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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. What enzyme does Zileuton inhibit?
Lipoxygenase
Doxycycline - because it is fecally eliminated
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
- Hydralazine - Procainamide - INH - phenytoin

2. What effect would atropine have on a patient with peptic ulcer disease?
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Beta - lactam antibiotics
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

3. What is the MOA for Methicillin - Nafcillin - and Dicloxacillin?
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Same as penicillin. Act as narrow spectrum antibiotics
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Tendonitis and Tendon rupture

4. How does botulinum toxin result in respiratory arrest?
Protease Inhibitors and Reverse Transcriptase Inhibitors
Sotalol - Ibutilide - Bretylium - Amiodarone
Those patients who are taking nitrates.
Prevents the release of ACh - Which results in muscle paralysis.

5. How are the HIV drugs used clinically?

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6. What are two conditions in Which COX-2 inhibitors might be used?
Inhibits DNA dependent RNA polymerase
Rheumatoid and osteoarthritis.
As an anticholinesterase it increases endogenous ACh and thus increases strength.
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

7. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Give an antichloinesterase - neostigmine - edrophonium - etc
Rare.
- B51Naloxone / naltrexone (Narcan)
Aminoglycosides

8. Which RT inhibitors cause a Rash?
- Aminocaproic acid
cortical collecting tubule
first dose orthostatic hypotension - dizziness - headache
Non - Nucleosides

9. What is the category of drug names ending in - terol (e.g. Albuterol)
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Beta -2 agonist.
- Act on same receptor - Full has greater efficacy

10. Adverse effects of Hydralazine?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
physostigmine
Same as penicillin. Extended spectrum antibiotics
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

11. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Amphetamine and Ephedrine

12. Name four Antiarrhythmic drugs in class IA.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Paranteral (IV - SC)
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Quinidine - Amiodarone - Procainamide - Disopyramide

13. What is the mecanism of action of Sucralfate?
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.
Pregnant women - Children; because animal studies show Damage to Cartilage
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Topical and Oral - for Oral Candidiasis (Thrush)

14. Common toxicities associated with Griseofulvin?
Teratogenic - Carcinogenic - Confusion - Headaches
Acts as a wide spectrum carbapenem
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.

15. What is the difference between the affinity for beta receptors between albuterol/terbutaline and dantroline?
Hypersensitivity reactions
Binding to the presynaptic alpha 2 release modulating receptors
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.
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

16. Classes of antihypertensive drugs?
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
RESPIre

17. What is the category of drug names ending in - pril (e.g. Captopril)
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
ACE inhibitor.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Bethanechol - Neostigmine - physostigmine

18. Adverse effect of Nitroprusside?
troponin - tropomyosin system
cyanide toxicity (releases CN)
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
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

19. What is the mechanism of action of Mifepristone (RU486)?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
CMV - esp in Immunocompromised patients
Competitive inibitor of progestins at progesterone receptors.

20. What type of gout is treated with Colchicine?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
anuria - CHF
GI side effects. (Indomethacin is less toxic - more commonly used.)
Acute gout.

21. Ethacrynic Acid - mechanism?
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
not a sulfonamide - but action is the same as furosemide
Chronic (weeks or months)
Alpha -1 antagonist

22. What is the effect of norepinephrine on bp and pulse pressure?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Scopolamine
Those patients who are taking nitrates.

23. What is the clinical use for Penicillin?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Aminoglycosides
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

24. List the mechanism - clinical use - & toxicity of Etoposide.
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Penicillin - G
- Formaldehyde & formic acid - severe acidosis & retinal damage
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

25. Digoxin v. Digitoxin: half life?
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Digitoxin 168hrs Digoxin 40 hrs
Protease inhibitor.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

26. Acetazolamide - mechanism?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Protease Inhibitors and Reverse Transcriptase Inhibitors
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Chronic (weeks or months)

27. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
loop diuretics - spironolactone
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Aplastic anemia (dose independent) - Gray Baby Syndrome
- Niacin - Ca++ channel blockers - adenosine - vancomycin

28. What are Aminoglycosides synergistic with?
physostigmine
Inhibt Assembly of new virus by Blocking Protease Enzyme
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
Beta - lactam antibiotics

29. What is the mechanism of action of the glucocorticoids?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Yes - it does not cross the placenta.

30. How do Sulfonamides act on bacteria?
reversible SLE- like syndrome
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
- Daunorubicin & Doxorubicin

31. Describe Phase II metabolism in liver(3)?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Inhibition of 50S peptidyl transferase - Bacteriostatic
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

32. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Impairs the synthesis of vitamin K- dependent clotting factors

33. What is the category of drug names ending in - phylline (e.g. Theophylline)
Methylxanthine.
Hypersensitivity reactions
Verapamil - Diltiazem - Bepridil
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.

34. For Heparin What is the Duration of action
Acute (hours)
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
compensatory tachycardia - fluid retention - lupus - like syndrome
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

35. What is action of insulin in the liver - in muscle - and in adipose tissue?
Long.
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.
- Deferoxamine
Staphlococcus aureus

36. What is used to reverse the action of Heparin?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
- Ethanol - dialysis - & fomepizole
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.

37. Resistance mechanisms for Sulfonamides
Cilastatin
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Gram + cocci - Gram - rods - and Anerobes

38. What is the MOA for Vancomycin?
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Inhibits cell wall mucopeptide formation - Bactericidal
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
- B51Naloxone / naltrexone (Narcan)

39. What reversal agent could a Anes give to reverse the effects of Atropine
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
YES
Bethanechol - Neostigmine - physostigmine

40. List the specific antidote for this toxin: Lead
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- Glucocorticoid withdrawal
- EDTA - dimercaprol - succimer - & penicillamine
Stimulates beta adrenergic receptors

41. What are two toxicities associated with Cyclosporine?
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Indirect agonist - uptake inhibitor
Prevention of NSAID- induced peptic ulcers - maintains a PDA.

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

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43. Which drug(s) cause this reaction: Gingival hyperplasia?
- Glucocorticoid withdrawal
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
- Phenytoin
Acute gout.

44. What is the category of drug names ending in - azepam (e.g. Diazepam)
Bleeding.
Benzodiazepine.
Mebendazole/Thiabendazole - Pyrantel Pamoate
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.

45. What is the mechanism of Leuprolide?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
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

46. Why would you give a drug like pancuronium or succinylcholine?
No - it inhibits the release of Nor Epi
Useful in muscle paralysis during surgery or mechanical ventilation.
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Non - Nucleosides

47. Name two LPL stimulators.
Mg = Must go to the bathroom.
Cilastatin
Gemfibrozil - Clofibrate
Activates antithrombin III

48. What antimuscarinic drug is useful for the tx of asthma
Chronic gout.
Primaquine
RESPIre
Ipratropium

49. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
- Chlorpromazine - thioridazine - haloperidol
Disulfiram - like reaction with EtOH - Headache
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

50. Where does Griseofulvin deposit?
Ipratropium
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
VACUUM your Bed Room'
Keratin containing tissues - e.g. - nails