.
DOC in diagnosing and abolishing AV nodal arrhythmias

3. What are five possible toxic effects of Aspirin therapy?

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4. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
Praziquantel
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
GI disturbances.

5. List the mechanism - clinical use - & toxicity of Busulfan.
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.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Inhibits reabsorption of uric acid.
Na/K ATPase

6. What is the MOA for the Tetracyclines?
AluMINIMUM amount of feces.
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
block Na+ channels in the cortical collecting tubule
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic

7. List the specific antidote for this toxin: Acetaminophen
Chronic gout.
blocks SR Ca2+ channels
- N- acetylcystine
torsade de pointes - excessive Beta block

8. Beta Blockers - BP?
decrease
Acute (hours)
- Tricyclic antidepressants
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

9. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Activates antithrombin III
Gram + and Anerobes
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

10. List the specific antidote for this toxin: Cyanide
- Act on same receptor - Full has greater efficacy
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Short.
- Nitrate - hydroxocobalamin thiosulfate

11. Steady state concentration is reached in __ number of half - lifes
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

12. What parasitic condition is treated with Ivermectin?

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13. Ca2+ channel blockers - clinical use?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
hypertension - angina - arrhythmias
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

14. For Heparin What is the Site of action
Blood
AZT
These B-2 agonists cause respiratory smooth muscle to relax.
Indirect agonist - uptake inhibitor

15. What is the MOA of Foscarnet?
Inhibits Viral DNA polymerase
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Staphlococcus aureus
PT

16. What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
Potent immunosuppressive used in organ transplant recipients.
Activates antithrombin III
Only in limited amounts

17. Beta Blockers - CV toxicity?
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
bradycardia - AV block - CHF
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

18. ___________ are Teratogenic
Chronic anticoagulation.
Aminoglycosides
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
depresses ectopic pacemakers - especially in digoxin toxicity

19. Isopoterenol was given to a patient with a developing AV block - why?
Sulfonamides - Trimethoprim
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Stimulates beta adrenergic receptors
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

20. What is the MOA for Trimethoprim (TMP)?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Inhibt Assembly of new virus by Blocking Protease Enzyme
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

21. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
- Disulfram & also sulfonylureas - metronidazole
thick ascending limb
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

22. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Treatment of infertility.
scopolamine

23. What is the MOA for Amphotericin B?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Indirect agonist - uptake inhibitor
Na/K ATPase
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

24. What parasites are treated with Pyrantel Pamoate (more specific)?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

25. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
loop diuretics - spironolactone
Staphlococcus aureus
Hypersensitivity reactions
- Glucagon

26. Name three Antiarrhythmic drugs in class IV.
Abortifacient.
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Nephrotoxicity
Verapamil - Diltiazem - Bepridil

27. List the specific antidote for this toxin: Beta Blockers
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Lipoxygenase
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
- Glucagon

28. What is the MOA for Metronidazole?
Blocks Norepi - but not Dopamine
Forms toxic metabolites in the bacterial cell - Bactericidal
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Rheumatoid and osteoarthritis.

29. What conditions would you use dantrolene?
ACIDazolamide' causes acidosis
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Carbachol - pilocarpine - physostigmine - echothiophate
Inhibition of 50S peptidyl transferase - Bacteriostatic

30. Sotalol - toxicity?
Triple sulfas or SMZ
torsade de pointes - excessive Beta block
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Norepinephrine

31. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Epinephrine
Non - Nucleosides
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.

32. What are common toxic side effects of Sulfonamides? (5)
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Chronic (weeks or months)
Premature infants - because they lack UDP- glucuronyl transferase
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)

33. Which drug(s) cause this reaction: Tendonitis and rupture?
Penicillin.
- Fluoroquinolones
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
- Oxalic acid - Acidosis & nephrotoxicity

34. How do spare receptors effect the Km?
- ED 50 is less than the Km (less than 50% of receptors)
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

35. Name some common Tetracyclines (4)
Inhibits reabsorption of uric acid.
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
The PT.
Tetracycline - Doxycycline - Demeclocycline - Minocycline

36. List the specific antidote for this toxin: TPA & Streptokinase
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
- Tetracycline - amiodarone - sulfonamides
- Aminocaproic acid
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

37. Resistance mechanisms for Vancomycin
is resistant
Rash - Pseudomembranous colitis
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

38. Hydralazine - class and mechanism?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Antileukotriene; blocks synthesis by lipoxygenase.
It must be Phosphorylated by Viral Thymidine Kinase

39. What are four clinical uses of glucocorticoids?

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40. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Clavulanic acid
Cyclooxygenases (COX I - COX II).
Pretreat with antihistamines and a slow infusion rate

41. Ibutilide - toxicity?
torsade de pointes
CMV - esp in Immunocompromised patients
Dopamine
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

42. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
Beta antagonist.
AmOxicillin has greater Oral bioavailability
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
- ED 50 is less than the Km (less than 50% of receptors)

43. Decrease Digoxin dose in renal failure?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
YES

44. Which Tetracycline is used in patients with renal failure? / Why?
Doxycycline - because it is fecally eliminated
hypertension - angina - arrhythmias
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

45. In What population does Gray Baby Syndrome occur? Why?
RESPIre
No
Premature infants - because they lack UDP- glucuronyl transferase
blocks SR Ca2+ channels

46. What are four thrombolytics?
- Tetracycline - amiodarone - sulfonamides
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Same as penicillin. Extended spectrum antibiotics
Aminoglycosides

47. What is the category of drug names ending in - operidol (e.g. Haloperidol)
Sildenafil fills the penis
- Oral Contraceptives
Hemolytic anemia
Butyrophenone (neuroleptic).

48. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Modification via Acetylation - Adenylation - or Phosphorylation
cyanide toxicity (releases CN)

49. Side effects of Isoniazid (INH)?
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Pseudomonas species and Gram - rods
- polymyxins
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

50. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
- Cloazapine - carbamazapine - colchicine - PTU
- Formaldehyde & formic acid - severe acidosis & retinal damage
propanolol - esmolol - metoprolol - atenolol - timolol
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

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USMLE Step 1 Pharmacology

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