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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. Furosemide increases the excretion of What ion?
Ca2+ (Loops Lose calcium)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Diarrhea

2. MOA: Block DNA topoisomerases
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Beta lactams - inhibit cell wall synthesis - Bactericidal
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Quinolones

3. What type of gout is treated with Allopurinol?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
- Alkalinize urine & dialysis
Chronic gout.
Hypersensitivity reactions

4. What are signs of Sildenafil (Viagra) toxicity?
Binding to the presynaptic alpha 2 release modulating receptors
Headache - flushing - dyspepsia - blue - green color vision.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Hypersensitivity reactions

5. Which drug(s) cause this reaction: Torsade de pointes (2)?
Same as penicillin. Extended spectrum antibiotics
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
first dose orthostatic hypotension - dizziness - headache
Rheumatoid and osteoarthritis.

6. What reversal agent could a Anes give to reverse the effects of Atropine
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
sedation - sleep alterations
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Bethanechol - Neostigmine - physostigmine

7. What are common toxicities associated with Macrolides? (4)
Yes - it does not cross the placenta.
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

8. What are the major structural differences between Penicillin and Cephalosporin?
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)
AV nodal cells
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

9. List the mechanism - clinical use - & toxicity of Paclitaxel.
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Cyclooxygenases (COX I - COX II).
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

10. Antiarrhythmic class II- effects?
check PFTs - LFTs - and TFTs
- Phenytoin
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Dopamine

11. What is the MOA for Acyclovir?
Pretreat with antihistamines and a slow infusion rate
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Inhibit viral DNA polymerase
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

12. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
- Oxalic acid - Acidosis & nephrotoxicity
Onchocerciasis ('river blindness'-- rIVER- mectin)
No - hemicholinum block the uptake of Choline and thus Ach synthesis

13. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Acetylcholinesterase; ACh is broken down into choline and acetate.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

14. Adverse effects of Hydralazine?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Minor hepatotoxicity - Drug interactions (activates P450)

15. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
Vd= (Amt. of drug in body/ Plasma drug conc.)
Forms toxic metabolites in the bacterial cell - Bactericidal
- Haloperidol - chlorpromazine - reserpine - MPTP
1. Acarbose 2. Miglitol

16. List the specific antidote for this toxin: Benzodiazepines
- Flumazenil
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- ACE inhibitors (Losartan>no cough)
- Ammonium Chloride

17. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
severe hypertension - CHF
- Normalize K+ - Lidocaine - & Anti - dig Mab
PT

18. What are common side effects of Amphotericin B?
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Only in limited amounts
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

19. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Scopolamine
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

20. What are two Alpha - glucosidase inhibitors?
carbonic anhydrase inhibitors - K+ sparing diuretics
Beta Blockers
1. Acarbose 2. Miglitol
Nevirapine - Delavirdine

21. What is the MOA for the Tetracyclines?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

22. How is Amantadine used clinically?

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23. What are three clinical uses of the NSAIDs?
Prophylaxis for Influenza A - Rubella; Parkinson's disease
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Norepinephrine

24. What enzyme is responsible for the degredation of Ach
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Acetylcholine esterase
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

25. What is the mechanism of action of the thrombolytics?
cyanide toxicity (releases CN)
Nifedipine - Verapamil - Diltiazem
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.)
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

26. What type of gout is treated with Colchicine?
Acute gout.
Inhalational general anesthetic.
Pseudomembranous colitis (C. difficile) - fever - diarrhea
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

27. List the mechanism - clinical use - & toxicity of Etoposide.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Nucleosides

28. What is the category of drug names ending in - caine (e.g. Lidocaine)
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Suramin
amphetamine and ephedrine
Local anesthetic.

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

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30. Adverse effects of Nifedipine - verapamil?
Ceftriaxone
Nitrates
dizziness - flushing - constipation (verapamil) - nausea
Disulfiram - like reaction with EtOH - Headache

31. Which receptors does phenylephrine act upon?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Hypersensitivity reactions
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

32. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
- Aminocaproic acid

33. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Inhibit Ergosterol synthesis
Rifampin
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Same as penicillin. Extended spectrum antibiotics

34. Acetazolamide - mechanism?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Antibiotic - protein synthesis inhibitor.
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.

35. What is the MOA for Methicillin - Nafcillin - and Dicloxacillin?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
cortical collecting tubule
Same as penicillin. Act as narrow spectrum antibiotics

36. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Rapid (seconds)
Cephalosporins
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

37. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Scopolamine
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

38. What are two processes Corticosteroids inhibit leading to decreased inflammation?
- Bleomycin - amiodarone - busulfan
Non - Nucleosides
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses

39. Antimicrobial prophylaxis for Meningococcal infection
Cephalosporins
Inhibits reabsorption of uric acid.
Rifampin (DOC) - minocycline
Hypersensitivity reactions

40. Name five Antiarrhythmic drugs in class II?
Hemolytic anemia
propanolol - esmolol - metoprolol - atenolol - timolol
Malaria (P. falciparum)
not a sulfonamide - but action is the same as furosemide

41. Hydralazine - class and mechanism?
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Binds to the Pyrophosphate Binding Site of the enzyme
- Vinca alkaloids(inhibit MT) - Paclitaxel
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)

42. Common toxicities associated with Fluoroquinolones?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
severe hypertension - CHF
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
GI upset - Superinfections - Skin rashes - Headache - Dizziness

43. What is Metronidazole combined with for 'triple therapy'? Against What organism?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
It must be Phosphorylated by Viral Thymidine Kinase

44. Name the common Nucleoside Reverse Transcriptase Inhibitors
Pseudomonas species and Gram - rods
Carbenicillin - Piperacillin - and Ticarcillin
Dopamine; causes its release from intact nerve terminals
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

45. What is the memory key for Metronidazole's clinical uses?
Local anesthetic.
GET on the Metro
Chronic anticoagulation.
Pentavalent Antimony

46. Are Ampicillin and Amoxicillin are not...
Chronic Hepatitis A and B - Kaposi's Sarcoma
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
penicillinase resistant
Staphlococcus aureus

47. What are the major toxic side effects of the Cephalosporins?
Cilastatin
- Alkalinize urine & dialysis
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- Hydralazine - Procainamide - INH - phenytoin

48. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
Chronic Hepatitis A and B - Kaposi's Sarcoma
- Disulfram & also sulfonylureas - metronidazole
Penicillin.
Same as penicillin. Extended spectrum antibiotics

49. What are two types of drugs that interfere with the action of Sucralfate and why?
Delirium - Tremor - Nephrotoxicity
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
TMP- SMZ (DOC) - aerosolized pentamidine
Aminoglycosides

50. What is a possible toxicity of Alpha - glucosidase inhibitors used in type -2 diabetes?
GI disturbances.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Inhibition of 50S peptidyl transferase - Bacteriostatic
RESPIre