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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 a common side effect of Colchicine used to treat acute gout - especially When given orally?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
GI side effects. (Indomethacin is less toxic - more commonly used.)
check PFTs - LFTs - and TFTs
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

2. What drug is used to diagnose myasthenia gravis?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Paranteral (IV - SC)
edrophonium (extremely short acting anticholinesterase)
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

3. Name four Antiarrhythmic drugs in class IA.
Quinidine - Amiodarone - Procainamide - Disopyramide
Slow - limited by half lives of clotting factors
TMP- SMZ (DOC) - aerosolized pentamidine
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

4. What are common side effects of Protease Inhibitors?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- Physostigmine salicylate
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
- Ammonium Chloride

5. Name the common Azoles
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Atropine & pralidoxime
It inhibits release of NE.

6. How can the t1/2 of INH be altered?
- Vinca alkaloids(inhibit MT) - Paclitaxel
Fast vs. Slow Acetylators
1. Renal damage 2. Aplastic anemia 3. GI distress
1. Antiandrogen 2. Nausea 3. Vomiting

7. What populations are Floroquinolones contraindicated in? Why?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
check PFTs - LFTs - and TFTs
Pregnant women - Children; because animal studies show Damage to Cartilage
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia

8. For Heparin What is the Route of administration
Antifungal.
Ibuprofen - Naproxen - and Indomethacin
- Vinca alkaloids(inhibit MT) - Paclitaxel
Paranteral (IV - SC)

9. Which RT inhibitors cause Lactic Acidosis?
- Haloperidol - chlorpromazine - reserpine - MPTP
Aminoglycosides
Nucleosides
decrease

10. Ganciclovir associated toxicities?
Diarrhea
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
PT
Prophylaxis for Influenza A - Rubella; Parkinson's disease

11. What is the mechanism of action of Clomiphene?
loop diuretics - spironolactone
sedation - sleep alterations
Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback inhibition and increses release of LH and FSHfrom the pituitary - Which stimulates ovulation.
hyperaldosteronism - K+ depletion - CHF

12. What is the MOA of Amantadine?
Ca2+ (Loops Lose calcium)
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
thick ascending limb

13. Decrease Digitoxin dose in renal failure?
Pralidoxime regenerates active cholinesterase.
Amphotericin B - Nystatin - Fluconazole/azoles
NO
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

14. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
not a sulfonamide - but action is the same as furosemide
Methylxanthine.
Hypersensitivity reactions
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

15. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Verapamil - Diltiazem - Bepridil
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Rare.

16. MOA: Disrupt bacterial/fungal cell membranes
Polymyxins
No - warfarin - unlike heparin - can cross the placenta.
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

17. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Lipoxygenase
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

18. What is a common drug interaction associated with Griseofulvin?
Increases coumadin metabolism
Doxycycline - because it is fecally eliminated
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

19. Name four Antiarrhythmic drugs in class III.
Sotalol - Ibutilide - Bretylium - Amiodarone
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
GET on the Metro
dry mouth - sedation - severe rebound hypertension

20. How is Leishmaniasis treated?
Bethanechol - Neostigmine - physostigmine
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Pentavalent Antimony
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

21. Which drug(s) cause this reaction: Anaphylaxis?
- Penicillin
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Used in combination therapy with SMZ to sequentially block folate synthesis
Indomethacin is used to close a patent ductus arteriosus.

22. What is the mechanism of action of Mifepristone (RU486)?
dry mouth - sedation - severe rebound hypertension
Competitive inibitor of progestins at progesterone receptors.
No - it inhibits the release of Nor Epi
Bethanechol - Neostigmine - physostigmine

23. Ethacrynic Acid - clinical use?
YES
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Diuresis in pateints with sulfa allergy
Hydralazine and Minoxidil

24. What is the MOA for the Tetracyclines?
ACIDazolamide' causes acidosis
Long.
Oxygen
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic

25. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Pituitary hormone.
Pyridoxine (B6) administration
- Fluoroquinolones

26. ___________ are Teratogenic
Abortifacient.
Aminoglycosides
Severe Gram - rod infections.
Yes - it does not cross the placenta.

27. How does dantrolene work?
Nifedipine - Verapamil - Diltiazem
Hypersensitivity reactions
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.

28. How do you calculate maintenance dose?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Same as penicillin. Extended spectrum antibiotics
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

29. List the mechanism - clinical use - & toxicity of 5 FU.
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
- Methotrexate - 5 FU - 6 mercaptopurine
check PFTs - LFTs - and TFTs
sedation - sleep alterations

30. Are penicillinase resistant
Aplastic anemia (dose independent) - Gray Baby Syndrome
Diarrhea
Antileukotriene; blocks leukotriene receptors.
Methicillin - Nafcillin - and Dicloxacillin

31. What are the major toxic side effects of Imipenem/cilastatin?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
- Dimercaprol - succimer
GI distress - Skin rash - and Seizures at high plasma levels

32. Which drug(s) cause this reaction: Diabetes insipidus?
ACE inhibitor.
Gram + and Anerobes
- Ethanol - dialysis - & fomepizole
- Lithium

33. Adverse effects of Clonidine?
Binds ergosterol - Disrupts fungal membranes
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.
dry mouth - sedation - severe rebound hypertension
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

34. What are toxicities associated with Chloramphenicol?
Aplastic anemia (dose independent) - Gray Baby Syndrome
Liver
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation

35. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
Only in limited amounts
Primaquine
Oral treatment of superficial infections

36. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
These B-2 agonists cause respiratory smooth muscle to relax.
Prevents the release of ACh - Which results in muscle paralysis.

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

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38. What is the loading dose formula?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
torsade de pointes - excessive Beta block
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
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.

39. What are two toxicities associated with Cyclosporine?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
- Bleomycin - amiodarone - busulfan
Systemic mycoses
Those patients who are taking nitrates.

40. List the specific antidote for this toxin: Opioids
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
- B51Naloxone / naltrexone (Narcan)
Antileukotriene; blocks synthesis by lipoxygenase.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

41. Acetazolamide - toxicity?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Hydralazine and Minoxidil
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

42. What are common serious side effects of Aminoglycosides and What are these associated with?
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Chronic (weeks or months)

43. Why does NE result in bradycardia?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Epinephrine
Blocks Norepi - but not Dopamine
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

44. How is Amphotericin B administered for fungal meningitis?
- Dimercaprol - succimer
Intrathecally
- Daunorubicin & Doxorubicin
Erectile dysfunction.

45. MOA: Block protein synthesis at 30s subunit
carbonic anhydrase inhibitors - K+ sparing diuretics
Pretreat with antihistamines and a slow infusion rate
Aminoglycosides - Tetracyclines
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

46. MOA: Bactericidal antibiotics
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Vd= (Amt. of drug in body/ Plasma drug conc.)
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Diarrhea

47. What type of gout is treated with Allopurinol?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Chronic gout.
Pyridoxine (B6) administration
For serious - Gram + multidrug - resistant organisms

48. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Rifampin
Indirect agonist - uptake inhibitor
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

49. What is the category of drug names ending in - tropin (e.g. Somatotropin)
severe hypertension - CHF
Methicillin - Nafcillin - and Dicloxacillin
Pituitary hormone.
Early myocardial infarction.

50. How is Foscarnet used clinically?
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
CMV Retinitis in IC pts When Ganciclovir fails
Aminoglycosides

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USMLE Step 1 Pharmacology

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