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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

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1. What drug is used during the pregnancy of an HIV+ mother? - Why?
- B51Naloxone / naltrexone (Narcan)
AZT
Imipenem
AZT - to reduce risk of Fetal Transmission

2. Reserpine will block the syntheis of this drug and but not its precursor.
Forms toxic metabolites in the bacterial cell - Bactericidal
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Blocks Norepi - but not Dopamine
Dopamine

3. Antimicrobial prophylaxis for PCP
TMP- SMZ (DOC) - aerosolized pentamidine
hypertension - CHF - diabetic renal disease
Dopamine; causes its release from intact nerve terminals
very short acting

4. What is a common side effect of Misoprostol?
first dose orthostatic hypotension - dizziness - headache
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Diarrhea
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol

5. Mannitol - site of action?
Small lipid - soluble molecule
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
proximal convoluted tubule - thin descending limb - and collecting duct
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

6. What cholinomimetics might your pt be taking for his glaucoma
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Carbachol - pilocarpine - physostigmine - echothiophate
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

7. What side effect of using atropine to induce pupillary dilation would you expect?
Nevirapine - Delavirdine
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.

8. How would you treat African Trypanosomiasis (sleeping sickness)?
dry mouth - sedation - severe rebound hypertension
H2 antagonist
Suramin
Interferes with microtubule function - disrupts mitosis - inhibits growth

9. Adenosine - clinical use?
DOC in diagnosing and abolishing AV nodal arrhythmias
Prevents the release of ACh - Which results in muscle paralysis.
for RSV
Antileukotriene; blocks leukotriene receptors.

10. What are five toxicities associated with Tacrolimus (FK506)?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Sotalol - Ibutilide - Bretylium - Amiodarone
Heparin catalyzes the activation of antithrombin III.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

11. ACE inhibitors - clinical use?
Binds to the Pyrophosphate Binding Site of the enzyme
Penicillin - V
Nucleosides
hypertension - CHF - diabetic renal disease

12. What parasitic condition is treated with Ivermectin?

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13. Which drug(s) cause this reaction: Gray baby syndrome?
Protamine sulfate
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
- Chloramphenicol
Forms toxic metabolites in the bacterial cell - Bactericidal

14. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Antifungal.
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
cardiac depression - peripheral edema - flushing - dizziness - constipation
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

15. Which drug(s) cause this reaction: Hot flashes?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Beta antagonist.
- Shifts the curve to the right - increases Km
- Tamoxifen

16. Furosemide increases the excretion of What ion?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Ca2+ (Loops Lose calcium)
Rifampin (DOC) - minocycline
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

17. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
Babiturate.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
- Methylene blue
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

18. Acetazolamide - clinical uses?
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Acute (hours)
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Due to the presence of a bulkier R group

19. Adverse effects of Captopril?
Nephrotoxicity
Impairs the synthesis of vitamin K- dependent clotting factors
hyperaldosteronism - K+ depletion - CHF
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

20. List the specific antidote for this toxin: Benzodiazepines
- Flumazenil
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
G6PD deficient individuals

21. Name five Antiarrhythmic drugs in class II?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Amphotericin B - Nystatin - Fluconazole/azoles
Decreased uptake or Increased transport out of cell
propanolol - esmolol - metoprolol - atenolol - timolol

22. Ryanodine - site of action?
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
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.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
blocks SR Ca2+ channels

23. Name some common Tetracyclines (4)
- Methylene blue
Onchocerciasis ('river blindness'-- rIVER- mectin)
RESPIre
Tetracycline - Doxycycline - Demeclocycline - Minocycline

24. What are the clinical uses for 2nd Generation Cephalosporins?
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Inhibits Viral DNA polymerase
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
With an amino acid change of D- ala D- ala to D- ala D- lac

25. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
competitive inhibirot of aldosterone in the cortical collecting tubule
Pseudomonas species and Gram - rods
AmOxicillin has greater Oral bioavailability
Phenothiazine (neuroleptic - antiemetic).

26. List the mechanism - clinical use - & toxicity of Vincristine.

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27. Acetazolamide - mechanism?
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Mg = Must go to the bathroom.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

28. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Pseudomembranous colitis (C. difficile) - fever - diarrhea
scopolamine

29. Antiarrhythmic class IV- primary site of action?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
AV nodal cells
blocks SR Ca2+ channels

30. What is the memory key involving the '4 R's of Rifampin?'
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Modification via Acetylation - Adenylation - or Phosphorylation

31. For Heparin What is the Site of action
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Used in combination therapy with SMZ to sequentially block folate synthesis
Pseudomonas species and Gram - rods
Blood

32. Name several common Macrolides (3)
Sotalol - Ibutilide - Bretylium - Amiodarone
- Tetracycline - amiodarone - sulfonamides
- Shifts the curve down - reduces Vmax
Erythromycin - Azithromycin - Clarithromycin

33. Antiarrhythmic class IB- toxicity?
Tricyclic antidepressant.
local anesthetic. CNS stimulation or depression. CV depression.
Neomycin
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

34. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Nevirapine - Delavirdine
TMP- SMZ
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Ganciclovir is more toxic to host enzymes

35. ADH antagonists - site of action?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
collecting ducts
DHPG (dihydroxy-2- propoxymethyl guanine)
Disulfiram - like reaction with EtOH - Headache

36. Mannitol - mechanism?
Cephalosporins
distal convoluted tubule (early)
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Rifampin

37. How is Ganciclovir used clinically?
Delirium - Tremor - Nephrotoxicity
Edrophonium
CMV - esp in Immunocompromised patients
Anaerobes

38. Adverse effects of Methyldopa?

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39. What anticholinesterase crosses the blood - brain - barrier?
Amphotericin B - Nystatin - Fluconazole/azoles
Competitive inibitor of progestins at progesterone receptors.
physostigmine
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

40. What is the category of drug names ending in - cillin (e.g. Methicillin)
Scopolamine
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Penicillin.
all of them

41. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
Praziquantel
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Constant FRACTION eliminated per unit time.(exponential)

42. What is Metronidazole used for clinically?
G6PD deficient individuals
distal convoluted tubule (early)
- Normalize K+ - Lidocaine - & Anti - dig Mab
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

43. How can the toxic effects of TMP be ameliorated?
With supplemental Folic Acid
- Oral Contraceptives
Systemic mycoses
Inhibits reabsorption of uric acid.

44. What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
Long.
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.

45. What is the clincial use for Misoprostol?
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Dopamine
- NaHCO3
Penicillin - V

46. What is the effect of epinephrine infusion on bp and pulse pressure?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Acute gout.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
- Tetracycline

47. Resistance mechanisms for Sulfonamides
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
GI distress - Skin rash - and Seizures at high plasma levels
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
aPTT (intrinsic pathway)

48. What are common toxicities related to Vancomycin therapy?

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49. Describe first - order kinetics?
Beta adrenergic receptors and Ca2+ channels (stimulatory)
It must be Phosphorylated by Viral Thymidine Kinase
Constant FRACTION eliminated per unit time.(exponential)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

50. What are Fluoroquinolones indicated for? (3)
Prevents the release of ACh - Which results in muscle paralysis.
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

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USMLE Step 1 Pharmacology

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