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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. Which diuretics increase urine NaCl?
Malaria (P. falciparum)
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
all of them

2. Side effects of Isoniazid (INH)?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
collecting ducts
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

3. Resistance mechanisms for Macrolides

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4. What parasitic condition is treated with Ivermectin?

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5. What are common side effects of Amphotericin B?
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
- Act on same receptor - Full has greater efficacy
prevention of nodal arrhythmias (SVT)
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

6. What is the specific clinical use of Indomethacin in neonates?
Alpha -1 antagonist
Indomethacin is used to close a patent ductus arteriosus.
- Shifts the curve to the right - increases Km
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

7. What is the category of drug names ending in - ane (e.g. Halothane)
Inhalational general anesthetic.
Pentamidine
No
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

8. What is the category of drug names ending in - navir (e.g. Saquinavir)
Benzathine penicillin G
Protease inhibitor.
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

9. Why is reserpine effective in treating HTN?
Inhalational general anesthetic.
Hemolytic anemia
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)

10. What antimicrobial class is Aztreonam syngergestic with?
Aminoglycosides
Only in limited amounts
- Cloazapine - carbamazapine - colchicine - PTU
- Tricyclic antidepressants

11. How do spare receptors effect the Km?
- Normalize K+ - Lidocaine - & Anti - dig Mab
Aminoglycosides
- ED 50 is less than the Km (less than 50% of receptors)
torsade de pointes - excessive Beta block

12. K+ sparing diuretics - clinical use?
hyperaldosteronism - K+ depletion - CHF
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Atropine & pralidoxime

13. What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
Blood
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
very short acting
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

14. List the specific antidote for this toxin: Methanol & Ethylene glycol
Choline acetyltransferase
Inhibits cell wall mucopeptide formation - Bactericidal
Large anionic polymer - acidic
- Ethanol - dialysis - & fomepizole

15. Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
- Bleomycin - amiodarone - busulfan
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Binds to the Pyrophosphate Binding Site of the enzyme
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk

16. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Hypersensitivity reactions
Due to the presence of a bulkier R group
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

17. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
- Oxalic acid - Acidosis & nephrotoxicity
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

18. What is the MOA for Clindamycin?
Inhibits Viral DNA polymerase
Tricyclic antidepressant.
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Inhalational general anesthetic.

19. Antiarrhythmic class IA effects?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

20. What are the clinical indications for bethanechol?
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
For serious - Gram + multidrug - resistant organisms

21. For Heparin What is the Treatment for overdose
Protamine sulfate
Succinylcholine
Polymyxins
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased

22. How can the toxic effects of TMP be ameliorated?
- Steroids - Tamoxifen
Antileukotriene; blocks leukotriene receptors.
With supplemental Folic Acid
Yes

23. Toxic side effects of the Azoles?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Protamine sulfate
Albuterol - tertbutaline

24. Which drug(s) cause this reaction: P450 induction(6)?
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

25. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Liver

26. K+ sparing diuretics - toxicity?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Praziquantel
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

27. What is Nifurtimox administered for?

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28. Cocaine shares is mechanism of action with What antidepressant
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
TCA

29. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
INH: Injures Neurons and Hepatocytes
scopolamine
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB

30. In coma situations you rule out What (7)?

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31. What is are two clinical uses of Cyclosporine?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
GI side effects. (Indomethacin is less toxic - more commonly used.)
anuria - CHF
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

32. For Heparin What is the Duration of action
cardiac depression - peripheral edema - flushing - dizziness - constipation
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Inhibt Assembly of new virus by Blocking Protease Enzyme
Acute (hours)

33. What is the MOA for Nystatin?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Competitive inibitor of progestins at progesterone receptors.
Binds ergosterol - Disrupts fungal membranes
ACE inhibitor.

34. Decrease Digoxin dose in renal failure?
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
anticholinesterase glaucoma
- Phenytoin
YES

35. Which drug(s) cause this reaction: Pseudomembranous colitis?
decrease
With supplemental Folic Acid
Butyrophenone (neuroleptic).
- Clindamycin

36. List the specific antidote for this toxin: Copper
Competitive inibitor of progestins at progesterone receptors.
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
- Penicillamine
Digitoxin 168hrs Digoxin 40 hrs

37. Digoxin v. Digitoxin: half life?
Digitoxin 168hrs Digoxin 40 hrs
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Cell membrane Ca2+ channels of cardiac sarcomere
Oral

38. When is HIV therapy initiated?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
AmOxicillin has greater Oral bioavailability
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Acute (hours)

39. What is the MOA for Trimethoprim (TMP)?
Praziquantel
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Penicillin - V
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

40. What is the possible mechanism and effect of Metformin in treating diabetes?
Oral treatment of superficial infections
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
No - hemicholinum block the uptake of Choline and thus Ach synthesis
- Flumazenil

41. Amprotericin B ___________ the BBB
Does not cross
Buy AT 30 - CELL at 50'
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Systemic mycoses

42. What are two conditions in Which COX-2 inhibitors might be used?
Rheumatoid and osteoarthritis.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
- Ethosuxamide - sulfonamides - lamotrigine

43. Antiarrhythmic class IV- effects?
decrease conduction velocity - increase ERP - increase PR interval
Blocks Norepi - but not Dopamine
TMP- SMZ (DOC) - aerosolized pentamidine
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)

44. Adverse effects of Losartan?
edrophonium (extremely short acting anticholinesterase)
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
fetal renal toxicity - hyperkalemia
Lipoxygenase

45. What is the mechanism of action of Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
Beta Blockers
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

46. What is the mechanism of action of Sildenafil (Viagra)?
sedation - sleep alterations
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
- Disulfram & also sulfonylureas - metronidazole
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

47. What is the clinical use for Sucralfate?
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Peptic ulcer disease.
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

48. Which drug(s) cause this reaction: Cough?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- ACE inhibitors (Losartan>no cough)
Heparin catalyzes the activation of antithrombin III.

49. Which drug(s) cause this reaction: Hepatitis?
- Isoniazid
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.
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Pregnant women - Children; because animal studies show Damage to Cartilage

50. Which cancer drugs effect nuclear DNA (4)?
Anaerobes
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
H2 antagonist

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USMLE Step 1 Pharmacology

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