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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 of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
- Nitrate - hydroxocobalamin thiosulfate
- Glucagon
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
edrophonium (extremely short acting anticholinesterase)

2. Ibutilide - toxicity?
torsade de pointes
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Pseudomembranous colitis (C. difficile) - fever - diarrhea

3. Dobutamine used for the tx of shock acts on Which receptors
Gram + cocci - Gram - rods - and Anerobes
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Beta1 more than B2
Inhibit Ergosterol synthesis

4. MOA: Bactericidal antibiotics
Useful in muscle paralysis during surgery or mechanical ventilation.
Used in combination therapy with SMZ to sequentially block folate synthesis
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

5. What is Clindamycin used for clinically?
Quinidine - Amiodarone - Procainamide - Disopyramide
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Hypersensitivity reactions
Forms toxic metabolites in the bacterial cell - Bactericidal

6. What is a sign of toxicity with the use of thrombolytics?
- NaHCO3
Bleeding.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
- Disulfram & also sulfonylureas - metronidazole

7. What conditions are treated with Metronidazole?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
for RSV
Acetylcholine esterase
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

8. Which drug(s) cause this reaction: Adrenocortical Insufficiency
cholestyramine - colestipol
- NaHCO3
- Glucocorticoid withdrawal
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

9. Why is reserpine effective in treating HTN?
Antileukotriene; blocks leukotriene receptors.
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Na/K ATPase
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

10. Name the Protease Inhibitors (4)
- aminoglycosides - loop diuretics - cisplatin
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Rifampin
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

11. A 57 yo heart failure pt develops cardiac decompensation - What drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
Dopamine
Non - Nucleosides
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

12. Spironolactone - mechanism?
competitive inhibirot of aldosterone in the cortical collecting tubule
Foscarnet = pyroFosphate analog
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Lipoxygenase

13. What are four clinical activities of Aspirin?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Give an antichloinesterase - neostigmine - edrophonium - etc
- Physostigmine salicylate
amphetamine and ephedrine

14. List the mechanism - clinical use - & toxicity of Nitrosureas.
No - warfarin - unlike heparin - can cross the placenta.
- Nitrate - hydroxocobalamin thiosulfate
Hypersensitivity reactions
- Alkalate DNA - Brain tumors - CNS toxicity

15. Quinidine - toxicity?
Inhibits Viral DNA polymerase
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
These B-2 agonists cause respiratory smooth muscle to relax.

16. How do you treat coma in the ER (4)?
Methicillin - Nafcillin - and Dicloxacillin
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
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.
1. Pioglitazone 2. Rosiglitazone.

17. Digoxin v. Digitoxin: half life?
Digitoxin 168hrs Digoxin 40 hrs
Anaerobes
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure

18. What are Aminoglycosides used for clinically?
TMP- SMZ
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Severe Gram - rod infections.

19. Name some common Tetracyclines (4)
Nephrotoxicity
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

20. List the specific antidote for this toxin: Salicylates
- Alkalinize urine & dialysis
Acetylcholinesterase; ACh is broken down into choline and acetate.
TMP- SMZ
Erectile dysfunction.

21. What are four clinical uses of glucocorticoids?

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22. List the specific antidote for this toxin: Digitalis
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Antileukotriene; blocks leukotriene receptors.
- Normalize K+ - Lidocaine - & Anti - dig Mab
- Flumazenil

23. For Heparin What is the Mechanism of action
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Activates antithrombin III

24. What is a mnemonic to remember Amantadine's function?
Blocks Influenza A and RubellA; causes problems with the cerebellA
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

25. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Those patients who are taking nitrates.
Pyridoxine (B6) administration
It acts presynaptically to increase NE release.
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

26. What is the mechanism of action of Cyclosporine?
Antileukotriene; blocks synthesis by lipoxygenase.
Intrathecally
1. Weight gain 2. Hepatotoxicity (troglitazone)
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.

27. What are two toxicities of the Glitazones?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
1. Weight gain 2. Hepatotoxicity (troglitazone)
atropine - homatropine - tropicamide

28. What are Polymyxins used for?
Penicillin - V
Liver
Edrophonium
Resistant Gram - infections

29. How are the HIV drugs used clinically?

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30. List the specific antidote for this toxin: TPA & Streptokinase
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
- Tricyclic antidepressants
- Aminocaproic acid
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'

31. Name some common Sulfonamides (4)
Inhibits cell wall mucopeptide formation - Bactericidal
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

32. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Rare.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

33. Why are the Sulfonylureas inactive in IDDM (type -1)?
Rheumatoid and osteoarthritis.
Blood
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Because they require some residual islet function.

34. Name four HMG- CoA reductase inhibitors.
- Tetracycline - amiodarone - sulfonamides
It acts presynaptically to increase NE release.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

35. Describe Phase II metabolism in liver(3)?
Primaquine
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Gram + cocci - Gram - rods - and Anerobes

36. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
Ipratropium
Staphlococcus aureus
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Interstitial nephritis

37. What are the indications for using amphetamine?

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38. Which RT inhibitors cause Lactic Acidosis?
TMP- SMZ (DOC) - aerosolized pentamidine
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
PT
Nucleosides

39. What is the clinical use for Penicillin?
- Glucagon
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Indomethacin is used to close a patent ductus arteriosus.

40. Name several common Macrolides (3)
Flecainide - Encainide - Propafenone
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Erythromycin - Azithromycin - Clarithromycin
K+ wasting - metabolic alkalosis - hypotension - ototoxicity

41. What is the clinical use for Clomiphene?
reversible SLE- like syndrome
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Chronic (weeks or months)
Treatment of infertility.

42. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Buy AT 30 - CELL at 50'
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Antifungal.

43. How is Chloramphenical used clinically?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Succinylcholine
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

44. What are four conditions in Which H2 Blockers are used clinically?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Impairs the synthesis of vitamin K- dependent clotting factors
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
amphetamine and ephedrine

45. What is a common side effect of Colchicine used to treat acute gout - especially When given orally?
- N- acetylcystine
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
GI side effects. (Indomethacin is less toxic - more commonly used.)

46. List the mechanism - clinical use - & toxicity of Cisplatin.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

47. What side effect of using atropine to induce pupillary dilation would you expect?
physostigmine
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
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

48. Name three K+ sparing diuretics?
Rheumatoid and osteoarthritis.
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

49. What are the clinical indications for bethanechol?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Hemolytic anemia
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)

50. Beta Blockers - BP?
Malaria (P. falciparum)
decrease
Does not cross
Ceftriaxone

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USMLE Step 1 Pharmacology

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