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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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Match each statement with the correct term.
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1. What is the MOA for Acyclovir?
Prevents the release of Ca from SR of skeletal muscle
Inhibit viral DNA polymerase
GI distress - Skin rash - and Seizures at high plasma levels
- Cloazapine - carbamazapine - colchicine - PTU

2. What are two processes Corticosteroids inhibit leading to decreased inflammation?
prevention of nodal arrhythmias (SVT)
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
- EDTA - dimercaprol - succimer - & penicillamine
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

3. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
- N- acetylcystine
Hypersensitivity reactions
Rheumatoid and osteoarthritis.
depresses ectopic pacemakers - especially in digoxin toxicity

4. List the mechanism - clinical use - & toxicity of Busulfan.
- Antipsychotics
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Ipratropium

5. Name the common Fluoroquinolones (6)
Amphotericin B - Nystatin - Fluconazole/azoles
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

6. What are four unwanted effects of Clomiphene use?
Topical and Oral - for Oral Candidiasis (Thrush)
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Alpha -1 antagonist
Pseudomonas species and Gram - rods

7. Which drug(s) cause this reaction: Gingival hyperplasia?
No
dry mouth - sedation - severe rebound hypertension
Digoxin=urinary Digitoxin=biliary
- Phenytoin

8. Antiarrhythmic class IC- effects?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
collecting ducts
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction

9. List the specific antidote for this toxin: Arsenic (all heavy metals)
- Dimercaprol - succimer
loop diuretics - spironolactone
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)

10. Which cancer drugs effect nuclear DNA (4)?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Pentamidine
scopolamine

11. ACE inhibitors - toxicity?
Useful in muscle paralysis during surgery or mechanical ventilation.
competitive inhibirot of aldosterone in the cortical collecting tubule
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Yes

12. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
Onchocerciasis ('river blindness'-- rIVER- mectin)
GET on the Metro
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Those patients who are taking nitrates.

13. Does Heparin have a long - medium - or short half life?
Beta lactams - inhibit cell wall synthesis - Bactericidal
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
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Short.

14. For Heparin What is the Lab value to monitor
all of them
aPTT (intrinsic pathway)
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
- Oxalic acid - Acidosis & nephrotoxicity

15. What is used to reverse the action of Heparin?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Leukotrienes increasing bronchial tone.

16. What is the mechanism of action of the H2 Blockers?
- polymyxins
Reversible block of histamine H2 receptors
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
- Ethanol - dialysis - & fomepizole

17. What is the mechanism of action of Sildenafil (Viagra)?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

18. Adverse effects of Methyldopa?

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19. Furosemide - clinical use?
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
proximal convoluted tubule
These B-2 agonists cause respiratory smooth muscle to relax.
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

20. ___________ are Teratogenic
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Praziquantel
Aminoglycosides
Polymyxin B - Polymyxin E

21. What is an occasional side effect of Aztreonam?
Ibuprofen - Naproxen - and Indomethacin
cholestyramine - colestipol
GI upset
Decreases synthesis of Mycolic Acid

22. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Bleeding.
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Short.
- Chlorpromazine - thioridazine - haloperidol

23. What is the specific clinical use of Indomethacin in neonates?
Indomethacin is used to close a patent ductus arteriosus.
These B-2 agonists cause respiratory smooth muscle to relax.
thick ascending limb
block Na+ channels in the cortical collecting tubule

24. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
atropine - homatropine - tropicamide
1. Pioglitazone 2. Rosiglitazone.
hypertension - CHF - diabetic renal disease

25. What process does Zafirlukast interfere with?
- Vitamin K & fresh frozen plasma
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
- Glucocorticoid withdrawal
Leukotrienes increasing bronchial tone.

26. Side effects of Isoniazid (INH)?
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Disulfiram - like reaction with EtOH - Headache
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

27. What are five disadvantages of Oral Contraceptives (synthetic progestins - estrogen)?
1. Pioglitazone 2. Rosiglitazone.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Due to the presence of a bulkier R group
thiazides - amiloride

28. List the mechanism - clinical use - & toxicity of Paclitaxel.
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Shifts the curve down - reduces Vmax
Scopolamine

29. Which drug(s) cause this reaction: Gray baby syndrome?
aPTT (intrinsic pathway)
TCA
- Chloramphenicol
ACIDazolamide' causes acidosis

30. What is the clinical use for Heparin?
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
AmOxicillin has greater Oral bioavailability
Decreases synthesis of Mycolic Acid

31. What is the mechanism of action of Misoprostol?
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
-100% oxygen - hyperbaric
thick ascending limb
Captopril - Enalapril - Lisinopril

32. Resistance mechanisms for Chloramphenicol
Modification via Acetylation
Hypersensitivity reactions
torsade de pointes - excessive Beta block
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone

33. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
Succinylcholine
- Quinidine - quinine
Increases coumadin metabolism
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

34. Which drug(s) cause this reaction: SLE- like syndrome?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
- Steroids - Tamoxifen
- Hydralazine - Procainamide - INH - phenytoin
- Cloazapine - carbamazapine - colchicine - PTU

35. Why does NE result in bradycardia?
- Cloazapine - carbamazapine - colchicine - PTU
Chronic anticoagulation.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

36. What is the effect of the Glitazones in diabetes treatment?
Increase target cell response to insulin.
Pituitary hormone.
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Cyclooxygenases (COX I - COX II).

37. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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38. What is the mechanism of Azathioprine?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Long.
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
It inhibits release of NE.

39. Adverse effects of Reserpine?
sedation - depression - nasal stuffiness - diarrhea
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
1. Acarbose 2. Miglitol
Verapamil - Diltiazem - Bepridil

40. List the specific antidote for this toxin: Amphetamine
- Ammonium Chloride
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
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Teratogenic - Carcinogenic - Confusion - Headaches

41. Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
- Disulfram & also sulfonylureas - metronidazole
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

42. What are the clinical uses for 3rd Generation Cephalosporins?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
IV vitamin K and fresh frozen plasma
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Decreased uptake or Increased transport out of cell

43. How would you reverse the effect of a neuromuscular blocking agent?
Nitrates
proximal convoluted tubule - thin descending limb - and collecting duct
Give an antichloinesterase - neostigmine - edrophonium - etc
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

44. Antimicrobial prophylaxis for Syphilis
Benzathine penicillin G
Only in limited amounts
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
- Glucagon

45. List the mechanism - clinical use - & toxicity of Doxorubicin.

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46. Which drug(s) cause this reaction: Pseudomembranous colitis?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
- Clindamycin
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
ACIDazolamide' causes acidosis

47. What are two indirect acting adrenergic agonists?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
- polymyxins
amphetamine and ephedrine
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

48. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Impairs the synthesis of vitamin K- dependent clotting factors
They inhibit reuptake of NE at the nerve terminal (as does cocaine).

49. What conditions are treated with Metronidazole?
Delirium - Tremor - Nephrotoxicity
Flecainide - Encainide - Propafenone
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

50. What is the MOA for Rifampin?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Inhibits DNA dependent RNA polymerase
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

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USMLE Step 1 Pharmacology

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