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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 an occasional side effect of Aztreonam?
- Flumazenil
Bleeding.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
GI upset

2. Why are the Sulfonylureas inactive in IDDM (type -1)?
Because they require some residual islet function.
Hydralazine and Minoxidil
Yes - it does not cross the placenta.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

3. Name three Antiarrhythmic drugs in class IC.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Flecainide - Encainide - Propafenone
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

4. What is are two clinical uses of Cyclosporine?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Hypersensitivity reactions
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

5. 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
Carbachol - pilocarpine - physostigmine - echothiophate
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Dopamine

6. Sotalol - toxicity?
Beta -2 agonist.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
torsade de pointes - excessive Beta block
Alpha -1 antagonist

7. Which drug(s) cause this reaction: SLE- like syndrome?
Protease inhibitor.
Digitoxin 70% Digoxin 20-40%
Acute (hours)
- Hydralazine - Procainamide - INH - phenytoin

8. Ca2+ channel blockers - mechanism?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
AmOxicillin has greater Oral bioavailability
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Albuterol - tertbutaline

9. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Beta - lactamase cleavage of Beta - lactam ring
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Local anesthetic.

10. How is Foscarnet used clinically?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
YES
CMV Retinitis in IC pts When Ganciclovir fails
propanolol - esmolol - metoprolol - atenolol - timolol

11. What antimuscarinic drug is useful for the tx of asthma
Impairs the synthesis of vitamin K- dependent clotting factors
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Ipratropium

12. Which RT inhibitor causes Megaloblastic Anemia?
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
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.
AZT

13. What should not be taken with Tetracyclines? / Why?
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Beta lactams - inhibit cell wall synthesis - Bactericidal
Bleeding.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

14. What are two clinical uses of Azathioprine?
Severe Gram - rod infections.
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Aminoglycosides
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

15. What are Amantadine - associated side effects?
Ataxia - Dizziness - Slurred speech
anticholinesterase glaucoma
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

16. Name several common Macrolides (3)
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Erythromycin - Azithromycin - Clarithromycin
ACE inhibitor.

17. How can the t1/2 of INH be altered?
Fast vs. Slow Acetylators
- NaHCO3
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
1. Acarbose 2. Miglitol

18. What is the MOA for Trimethoprim (TMP)?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Rash - Pseudomembranous colitis
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Hemolytic anemia

19. What effect would atropine have on the preganglionic sympathetic activation of sweat glands? Would this person sweat?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.

20. Nifedipine has similar action to?
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Nitrates
Early myocardial infarction.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

21. Antiarrhythmic Class III- effects?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
proximal convoluted tubule
Suramin
Prevention of NSAID- induced peptic ulcers - maintains a PDA.

22. Do Tetracyclines penetrate the CNS?
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
These B-2 agonists cause respiratory smooth muscle to relax.
Only in limited amounts

23. What is the effect of TCA's on the adrenergic nerve?
Acute (hours)
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
torsade de pointes - excessive Beta block
Peptic ulcer disease.

24. What is the mechanism of action of Sildenafil (Viagra)?
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Antileukotriene; blocks leukotriene receptors.

25. What is the lab value used to monitor the effectiveness of Heparin therapy?
The PTT.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Keratin containing tissues - e.g. - nails

26. Name two LPL stimulators.
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Gemfibrozil - Clofibrate
Neomycin
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

27. Decrease Digoxin dose in renal failure?
YES
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

28. MOA for Penicillin (3 answers)?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
BM suppression (neutropenia - anemia) - Peripheral neuropathy

29. Which receptors does phenylephrine act upon?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Methicillin - Nafcillin - and Dicloxacillin
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

30. What is the MOA for the Azoles?
Hypersensitivity reactions
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Inhibit Ergosterol synthesis

31. Does Heparin have a long - medium - or short half life?
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Short.
Hypersensitivity reactions
Norepinephrine (Alpha1 -2 and beta 1)

32. How does NE modulate its own release? What other neurotransmitter has this same effect?
Norepinephrine (Alpha1 -2 and beta 1)
Pentamidine
Ibuprofen - Naproxen - and Indomethacin
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

33. Antiarrhythmic class IC- toxicity?
Succinylcholine
proarrhythmic
carbonic anhydrase inhibitors - K+ sparing diuretics
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

34. Why is carbachol and pilocarpine useful in treatment of glaucoma?
Modification via Acetylation - Adenylation - or Phosphorylation
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

35. Mannitol - site of action?
Carbenicillin - Piperacillin - and Ticarcillin
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
proximal convoluted tubule - thin descending limb - and collecting duct
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

36. For Heparin What is the Route of administration
Abortifacient.
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Blood
Paranteral (IV - SC)

37. List the specific antidote for this toxin: Carbon monoxide
Long.
Protamine sulfate
-100% oxygen - hyperbaric
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

38. What conditions are treated with Metronidazole?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
first dose orthostatic hypotension - dizziness - headache
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.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'

39. Name the common Aminoglycosides (5)
Sotalol - Ibutilide - Bretylium - Amiodarone
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Doxycycline - because it is fecally eliminated
- NaHCO3

40. What is the MOA of Aztreonam?
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Suramin
Antibiotic - protein synthesis inhibitor.

41. Beta Blockers - site of action?
Hydralazine and Minoxidil
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Babiturate.

42. List the specific antidote for this toxin: Warfarin
- Vitamin K & fresh frozen plasma
Yes
- Tetracycline - amiodarone - sulfonamides
depresses ectopic pacemakers - especially in digoxin toxicity

43. What antimuscarinic agent is used in asthma and COPD?
Ipratropium
- Nitrate - hydroxocobalamin thiosulfate
Antibiotic - protein synthesis inhibitor.
Acetylcholine esterase

44. What is a possible toxicity of Alpha - glucosidase inhibitors used in type -2 diabetes?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
hyperaldosteronism - K+ depletion - CHF
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
GI disturbances.

45. List the specific antidote for this toxin: Benzodiazepines
- Flumazenil
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
sedation - sleep alterations

46. How is Leishmaniasis treated?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Inhalational general anesthetic.
Pentavalent Antimony
Competitive inibitor of progestins at progesterone receptors.

47. What is the MOA for the Fluoroquinolones?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
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.
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

48. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
Due to the presence of a bulkier R group
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
hypertension - angina - arrhythmias
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction

49. What are Aminoglycosides synergistic with?
Beta - lactam antibiotics
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
- Quinidine - quinine
post MI and digitalis induced arrhythmias

50. Name the Protease Inhibitors (4)
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Saquinavir - Ritonavir - Indinavir - Nelfinavir
- Flumazenil
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

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USMLE Step 1 Pharmacology

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