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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. Mannitol - contraindications?
Pretreat with antihistamines and a slow infusion rate
distal convoluted tubule (early)
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
anuria - CHF

2. Furosemide increases the excretion of What ion?
GI disturbances.
Sulfonamides - Trimethoprim
- N- acetylcystine
Ca2+ (Loops Lose calcium)

3. Mg+- clinical use?
- Oral Contraceptives
thick ascending limb
effective in torsade de pointes and digoxin toxicity
- Ammonium Chloride

4. Name the steps in drug approval(4)?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

5. Which drug(s) cause this reaction: Gynecomastia (6)?
GI side effects. (Indomethacin is less toxic - more commonly used.)
anuria - CHF
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Norepinephrine

6. Acetazolamide - clinical uses?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
carbonic anhydrase inhibitors - K+ sparing diuretics
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

7. What is a mnemonic to remember Amantadine's function?
No
Gram + - Gram - - Norcardia - Chlamydia
Blocks Influenza A and RubellA; causes problems with the cerebellA
proximal convoluted tubule

8. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Nifedipine - Verapamil - Diltiazem
Tendonitis and Tendon rupture
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
GI distress - Skin rash - and Seizures at high plasma levels

9. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Oxygen
Pretreat with antihistamines and a slow infusion rate
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Resistant Gram - infections

10. Amprotericin B ___________ the BBB
- Formaldehyde & formic acid - severe acidosis & retinal damage
Does not cross
Pregnant women - Children; because animal studies show Damage to Cartilage
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

11. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
- EDTA - dimercaprol - succimer - & penicillamine
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil

12. Which drug(s) cause this reaction: P450 inhibition(6)?
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Ibuprofen - Naproxen - and Indomethacin
Primaquine
Protease inhibitor.

13. Adverse effects of Guanethidine?
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Inhibits reabsorption of uric acid.
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

14. What are two indirect acting adrenergic agonists?
decrease
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
amphetamine and ephedrine
Neurotoxicity - Acute renal tubular necrosis

15. Name two LPL stimulators.
- Chlorpromazine - thioridazine - haloperidol
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Gemfibrozil - Clofibrate

16. What drug is used to diagnose myasthenia gravis?
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses
proximal convoluted tubule - thin descending limb - and collecting duct
Aplastic anemia (dose independent) - Gray Baby Syndrome
edrophonium (extremely short acting anticholinesterase)

17. What are three possible complications of Heparin therapy?
sedation - positive Coombs' test
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
It must be Phosphorylated by Viral Thymidine Kinase
sedation - depression - nasal stuffiness - diarrhea

18. What parasitic condition is treated with Ivermectin?

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19. What microorganisms is Aztreonam not effective against?
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Gram + and Anerobes
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

20. List the specific antidote for this toxin: Iron
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
ACIDazolamide' causes acidosis
Epinephrine
- Deferoxamine

21. A common side effects of Interferon (INF) treatment is?
Hemolytic anemia
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.
cortical collecting tubule
Neutropenia

22. What drug is given for Pneumocystis carinii prophylaxis?
- Deferoxamine
Tricyclic antidepressant.
distal convoluted tubule (early)
Pentamidine

23. The MOA for Chloramphenicol is?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Beta -2 agonist.
Amphetamine and Ephedrine
Inhibition of 50S peptidyl transferase - Bacteriostatic

24. What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Treatment of infertility.
sedation - depression - nasal stuffiness - diarrhea

25. What is the clinical use for Nystatin?
post MI and digitalis induced arrhythmias
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Topical and Oral - for Oral Candidiasis (Thrush)
Local anesthetic.

26. What is the category and mechanism of action of Zileuton in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Polymyxins
TCA

27. What is the memory key for the effect of aluminum hydroxide overuse?
AluMINIMUM amount of feces.
Clavulanic acid
Choline acetyltransferase
Blood

28. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
The only local anesthetic with vasoconstrictive properties.
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Clavulanic acid
Resistant Gram - infections

29. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

30. What is the formula for Volume of distribution (Vd)
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
Vd= (Amt. of drug in body/ Plasma drug conc.)
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
- EDTA - dimercaprol - succimer - & penicillamine

31. List the specific antidote for this toxin: Digitalis
is resistant
hypertension - CHF - diabetic renal disease
- Normalize K+ - Lidocaine - & Anti - dig Mab
Methylation of rRNA near Erythromycin's ribosome binding site

32. What are Polymyxins used for?
competitive inhibirot of aldosterone in the cortical collecting tubule
Resistant Gram - infections
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
propanolol - esmolol - metoprolol - atenolol - timolol

33. What are are the Sulfonylureas (general description) and What is their use?
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
- Act on same receptor - Full has greater efficacy
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

34. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
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.)
- Hydralazine - Procainamide - INH - phenytoin
Aminoglycosides
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

35. Mannitol - clinical use?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Norepinephrine
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure

36. Name the common Azoles
AluMINIMUM amount of feces.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Methylxanthine.

37. What are toxicities associated with Chloramphenicol?
Penicillin.
Aplastic anemia (dose independent) - Gray Baby Syndrome
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Beta antagonist.

38. Which drug(s) cause this reaction: G6PD hemolysis(8)?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride

39. Which diuretics decrease urine Ca2+?
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Beta antagonist.
Norepinephrine (Alpha1 -2 and beta 1)
thiazides - amiloride

40. What are Fluoroquinolones indicated for? (3)
decrease conduction velocity - increase ERP - increase PR interval
- EDTA - dimercaprol - succimer - & penicillamine
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

41. Adverse effects of Minoxidil?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Buy AT 30 - CELL at 50'
Vd= (Amt. of drug in body/ Plasma drug conc.)
GI distress - Skin rash - and Seizures at high plasma levels

42. Adverse effects of Hydralazine?
Prevents the release of Ca from SR of skeletal muscle
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Ganciclovir is more toxic to host enzymes

43. Cocaine casues vasoconstriction and local anesthesia by What mechanism
dry mouth - sedation - severe rebound hypertension
Indirect agonist - uptake inhibitor
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
proximal convoluted tubule - thin descending limb - and collecting duct

44. MOA: Block protein synthesis at 30s subunit
Flecainide - Encainide - Propafenone
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Aminoglycosides - Tetracyclines

45. List the specific antidote for this toxin: Warfarin
Because they require some residual islet function.
- Vitamin K & fresh frozen plasma
Blood
- Oxalic acid - Acidosis & nephrotoxicity

46. List the specific antidote for this toxin: Arsenic (all heavy metals)
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Dimercaprol - succimer
Carbenicillin - Piperacillin - and Ticarcillin
bradycardia - AV block - CHF

47. What is the only depolarizing neuromuscular blocking agent?
Liver
Decreased uptake or Increased transport out of cell
Antibiotic - protein synthesis inhibitor.
Succinylcholine

48. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
not a sulfonamide - but action is the same as furosemide
Blocks Norepi - but not Dopamine
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
reversible SLE- like syndrome

49. MOA: Block nucleotide synthesis
Sulfonamides - Trimethoprim
propanolol - esmolol - metoprolol - atenolol - timolol
Same as penicillin. Extended spectrum antibiotics
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

50. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
The PTT.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Neomycin

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USMLE Step 1 Pharmacology

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