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

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2. Explain differences between full and partial agonists(2).
- Act on same receptor - Full has greater efficacy
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Antibiotic - protein synthesis inhibitor.

3. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Abortifacient.
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

4. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
for RSV
- Formaldehyde & formic acid - severe acidosis & retinal damage
-100% oxygen - hyperbaric
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

5. What microorganisms is Aztreonam not effective against?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
- Ethanol - dialysis - & fomepizole
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Gram + and Anerobes

6. Which drug(s) cause this reaction: Tubulointerstitial Nephritis (5)?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
anuria - CHF

7. What is the mechanism of action of Clomiphene?
Dopamine
Chronic gout.
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.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

8. Decrease Digoxin dose in renal failure?
Pyridoxine (B6) administration
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
YES
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

9. Antimicrobial prophylaxis for Gonorrhea
- Corticosteroids - heparin
- Phenytoin
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Ceftriaxone

10. How is Chloramphenical used clinically?
Premature infants - because they lack UDP- glucuronyl transferase
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

11. What are the clinical uses for Ticlopidine - Clopidogrel?
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Beta1 more than B2
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

12. Resistance mechanisms for Chloramphenicol
Modification via Acetylation
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
CMV Retinitis in IC pts When Ganciclovir fails
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

13. Antiarrhythmic class IB- toxicity?
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Butyrophenone (neuroleptic).
local anesthetic. CNS stimulation or depression. CV depression.
- B51Naloxone / naltrexone (Narcan)

14. What is the mechanism of Azathioprine?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

15. What is the category of drug names ending in - ipramine (e.g. Imipramine)
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Tricyclic antidepressant.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Cilastatin

16. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
VACUUM your Bed Room'
Indomethacin is used to close a patent ductus arteriosus.

17. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
NO
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Cardiac glycoside (inotropic agent).
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)

18. Which drug(s) cause this reaction: Torsade de pointes (2)?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Amphetamine and Ephedrine
Na/K ATPase
Ganciclovir is more toxic to host enzymes

19. What is the category of drug names ending in - azepam (e.g. Diazepam)
Benzodiazepine.
TMP- SMZ (DOC) - aerosolized pentamidine
Onchocerciasis ('river blindness'-- rIVER- mectin)
Nifedipine - Verapamil - Diltiazem

20. What is the mechanism of Leuprolide?
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
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Chronic Hepatitis A and B - Kaposi's Sarcoma

21. Which drug(s) cause this reaction: P450 induction(6)?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
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)
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
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.

22. What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
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
Large anionic polymer - acidic
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Delirium - Tremor - Nephrotoxicity

23. How is Griseofulvin used clinically?
Protease inhibitor.
Oral treatment of superficial infections
Acetylcholinesterase; ACh is broken down into choline and acetate.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

24. What is the chemical name for Ganciclovir?
1. Renal damage 2. Aplastic anemia 3. GI distress
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Intrathecally
DHPG (dihydroxy-2- propoxymethyl guanine)

25. What antimuscarinic agent is used in asthma and COPD?
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Ipratropium
Binds to the Pyrophosphate Binding Site of the enzyme

26. Why is pyridostigmine effective in the treatment of myasthenia gravis?
Due to the presence of a bulkier R group
- Vitamin K & fresh frozen plasma
Mebendazole/Thiabendazole - Pyrantel Pamoate
As an anticholinesterase it increases endogenous ACh and thus increases strength.

27. What is the mechanism of action of Misoprostol?
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
1. Pioglitazone 2. Rosiglitazone.
CMV Retinitis in IC pts When Ganciclovir fails
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

28. Antiarrhythmic class IV- clinical use?
Ganciclovir is more toxic to host enzymes
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
prevention of nodal arrhythmias (SVT)

29. How is Trimethoprim used clinically?
TMP- SMZ
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Used in combination therapy with SMZ to sequentially block folate synthesis
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)

30. Which H2 Blocker has the most toxic effects and What are they?
torsade de pointes
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
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.
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

31. What is the MOA for the Tetracyclines?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
TMP- SMZ (DOC) - aerosolized pentamidine
Chronic gout.

32. Antimicrobial prophylaxis for a history of recurrent UTIs
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
TMP- SMZ
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

33. Digoxin v. Digitoxin: protein binding?
bradycardia - AV block - CHF
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
- polymyxins
Digitoxin 70% Digoxin 20-40%

34. Name two classes of drugs for HIV therapy
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
proximal convoluted tubule
Protease Inhibitors and Reverse Transcriptase Inhibitors
Captopril - Enalapril - Lisinopril

35. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Rifampin (DOC) - minocycline
distal convoluted tubule (early)

36. Name the common Fluoroquinolones (6)
Beta1 more than B2
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Binds ergosterol - Disrupts fungal membranes
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

37. For Heparin What is the Route of administration
Paranteral (IV - SC)
Enterobacter
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Acute (hours)

38. What parasitic condition is treated with Ivermectin?

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39. List the specific antidote for this toxin: Iron
post MI and digitalis induced arrhythmias
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
- Deferoxamine
effective in torsade de pointes and digoxin toxicity

40. What reversal agent could a Anes give to reverse the effects of Atropine
- Formaldehyde & formic acid - severe acidosis & retinal damage
Bethanechol - Neostigmine - physostigmine
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Local anesthetic.

41. Acetazolamide causes?

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42. Which drug(s) cause this reaction: G6PD hemolysis(8)?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Nitrates
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

43. What is the memory key for Metronidazole's clinical uses?
GI discomfort
Topical and Oral - for Oral Candidiasis (Thrush)
GET on the Metro
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

44. Antiarrhythmic class II- toxicity?
- Methotrexate - 5 FU - 6 mercaptopurine
Does not cross
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

45. Mannitol - site of action?
atropine - homatropine - tropicamide
Teratogenic - Carcinogenic - Confusion - Headaches
proximal convoluted tubule - thin descending limb - and collecting duct
Antifungal.

46. What is the clinical use of Mifepristone (RU486)?
Abortifacient.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Tendonitis and Tendon rupture
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

47. Mannitol - clinical use?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Impairs the synthesis of vitamin K- dependent clotting factors

48. How is Ribavirin used clinically?
for RSV
TCA
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

49. The MOA for Chloramphenicol is?
Inhibition of 50S peptidyl transferase - Bacteriostatic
RESPIre
Beta1 more than B2
penicillinase resistant

50. MOA: Block protein synthesis at 50s subunit
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

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USMLE Step 1 Pharmacology

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