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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. MOA: Disrupt fungal cell membranes
Gram + cocci - Gram - rods - and Anerobes
Amphotericin B - Nystatin - Fluconazole/azoles
- Vinca alkaloids(inhibit MT) - Paclitaxel
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)

2. Name the common Nucleoside Reverse Transcriptase Inhibitors
- Clindamycin
Inhibit viral DNA polymerase
Anaerobes
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

3. What is the clinical use for Clomiphene?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Aminoglycosides
Treatment of infertility.

4. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
CMV Retinitis in IC pts When Ganciclovir fails
Those patients who are taking nitrates.

5. What anticholinesterase crosses the blood - brain - barrier?
cortical collecting tubule
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.
physostigmine
Acetylcholine esterase

6. Antiarrhythmic class IB- effects?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Malaria (P. falciparum)
BM suppression (neutropenia - anemia) - Peripheral neuropathy
The PT.

7. List the specific antidote for this toxin: Warfarin
Delirium - Tremor - Nephrotoxicity
H2 antagonist
- Vitamin K & fresh frozen plasma
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

8. What is the mechanism of Leuprolide?
Penicillin - V
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
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Used in combination therapy with SMZ to sequentially block folate synthesis

9. Which drug(s) cause this reaction: Agranulocytosis (3)?
- Corticosteroids - heparin
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
- Cloazapine - carbamazapine - colchicine - PTU

10. What is the category of drug names ending in - caine (e.g. Lidocaine)
Local anesthetic.
- Oxalic acid - Acidosis & nephrotoxicity
GI upset - Superinfections - Skin rashes - Headache - Dizziness
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

11. Which receptors does phenylephrine act upon?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Onchocerciasis ('river blindness'-- rIVER- mectin)
VACUUM your Bed Room'
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion

12. Acetazolamide causes?

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13. Procainamide - toxicity?
Disulfiram - like reaction with EtOH - Headache
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
reversible SLE- like syndrome
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

14. What are are the Sulfonylureas (general description) and What is their use?
Pseudomonas species and Gram - rods
- Chloramphenicol
- Chlorpromazine - thioridazine - haloperidol
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

15. List the specific antidote for this toxin: Carbon monoxide
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Beta1 more than B2
-100% oxygen - hyperbaric

16. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Useful in muscle paralysis during surgery or mechanical ventilation.
Same as penicillin. Extended spectrum antibiotics
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- Isoniazid

17. Antiarrhythmic class II- effects?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Glucagon
AZT - to reduce risk of Fetal Transmission
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

18. What is the memory key for Isoniazid (INH) toxicity?
INH: Injures Neurons and Hepatocytes
Norepinephrine
Nevirapine - Delavirdine
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

19. What cholinomimetics might your pt be taking for his glaucoma
bradycardia - AV block - CHF
Carbachol - pilocarpine - physostigmine - echothiophate
Alpha -1 antagonist
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

20. ACE inhibitors - clinical use?
Doxycycline - because it is fecally eliminated
The only local anesthetic with vasoconstrictive properties.
pulmonary edema - dehydration
hypertension - CHF - diabetic renal disease

21. How does Ganciclovir's toxicity relate to that of Acyclovir?
Ganciclovir is more toxic to host enzymes
Decreased uptake or Increased transport out of cell
Inhibit viral DNA polymerase
- polymyxins

22. What can result due to antacid overuse?
Doxycycline - because it is fecally eliminated
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

23. Can Warfarin be used during pregnancy?
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.
No - warfarin - unlike heparin - can cross the placenta.
Carbenicillin - Piperacillin - and Ticarcillin
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

24. Name some common Tetracyclines (4)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Hydralazine and Minoxidil
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

25. MOA: Block DNA topoisomerases
Beta - lactamase cleavage of Beta - lactam ring
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Quinolones

26. Antiarrhythmic class IC- toxicity?
Premature infants - because they lack UDP- glucuronyl transferase
proarrhythmic
Suramin
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

27. Adverse effects of ganglionic blockers?
Inhibits DNA dependent RNA polymerase
new arrhythmias - hypotension
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

28. Foscarnet does not require activation by a...
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.
Inhibit Ergosterol synthesis
Chronic (weeks or months)
viral kinase

29. ___________ are Teratogenic
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Oral treatment of superficial infections
Aminoglycosides

30. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
propanolol - esmolol - metoprolol - atenolol - timolol
Ibuprofen - Naproxen - and Indomethacin
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

31. Resistance mechanisms for Sulfonamides
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Beta antagonist.

32. Adverse effects of Losartan?
fetal renal toxicity - hyperkalemia
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

33. What is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
torsade de pointes
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

34. What drug is given for Pneumocystis carinii prophylaxis?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
DOC in diagnosing and abolishing AV nodal arrhythmias
Pentamidine
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

35. K+ sparing diuretics - toxicity?
Interferes with microtubule function - disrupts mitosis - inhibits growth
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
- Tetracycline

36. Antiarrhythmic class IC- effects?
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
- Hydralazine - Procainamide - INH - phenytoin
AZT - to reduce risk of Fetal Transmission
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.

37. A common side effects of Interferon (INF) treatment is?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
IV vitamin K and fresh frozen plasma
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Neutropenia

38. Which drug increases Sys BP w/o affecting Pulse Pressure
Epinephrine
Yes - it does not cross the placenta.
Chronic Hepatitis A and B - Kaposi's Sarcoma
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

39. Are penicillinase resistant
It must be Phosphorylated by Viral Thymidine Kinase
Methicillin - Nafcillin - and Dicloxacillin
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

40. Which diuretics decrease urine Ca2+?
Because they require some residual islet function.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
thiazides - amiloride
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

41. What is the mechanism of action of Mifepristone (RU486)?
Competitive inibitor of progestins at progesterone receptors.
Pregnant women - Children; because animal studies show Damage to Cartilage
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.

42. List the mechanism - clinical use - & toxicity of 6 MP.
The PT.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Lipoxygenase
Staphlococcus aureus

43. Furosemide - toxicity? (OH DANG)
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Tetracycline - Doxycycline - Demeclocycline - Minocycline

44. Name two LPL stimulators.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Gemfibrozil - Clofibrate
Verapamil - Diltiazem - Bepridil

45. What are the clinical uses for Ticlopidine - Clopidogrel?
Gemfibrozil - Clofibrate
Primaquine
Doxycycline - because it is fecally eliminated
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

46. What are four clinical activities of Aspirin?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Succinylcholine
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

47. Adverse effects of Clonidine?
- Quinidine - quinine
dry mouth - sedation - severe rebound hypertension
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.
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

48. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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49. Which drug(s) cause this reaction: Gingival hyperplasia?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Praziquantel
1. Pioglitazone 2. Rosiglitazone.
- Phenytoin

50. Hydralazine - toxicity?
Neomycin
compensatory tachycardia - fluid retention - lupus - like syndrome
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Succinylcholine