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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. What is the clinical use for Warfarin?
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Chronic anticoagulation.
INH: Injures Neurons and Hepatocytes

2. Name three Antiarrhythmic drugs in class IC.
decrease conduction velocity - increase ERP - increase PR interval
Flecainide - Encainide - Propafenone
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.
proximal convoluted tubule - thin descending limb - and collecting duct

3. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

4. What is the MOA for Ampicillin and Amoxicillin?
cardiac depression - peripheral edema - flushing - dizziness - constipation
Only in limited amounts
Antileukotriene; blocks synthesis by lipoxygenase.
Same as penicillin. Extended spectrum antibiotics

5. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
Enterobacter
- Penicillin
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
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.

6. What is the MOA of Ribavirin?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
proximal convoluted tubule
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

7. Which drug(s) cause this reaction: Thrombotic complications?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- Oral Contraceptives
- aminoglycosides - loop diuretics - cisplatin
- Tetracycline - amiodarone - sulfonamides

8. List the specific antidote for this toxin: Methemoglobin
Protease inhibitor.
AluMINIMUM amount of feces.
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
- Methylene blue

9. Name the common Aminoglycosides (5)
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Verapamil - Diltiazem - Bepridil
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation

10. Is resistant to penicillinase?
Norepinephrine
Imipenem
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)

11. What is the category of drug names ending in - azepam (e.g. Diazepam)
torsade de pointes - excessive Beta block
YES
Benzodiazepine.
Buy AT 30 - CELL at 50'

12. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Those patients who are taking nitrates.

13. What are five toxicities associated with Tacrolimus (FK506)?
Treatment of infertility.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
1. Weight gain 2. Hepatotoxicity (troglitazone)
Pretreat with antihistamines and a slow infusion rate

14. What conditions are treated with Metronidazole?
Impairs the synthesis of vitamin K- dependent clotting factors
Non - Nucleosides
- Daunorubicin & Doxorubicin
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

15. What is the main clinical use for the thrombolytics?
Beta - lactam antibiotics
Early myocardial infarction.
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
- Shifts the curve down - reduces Vmax

16. What is the MOA of the RT Inhibitors?
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

17. What are the clinical uses for Ticlopidine - Clopidogrel?
- Phenytoin
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

18. What is combination TMP- SMZ used to treat?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
- Clindamycin
Minor hepatotoxicity - Drug interactions (activates P450)
Acts as a wide spectrum carbapenem

19. Why is reserpine effective in treating HTN?
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Indomethacin is used to close a patent ductus arteriosus.
amphetamine and ephedrine

20. How do we stop angina?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
- Physostigmine salicylate
Gram + and Anerobes

21. What organism is Imipenem/cilastatin the Drug of Choice for?
- Dimercaprol - succimer
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Enterobacter
VACUUM your Bed Room'

22. Name the common Azoles
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.

23. How is Ribavirin used clinically?
Captopril - Enalapril - Lisinopril
for RSV
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

24. Digitalis - site of action?
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Neurotoxicity - Acute renal tubular necrosis
Na/K ATPase
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)

25. What is a common drug interaction associated with Griseofulvin?
Increases coumadin metabolism
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Norepinephrine
CMV Retinitis in IC pts When Ganciclovir fails

26. What are signs of Sildenafil (Viagra) toxicity?
Headache - flushing - dyspepsia - blue - green color vision.
Quinolones
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.

27. Ethacrynic Acid - mechanism?
- Atropine & pralidoxime
not a sulfonamide - but action is the same as furosemide
Ibuprofen - Naproxen - and Indomethacin
Systemic mycoses

28. Which drug(s) cause this reaction: Anaphylaxis?
- Lithium
Decreased uptake or Increased transport out of cell
- Penicillin
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

29. Mannitol - clinical use?
It affects beta receptors equally and is used in AV heart block (rare).
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Carbachol - pilocarpine - physostigmine - echothiophate

30. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
effective in torsade de pointes and digoxin toxicity
Beta -2 agonist.
Nevirapine - Delavirdine

31. What enzyme is responsible for the degredation of Ach
Acetylcholine esterase
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Benzodiazepine.
ACE inhibitor.

32. List the mechanism - clinical use - & toxicity of Methotrexate.
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.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
DOC in diagnosing and abolishing AV nodal arrhythmias

33. What drug is given for Pneumocystis carinii prophylaxis?
Beta Blockers
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Pentamidine
-100% oxygen - hyperbaric

34. Digoxin v. Digitoxin: excretion?
Digoxin=urinary Digitoxin=biliary
Chronic anticoagulation.
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Non - Nucleosides

35. What are common side effects of RT Inhibitors?
- Oral Contraceptives
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)
Tricyclic antidepressant.
BM suppression (neutropenia - anemia) - Peripheral neuropathy

36. What is Ketoconazole specifically used for?
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Protease inhibitor.
is resistant

37. What is the mechanism of action of Colchicine used to treat acute gout?
Diuresis in pateints with sulfa allergy
Protamine sulfate
- Nitrate - hydroxocobalamin thiosulfate
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.

38. Name two classes of drugs for HIV therapy
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Protease Inhibitors and Reverse Transcriptase Inhibitors
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

39. What reversal agent could a Anes give to reverse the effects of Atropine
Bethanechol - Neostigmine - physostigmine
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
- Antipsychotics
INH: Injures Neurons and Hepatocytes

40. For Warfarin What is the Onset of action
GI disturbances.
Digitoxin 168hrs Digoxin 40 hrs
Slow - limited by half lives of clotting factors
Inhibits CMV DNA polymerase

41. What is the mechanism of action of Ticlopidine - Clopidogrel
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

42. What is the possible mechanism and effect of Metformin in treating diabetes?
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
toxic
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

43. Adverse effects of Captopril?
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
- Quinidine - quinine
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

44. Antiarrhythmic class IC- toxicity?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
proarrhythmic
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Stimulates beta adrenergic receptors

45. Adverse effects of Minoxidil?
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
hypertension - angina - arrhythmias
Minor hepatotoxicity - Drug interactions (activates P450)
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

46. Explain potency in relation to full and partial agonists(2).
Quinolones
bradycardia - AV block - CHF
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

47. What is the effect of guanethidine on adrenergic NE release?
It inhibits release of NE.
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- Tamoxifen
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

48. Acetazolamide - toxicity?
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

49. What is the MOA for Amphotericin B?
Topical and Oral - for Oral Candidiasis (Thrush)
amphetamine and ephedrine
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

50. List the mechanism - clinical use - & toxicity of Prednisone.

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USMLE Step 1 Pharmacology

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