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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. For Heparin What is the Ability to inhibit coagulation in vitro
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
carbonic anhydrase inhibitors - K+ sparing diuretics
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Yes

2. What are the clinical indications for Azole therapy?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Spironolactone - Triamterene - Amiloride (the K+ STAys)
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Systemic mycoses

3. How does angiotensin II affect NE release?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
It acts presynaptically to increase NE release.
Captopril - Enalapril - Lisinopril

4. What is the MOA of Polymyxins?
Treatment of infertility.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

5. What are the major structural differences between Penicillin and Cephalosporin?
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)
Dopamine; causes its release from intact nerve terminals
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
proximal convoluted tubule - thin descending limb - and collecting duct

6. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

7. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
atropine - homatropine - tropicamide
Pyridoxine (B6) administration
- B51Naloxone / naltrexone (Narcan)
Cilastatin

8. What is the major side effect for Ampicillin and Amoxicillin?
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Hypersensitivity reactions

9. Ethacrynic Acid - mechanism?
Neutropenia
- Penicillamine
- ACE inhibitors (Losartan>no cough)
not a sulfonamide - but action is the same as furosemide

10. What are the clinical uses for Aztreonam?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Inhalational general anesthetic.
- Clindamycin
No - hemicholinum block the uptake of Choline and thus Ach synthesis

11. What are three possible complications of Heparin therapy?
- Bleomycin - amiodarone - busulfan
- Steroids - Tamoxifen
- Methotrexate - 5 FU - 6 mercaptopurine
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

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

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13. What effect would atropine have on a patient with peptic ulcer disease?
Phosphorylation by a Viral Kinase
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

14. What is a sign of toxicity with the use of thrombolytics?
DOC in diagnosing and abolishing AV nodal arrhythmias
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Bleeding.

15. Name common Polymyxins
Tendonitis and Tendon rupture
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Polymyxin B - Polymyxin E
Potent immunosuppressive used in organ transplant recipients.

16. For Warfarin What is the Structure
Small lipid - soluble molecule
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
collecting ducts
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

17. A common side effects of Interferon (INF) treatment is?
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Acetylcholinesterase; ACh is broken down into choline and acetate.
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Neutropenia

18. Toxicities associated with Acyclovir?
Pralidoxime regenerates active cholinesterase.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Delirium - Tremor - Nephrotoxicity
- Deferoxamine

19. Name two LPL stimulators.
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Gemfibrozil - Clofibrate
Beta -2 agonist.
Ipratropium

20. What are the nondepolarizing neuromuscular blocking drugs?
Activates antithrombin III
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Epinephrine
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

21. Antimicrobial prophylaxis for PCP
Protamine sulfate
Cilastatin
TMP- SMZ (DOC) - aerosolized pentamidine
- Ethanol - dialysis - & fomepizole

22. Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Constant FRACTION eliminated per unit time.(exponential)
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Ganciclovir is more toxic to host enzymes

23. Do Tetracyclines penetrate the CNS?
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Constant FRACTION eliminated per unit time.(exponential)
Only in limited amounts
- Isoniazid

24. Digitalis - site of action?
Na/K ATPase
Small lipid - soluble molecule
Enterobacter
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

25. How is Rifampin used clinically?
Alpha -1 antagonist
For serious - Gram + multidrug - resistant organisms
- Bleomycin - amiodarone - busulfan
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

26. List the mechanism - clinical use - & toxicity of Cisplatin.
Same as penicillin. Extended spectrum antibiotics
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

27. Which diuretics increase urine NaCl?
Foscarnet = pyroFosphate analog
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
all of them
effective in torsade de pointes and digoxin toxicity

28. What type of gout is treated with Allopurinol?
Systemic mycoses
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Chronic gout.
Ganciclovir is more toxic to host enzymes

29. Hydrochlorothiazide - mechanism?
- Ethosuxamide - sulfonamides - lamotrigine
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

30. What anticholinesterase crosses the blood - brain - barrier?
physostigmine
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

31. What conditions are treated with Metronidazole?
Buy AT 30 - CELL at 50'
post MI and digitalis induced arrhythmias
Give an antichloinesterase - neostigmine - edrophonium - etc
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

32. Spironolactone - mechanism?
competitive inhibirot of aldosterone in the cortical collecting tubule
- Nitrate - hydroxocobalamin thiosulfate
Bethanechol - Neostigmine - physostigmine
Inhibit Ergosterol synthesis

33. For Heparin What is the Duration of action
Acute (hours)
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Staphlococcus aureus
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

34. What physiological effects was the Anes using Atropine to tx
Decreases synthesis of Mycolic Acid
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Premature infants - because they lack UDP- glucuronyl transferase

35. List the specific antidote for this toxin: Iron
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
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.)
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
- Deferoxamine

36. For Heparin What is the Route of administration
Paranteral (IV - SC)
Hemolytic anemia
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
Minor hepatotoxicity - Drug interactions (activates P450)

37. What antimicrobial class is Aztreonam syngergestic with?
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Aminoglycosides
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Ganciclovir is more toxic to host enzymes

38. List the specific antidote for this toxin: Heparin
- Protamine
Same as penicillin. Extended spectrum antibiotics
Epinephirine(Alpha1 -2 and Beta 1 -2)
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia

39. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
fetal renal toxicity - hyperkalemia
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Norepinephrine (Alpha1 -2 and beta 1)
sedation - positive Coombs' test

40. Name two classes of drugs for HIV therapy
Protease Inhibitors and Reverse Transcriptase Inhibitors
ACIDazolamide' causes acidosis
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

41. What are common side effects of RT Inhibitors?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Severe Gram - rod infections.
Rash - Pseudomembranous colitis
Na/K ATPase

42. Common toxicities associated with Griseofulvin?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Inhibits DNA dependent RNA polymerase
Teratogenic - Carcinogenic - Confusion - Headaches

43. What is the major toxic side effect of Penicillin?
Hypersensitivity reactions
torsade de pointes
Binds ergosterol - Disrupts fungal membranes
Neurotoxicity - Acute renal tubular necrosis

44. Which diuretics increase urine K+?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
- Clindamycin
1. Antiandrogen 2. Nausea 3. Vomiting
NO

45. Ca2+ channel blockers - clinical use?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
hypertension - angina - arrhythmias
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

46. What do Aminoglycosides require for uptake?
GI upset
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Oxygen
Decreased uptake or Increased transport out of cell

47. What is the lab value used to monitor the effectiveness of Heparin therapy?
The PTT.
Pretreat with antihistamines and a slow infusion rate
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

48. List the specific antidote for this toxin: Carbon monoxide
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
-100% oxygen - hyperbaric
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

49. What would be the effect on blood pressure with infusion of the alpha -2 agonist clonidine?
not a sulfonamide - but action is the same as furosemide
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

50. What are the four conditions in Which Omeprazole - Lansoprazole is used?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes