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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. Foscarnet does not require activation by a...
Foscarnet = pyroFosphate analog
Those patients who are taking nitrates.
viral kinase
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria

2. Which drug increases Sys BP w/o affecting Pulse Pressure
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Epinephrine
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
RESPIre

3. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Binding to the presynaptic alpha 2 release modulating receptors
post MI and digitalis induced arrhythmias
Hypersensitivity reactions

4. How do spare receptors effect the Km?
- EDTA - dimercaprol - succimer - & penicillamine
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Penicillin - V
- ED 50 is less than the Km (less than 50% of receptors)

5. What is the chemical name for Ganciclovir?
Carbachol - pilocarpine - physostigmine - echothiophate
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
DHPG (dihydroxy-2- propoxymethyl guanine)
cross - allergenic

6. What effect would atropine have on a patient with peptic ulcer disease?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
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.
- Glucocorticoid withdrawal
K+ wasting - metabolic alkalosis - hypotension - ototoxicity

7. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
cortical collecting tubule
- Chlorpromazine - thioridazine - haloperidol
Rash - Pseudomembranous colitis
reversible SLE- like syndrome

8. What is the clinical use for Warfarin?
Chronic anticoagulation.
Beta1 more than B2
Leukotrienes increasing bronchial tone.
Chronic gout.

9. Which cancer drugs effect nuclear DNA (4)?
Prevents the release of ACh - Which results in muscle paralysis.
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

10. Name four HMG- CoA reductase inhibitors.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
scopolamine
Ipratropium
Methicillin - Nafcillin - and Dicloxacillin

11. What is the mechanism of action of Probenacid used to treat chronic gout?
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Inhibits reabsorption of uric acid.
new arrhythmias - hypotension

12. MOA: Block protein synthesis at 30s subunit
propanolol - esmolol - metoprolol - atenolol - timolol
- Ethosuxamide - sulfonamides - lamotrigine
Inhibt Assembly of new virus by Blocking Protease Enzyme
Aminoglycosides - Tetracyclines

13. Name several common Macrolides (3)
- Glucocorticoid withdrawal
Erythromycin - Azithromycin - Clarithromycin
- Hydralazine - Procainamide - INH - phenytoin
Topical and Oral - for Oral Candidiasis (Thrush)

14. List the specific antidote for this toxin: Arsenic (all heavy metals)
Aminoglycosides
- Dimercaprol - succimer
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Inhibits Viral DNA polymerase

15. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Ca2+ (Loops Lose calcium)
- aminoglycosides - loop diuretics - cisplatin
new arrhythmias - hypotension

16. What is the category - mechanism of action - and effect of Ipratroprium in Asthma treatment?
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

17. What is the MOA for Rifampin?
Slow - limited by half lives of clotting factors
Triple sulfas or SMZ
Neurotoxicity - Acute renal tubular necrosis
Inhibits DNA dependent RNA polymerase

18. What Sulfonamides are used for simple UTIs?
Triple sulfas or SMZ
Anaerobes
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
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.

19. What are the Macrolides used for clinically?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
ACIDazolamide' causes acidosis

20. Which RT inhibitor causes Megaloblastic Anemia?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Aplastic anemia (dose independent) - Gray Baby Syndrome
AZT
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

21. For Warfarin What is the Duration of action
GI upset
Constant FRACTION eliminated per unit time.(exponential)
Chronic (weeks or months)
Indirect agonist - uptake inhibitor

22. Name the common Fluoroquinolones (6)
Flecainide - Encainide - Propafenone
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
The PTT.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

23. What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
1. Weight gain 2. Hepatotoxicity (troglitazone)
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Foscarnet = pyroFosphate analog

24. Ibutilide - toxicity?
Imipenem
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
torsade de pointes

25. Why would you use pralidoxime after exposure to an organophosphate?
Pralidoxime regenerates active cholinesterase.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
It inhibits release of NE.
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia

26. For Warfarin What is the Ability to inhibit coagulation in vitro
Aminoglycosides - Tetracyclines
No
Beta antagonist.
Heparin catalyzes the activation of antithrombin III.

27. What are common side effects of Amphotericin B?
ACIDazolamide' causes acidosis
Diarrhea
- Isoniazid
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias

28. What is the clinical use for Ampicillin and Amoxicillin?
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
atropine - homatropine - tropicamide
Hypersensitivity reactions
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.

29. For Warfarin What is the Mechanism of action
Impairs the synthesis of vitamin K- dependent clotting factors
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

30. Which drug(s) cause this reaction: Tendonitis and rupture?
Flecainide - Encainide - Propafenone
Prevents the release of ACh - Which results in muscle paralysis.
- Fluoroquinolones
Cyclooxygenases (COX I - COX II).

31. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Cyclooxygenases (COX I - COX II).
Chronic anticoagulation.
Acetylcholinesterase; ACh is broken down into choline and acetate.
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

32. What enzyme is responsible for the degredation of Ach
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
prevention of nodal arrhythmias (SVT)
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Acetylcholine esterase

33. Which receptors does phenylephrine act upon?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- Corticosteroids - heparin

34. For Warfarin What is the Structure
Chronic gout.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Small lipid - soluble molecule

35. What is a possible toxicity of Alpha - glucosidase inhibitors used in type -2 diabetes?
GI disturbances.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
1. Weight gain 2. Hepatotoxicity (troglitazone)
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.

36. Why is Cilastatin administered with Imipenem?
loop diuretics - spironolactone
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
reversible SLE- like syndrome
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

37. What is the specific clinical use of Indomethacin in neonates?
Antileukotriene; blocks leukotriene receptors.
Indomethacin is used to close a patent ductus arteriosus.
Inhibit viral DNA polymerase
Lipoxygenase

38. List five common glucocorticoids.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
GI discomfort
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Sotalol - Ibutilide - Bretylium - Amiodarone

39. Which drug(s) cause this reaction: G6PD hemolysis(8)?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Phosphorylation by a Viral Kinase
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Chronic Hepatitis A and B - Kaposi's Sarcoma

40. IV Penicillin
No
Penicillin - G
Small lipid - soluble molecule
- Fluoroquinolones

41. What organism is Imipenem/cilastatin the Drug of Choice for?
Severe Gram - rod infections.
Enterobacter
- Vinca alkaloids(inhibit MT) - Paclitaxel
Cyclooxygenases (COX I - COX II).

42. Aztreonam is not ________ with penicillins
cross - allergenic
Tendonitis and Tendon rupture
for RSV
distal convoluted tubule (early)

43. Which drug(s) cause this reaction: Torsade de pointes (2)?
- Alkalate DNA - Brain tumors - CNS toxicity
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
- Ammonium Chloride
Digitoxin>95% Digoxin 75%

44. Ganciclovir associated toxicities?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

45. Are penicillinase resistant
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Methicillin - Nafcillin - and Dicloxacillin
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

46. What is the definition of zero - order kinetics? Example?
Tendonitis and Tendon rupture
Digitoxin 168hrs Digoxin 40 hrs
Penicillin - V
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

47. For Warfarin What is the Onset of action
Slow - limited by half lives of clotting factors
Verapamil - Diltiazem - Bepridil
TMP- SMZ (DOC) - aerosolized pentamidine
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

48. What is the major side effect for Ampicillin and Amoxicillin?
Acts as a wide spectrum carbapenem
It acts presynaptically to increase NE release.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Hypersensitivity reactions

49. Which Tetracycline is used in patients with renal failure? / Why?
distal convoluted tubule (early)
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Doxycycline - because it is fecally eliminated
- Oral Contraceptives

50. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Carbachol - pilocarpine - physostigmine - echothiophate
Primaquine
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Acetylcholinesterase; ACh is broken down into choline and acetate.

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USMLE Step 1 Pharmacology

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