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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. Antiarrhythmic class IC- effects?
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

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

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3. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Pralidoxime regenerates active cholinesterase.

4. Decrease Digitoxin dose in renal failure?
NO
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
- Oral Contraceptives

5. MOA for Penicillin (3 answers)?
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
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.
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

6. Why does NE result in bradycardia?
It acts presynaptically to increase NE release.
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

7. What is the MOA for the Tetracyclines?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
compensatory tachycardia - fluid retention - lupus - like syndrome

8. What microorganisms is Aztreonam not effective against?
Doxycycline - because it is fecally eliminated
Gram + and Anerobes
Rheumatoid and osteoarthritis.
1. Antiandrogen 2. Nausea 3. Vomiting

9. What is the mechanism of action of Omeprazole - Lansoprazole?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
It affects beta receptors equally and is used in AV heart block (rare).
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA

10. What are two conditions in Which COX-2 inhibitors might be used?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Polymyxins
Rheumatoid and osteoarthritis.
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

11. What are Aminoglycosides used for clinically?
decrease
Severe Gram - rod infections.
With supplemental Folic Acid
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

12. Name the steps in drug approval(4)?
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
IV vitamin K and fresh frozen plasma
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Decreases synthesis of Mycolic Acid

13. What is the only depolarizing neuromuscular blocking agent?
Succinylcholine
proximal convoluted tubule
Pentamidine
- Quinidine - quinine

14. Which cancer drugs inhibit nucleotide synthesis(3)?
Inhibits DNA dependent RNA polymerase
torsade de pointes
Acetylcholinesterase; ACh is broken down into choline and acetate.
- Methotrexate - 5 FU - 6 mercaptopurine

15. Which drug(s) cause this reaction: Hepatitis?
Alpha -1 antagonist
- Isoniazid
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
thick ascending limb

16. Which drug(s) cause this reaction: Photosensitivity(3)?
all of them
- Isoniazid
Lipoxygenase
- Tetracycline - amiodarone - sulfonamides

17. What is the memory key for organisms treated with Tetracyclines?

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18. The MOA for Chloramphenicol is?
Inhibition of 50S peptidyl transferase - Bacteriostatic
- EDTA - dimercaprol - succimer - & penicillamine
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
check PFTs - LFTs - and TFTs

19. What are three clinical uses of the Leuprolide?
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
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
Buy AT 30 - CELL at 50'
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

20. Which diuretics cause alkalosis?
- N- acetylcystine
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
loop diuretics - thiazides
Spironolactone - Triamterene - Amiloride (the K+ STAys)

21. What are two mechanisms of action of Propythiouracil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Polymyxin B - Polymyxin E
cyanide toxicity (releases CN)
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 four clinical uses of glucocorticoids?

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23. Adverse effects of Methyldopa?

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24. For Warfarin What is the Treatment for overdose
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
IV vitamin K and fresh frozen plasma
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

25. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
H2 antagonist
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
1. Pioglitazone 2. Rosiglitazone.
Hydralazine and Minoxidil

26. How would you treat African Trypanosomiasis (sleeping sickness)?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Digitoxin 70% Digoxin 20-40%
Suramin

27. What cholinomimetics might your pt be taking for his glaucoma
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Carbachol - pilocarpine - physostigmine - echothiophate
GET on the Metro
Protease inhibitor.

28. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
first dose orthostatic hypotension - dizziness - headache
Sulfonamides - Trimethoprim

29. What are the nondepolarizing neuromuscular blocking drugs?
Potent immunosuppressive used in organ transplant recipients.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Albuterol - tertbutaline
Pregnant women - Children; because animal studies show Damage to Cartilage

30. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Binding to the presynaptic alpha 2 release modulating receptors
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Intrathecally

31. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Acetylcholinesterase; ACh is broken down into choline and acetate.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Dopamine
Inhibits reabsorption of uric acid.

32. Resistance mechanisms for Cephalosporins/Penicillins
Beta - lactamase cleavage of Beta - lactam ring
Aminoglycosides - Tetracyclines
- Atropine & pralidoxime
- Act on same receptor - Full has greater efficacy

33. What are signs of Sildenafil (Viagra) toxicity?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
- Glucocorticoid withdrawal
Headache - flushing - dyspepsia - blue - green color vision.

34. Isopoterenol was given to a patient with a developing AV block - why?
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Stimulates beta adrenergic receptors

35. What is a common drug interaction associated with Griseofulvin?
TMP- SMZ (DOC) - aerosolized pentamidine
Increases coumadin metabolism
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Inhibits cell wall mucopeptide formation - Bactericidal

36. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Hydralazine and Minoxidil
It must be Phosphorylated by Viral Thymidine Kinase

37. What is the MOA for Amphotericin B?
Hemolytic anemia
Acetylcholinesterase; ACh is broken down into choline and acetate.
Lipoxygenase
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

38. What is the category of drug names ending in - tidine (e.g. Cimetidine)
No
Inhibits reabsorption of uric acid.
H2 antagonist
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

39. What are the clinical uses for 3rd Generation Cephalosporins?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Hydralazine and Minoxidil
DHPG (dihydroxy-2- propoxymethyl guanine)

40. What is an acronym to remember Anti - TB drugs?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Ipratropium
RESPIre

41. What are common toxicities associated with Macrolides? (4)
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.
Aminoglycosides - Tetracyclines
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Indomethacin is used to close a patent ductus arteriosus.

42. Beta Blockers - site of action?
amphetamine and ephedrine
Beta adrenergic receptors and Ca2+ channels (stimulatory)
- EDTA - dimercaprol - succimer - & penicillamine
Cell membrane Ca2+ channels of cardiac sarcomere

43. Describe first - order kinetics?
Ibuprofen - Naproxen - and Indomethacin
Enterobacter
Constant FRACTION eliminated per unit time.(exponential)
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

44. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
Slow - limited by half lives of clotting factors
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Hypersensitivity reactions
Megaloblastic anemia - Leukopenia - Granulocytopenia

45. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Praziquantel

46. Cautions When using Amiodarone?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
check PFTs - LFTs - and TFTs
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.
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

47. Are penicillinase resistant
Praziquantel
Ataxia - Dizziness - Slurred speech
Methicillin - Nafcillin - and Dicloxacillin
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

48. What is the possible mechanism and effect of Metformin in treating diabetes?
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
-100% oxygen - hyperbaric

49. What is used to reverse the action of Heparin?
post MI and digitalis induced arrhythmias
ACIDazolamide' causes acidosis
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

50. Reserpine will block the syntheis of this drug and but not its precursor.
Blocks Norepi - but not Dopamine
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Quinidine - Amiodarone - Procainamide - Disopyramide
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.