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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 the chemical name for Ganciclovir?
- ED 50 is less than the Km (less than 50% of receptors)
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
DHPG (dihydroxy-2- propoxymethyl guanine)
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

2. What drug is used during the pregnancy of an HIV+ mother? - Why?
- EDTA - dimercaprol - succimer - & penicillamine
reversible SLE- like syndrome
AZT - to reduce risk of Fetal Transmission
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

3. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
These B-2 agonists cause respiratory smooth muscle to relax.
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

4. What is the mechanism of action of Omeprazole - Lansoprazole?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

5. ACE inhibitors - clinical use?
loop diuretics - thiazides
Nevirapine - Delavirdine
hypertension - CHF - diabetic renal disease
Nifedipine - Verapamil - Diltiazem

6. Name several common Macrolides (3)
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Erythromycin - Azithromycin - Clarithromycin
Pyridoxine (B6) administration
Dermatophytes (tinea - ringworm)

7. What are the clinical indications for neostigmine?
first dose orthostatic hypotension - dizziness - headache
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

8. Describe the MOA of Interferons (INF)
Epinephirine(Alpha1 -2 and Beta 1 -2)
Enterobacter
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
bradycardia - AV block - CHF

9. What is the MOA of Foscarnet?
Tricyclic antidepressant.
- Alkalate DNA - Brain tumors - CNS toxicity
scopolamine
Inhibits Viral DNA polymerase

10. What are two clinical uses of Azathioprine?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
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.
Phosphorylation by a Viral Kinase

11. What are the four conditions in Which Omeprazole - Lansoprazole is used?
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Increases coumadin metabolism
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

12. What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
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.
Choline acetyltransferase
-100% oxygen - hyperbaric
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

13. Ethacrynic Acid - clinical use?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Methicillin - Nafcillin - and Dicloxacillin
Diuresis in pateints with sulfa allergy
post MI and digitalis induced arrhythmias

14. What is the MOA for the Azoles?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Peptic ulcer disease.
Premature infants - because they lack UDP- glucuronyl transferase
Inhibit Ergosterol synthesis

15. Which RT inhibitor causes Megaloblastic Anemia?
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
AZT
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.

16. How do the Protease Inhibitors work?
Inhibt Assembly of new virus by Blocking Protease Enzyme
Potent immunosuppressive used in organ transplant recipients.
- Lithium
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

17. In What population does Gray Baby Syndrome occur? Why?
Delirium - Tremor - Nephrotoxicity
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Premature infants - because they lack UDP- glucuronyl transferase
Quinolones

18. Adverse effects of Losartan?
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.
Cardiac glycoside (inotropic agent).
- aminoglycosides - loop diuretics - cisplatin
fetal renal toxicity - hyperkalemia

19. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Antileukotriene; blocks leukotriene receptors.
Mebendazole/Thiabendazole - Pyrantel Pamoate
hypertension - CHF - diabetic renal disease

20. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
- Glucagon
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension

21. Ca2+ channel blockers - site of action?
Chronic (weeks or months)
Cell membrane Ca2+ channels of cardiac sarcomere
Beta -2 agonist.
Dopamine; causes its release from intact nerve terminals

22. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Protease Inhibitors and Reverse Transcriptase Inhibitors
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Pretreat with antihistamines and a slow infusion rate
blocks SR Ca2+ channels

23. How is Amantadine used clinically?

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24. What is the clinical use for Clomiphene?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Cilastatin
Treatment of infertility.
- Glucocorticoid withdrawal

25. What are four advantages of newer low - molecular - weight heparins (Enoxaparin)?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
Cilastatin
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

26. For Warfarin What is the Duration of action
Chronic (weeks or months)
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
- Niacin - Ca++ channel blockers - adenosine - vancomycin

27. What enzyme is responsible for the degredation of Ach
Acetylcholine esterase
Oral treatment of superficial infections
It must be Phosphorylated by Viral Thymidine Kinase
No - it inhibits the release of Nor Epi

28. List the mechanism - clinical use - & toxicity of Paclitaxel.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
- Bleomycin - amiodarone - busulfan
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Oral treatment of superficial infections

29. What are the clinical uses for 1st Generation Cephalosporins?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Blocks Norepi - but not Dopamine
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.
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)

30. What are common toxic side effects of Sulfonamides? (5)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Pseudomonas species and Gram - rods
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Beta adrenergic receptors and Ca2+ channels (stimulatory)

31. List the mechanism - clinical use - & toxicity of Etoposide.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Flecainide - Encainide - Propafenone
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Bleeding.

32. What is the formula for Volume of distribution (Vd)
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Due to the presence of a bulkier R group
- Tamoxifen
Vd= (Amt. of drug in body/ Plasma drug conc.)

33. Mnemonic for Foscarnet?
CMV - esp in Immunocompromised patients
- Tetracycline - amiodarone - sulfonamides
Onchocerciasis ('river blindness'-- rIVER- mectin)
Foscarnet = pyroFosphate analog

34. What cholinomimetics might your pt be taking for his glaucoma
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Carbachol - pilocarpine - physostigmine - echothiophate
Penicillin - V
Quinidine - Amiodarone - Procainamide - Disopyramide

35. Furosemide - clinical use?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Peptic ulcer disease.
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Megaloblastic anemia - Leukopenia - Granulocytopenia

36. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
GI disturbances.
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

37. What is the MOA for Rifampin?
- Steroids - Tamoxifen
Inhibits Viral DNA polymerase
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
Inhibits DNA dependent RNA polymerase

38. Specifically - How does Foscarnet inhibit viral DNA pol?
Binds to the Pyrophosphate Binding Site of the enzyme
loop diuretics - thiazides
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

39. Why is there a drop in systolic - mean - and diastolic bp with infusion of isoproterenol?
Indirect agonist - uptake inhibitor
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.

40. What is Nifurtimox administered for?

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41. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
Same as penicillin. Act as narrow spectrum antibiotics
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Acute (hours)
fetal renal toxicity - hyperkalemia

42. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
For serious - Gram + multidrug - resistant organisms
Heparin catalyzes the activation of antithrombin III.
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.)

43. Do Tetracyclines penetrate the CNS?
Only in limited amounts
G6PD deficient individuals
- Hydralazine - Procainamide - INH - phenytoin
Amphetamine and Ephedrine

44. Antiarrhythmic class II- mechanism?
Inhibits DNA dependent RNA polymerase
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Useful in muscle paralysis during surgery or mechanical ventilation.
Acts as a wide spectrum carbapenem

45. Steady state concentration is reached in __ number of half - lifes
Benzathine penicillin G
Cephalosporins
propanolol - esmolol - metoprolol - atenolol - timolol
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

46. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
- Ethosuxamide - sulfonamides - lamotrigine
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Sildenafil fills the penis
PT

47. Acetazolamide causes?

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48. Name four Antiarrhythmic drugs in class IA.
Megaloblastic anemia - Leukopenia - Granulocytopenia
Quinidine - Amiodarone - Procainamide - Disopyramide
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

49. What are toxic side effects for Metronidazole?
Gram + cocci - Gram - rods - and Anerobes
Disulfiram - like reaction with EtOH - Headache
Antifungal.
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

50. Resistance mechanisms for Vancomycin
Beta - lactamase cleavage of Beta - lactam ring
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
fetal renal toxicity - hyperkalemia
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

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USMLE Step 1 Pharmacology

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