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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. List the mechanism - clinical use - & toxicity of Etoposide.
Bleeding.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

2. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Nevirapine - Delavirdine
- Steroids - Tamoxifen
Used in combination therapy with SMZ to sequentially block folate synthesis
Verapamil - Diltiazem - Bepridil

3. List the specific antidote for this toxin: Opioids
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
- B51Naloxone / naltrexone (Narcan)
GI upset - Superinfections - Skin rashes - Headache - Dizziness

4. What is the memory key to remember Which pathway (extrinsic vs. intrinsic) and Which lab value Warfarin affects?
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Norepinephrine

5. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Scopolamine
Blocks Influenza A and RubellA; causes problems with the cerebellA
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Vd= (Amt. of drug in body/ Plasma drug conc.)

6. MOA: Block mRNA synthesis
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Rifampin
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.

7. What is the MOA of Ribavirin?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Na/K ATPase
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

8. How are Sulfonamides employed clinically?
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Gram + - Gram - - Norcardia - Chlamydia
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
- Cloazapine - carbamazapine - colchicine - PTU

9. Name common Polymyxins
Succinylcholine
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Polymyxin B - Polymyxin E

10. Which diuretics cause acidosis?
Aminoglycosides
Hypersensitivity reactions
Same as penicillin. Extended spectrum antibiotics
carbonic anhydrase inhibitors - K+ sparing diuretics

11. Is resistant to penicillinase?
Directly of indirectly aid conversion of plasminogen to plasmin Which cleaves thrombin and fibrin clots. (It is claimed that tPA specifically converts fibrin - bound plasminogen to plasmin.)
Imipenem
Potent immunosuppressive used in organ transplant recipients.
cholestyramine - colestipol

12. What type of neurological blockade would hexamethonium create?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Carbachol - pilocarpine - physostigmine - echothiophate

13. What is are two clinical uses of Cyclosporine?
Na/K ATPase
Large anionic polymer - acidic
It acts presynaptically to increase NE release.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

14. What is the clinical use for Nystatin?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Topical and Oral - for Oral Candidiasis (Thrush)
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

15. How does resistance to Vancomycin occur?
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Because they require some residual islet function.
DOC in diagnosing and abolishing AV nodal arrhythmias
With an amino acid change of D- ala D- ala to D- ala D- lac

16. What process does Zafirlukast interfere with?
propanolol - esmolol - metoprolol - atenolol - timolol
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
YES
Leukotrienes increasing bronchial tone.

17. What are three toxicities of Propylthiouracil?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
- Hydralazine - Procainamide - INH - phenytoin
Headache - flushing - dyspepsia - blue - green color vision.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

18. What type of gout is treated with Probenacid?
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
- Bleomycin - amiodarone - busulfan
Chronic gout.

19. Describe the MOA of Interferons (INF)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Bethanechol - Neostigmine - physostigmine

20. When is HIV therapy initiated?
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Epinephrine
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Local anesthetic.

21. Triamterene and amiloride - mechanism?
Early myocardial infarction.
hypertension - angina - arrhythmias
- Glucagon
block Na+ channels in the cortical collecting tubule

22. A common side effects of Interferon (INF) treatment is?
hypertension - CHF - diabetic renal disease
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Rifampin (DOC) - minocycline
Neutropenia

23. Acetazolamide - toxicity?
CMV Retinitis in IC pts When Ganciclovir fails
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
- Shifts the curve down - reduces Vmax

24. What is the mechanism of action of Heparin?
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
decrease conduction velocity - increase ERP - increase PR interval
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Heparin catalyzes the activation of antithrombin III.

25. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Yes - it does not cross the placenta.
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

26. Can Heparin be used during pregnancy?
physostigmine
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Yes - it does not cross the placenta.
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

27. Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Imipenem
- Bleomycin - amiodarone - busulfan
Amphotericin B - Nystatin - Fluconazole/azoles

28. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Gram + - Gram - - Norcardia - Chlamydia
No - hemicholinum block the uptake of Choline and thus Ach synthesis

29. What is Niclosamide used for?
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Carbachol - pilocarpine - physostigmine - echothiophate

30. What are four unwanted effects of Clomiphene use?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Inhibits Viral DNA polymerase
Bleeding.
Rapid (seconds)

31. What are toxic side effects for Metronidazole?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
- Formaldehyde & formic acid - severe acidosis & retinal damage
Disulfiram - like reaction with EtOH - Headache

32. ACE inhibitors - toxicity?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
PT
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
1. Weight gain 2. Hepatotoxicity (troglitazone)

33. Which receptors does phenylephrine act upon?
Rifampin (DOC) - minocycline
AZT
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Tricyclic antidepressant.

34. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Cyclooxygenases (COX I - COX II).
1. Renal damage 2. Aplastic anemia 3. GI distress
competitive inhibirot of aldosterone in the cortical collecting tubule
- Oral Contraceptives

35. Are not penicillinase resistant
Slow - limited by half lives of clotting factors
Leukotrienes increasing bronchial tone.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Carbenicillin - Piperacillin - and Ticarcillin

36. Which drug(s) cause this reaction: Aplastic anemia (5)?
Phenothiazine (neuroleptic - antiemetic).
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

37. What enzyme does Zileuton inhibit?
not a sulfonamide - but action is the same as furosemide
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Lipoxygenase
Ataxia - Dizziness - Slurred speech

38. Hydralazine - clinical use?
Babiturate.
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)
severe hypertension - CHF
- Deferoxamine

39. Resistance mechanisms for Chloramphenicol
- aminoglycosides - loop diuretics - cisplatin
Modification via Acetylation
- Phenytoin
cholestyramine - colestipol

40. List the mechanism - clinical use - & toxicity of Busulfan.
No
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
- Tetracycline - amiodarone - sulfonamides
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation

41. What is the memory key for the action of Sildenafil (Viagra)?
Sildenafil fills the penis
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)

42. Beta Blockers - CV toxicity?
Ceftriaxone
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Inhibit viral DNA polymerase
bradycardia - AV block - CHF

43. For Warfarin What is the Treatment for overdose
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
IV vitamin K and fresh frozen plasma
Hydralazine and Minoxidil
Prevents the release of Ca from SR of skeletal muscle

44. What is the effect of epinephrine infusion on bp and pulse pressure?
With supplemental Folic Acid
torsade de pointes - excessive Beta block
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Butyrophenone (neuroleptic).

45. What is the clinical use for Clomiphene?
Treatment of infertility.
Pseudomembranous colitis (C. difficile) - fever - diarrhea
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
AZT - to reduce risk of Fetal Transmission

46. Name four Antiarrhythmic drugs in class III.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Used in combination therapy with SMZ to sequentially block folate synthesis
- Glucagon
Sotalol - Ibutilide - Bretylium - Amiodarone

47. Describe first - order kinetics?
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
- Dimercaprol - succimer
- Antipsychotics
Constant FRACTION eliminated per unit time.(exponential)

48. What is the MOA for Acyclovir?
Botulinum
It affects beta receptors equally and is used in AV heart block (rare).
Inhibit viral DNA polymerase
Beta - lactam antibiotics

49. What is a common side effect of Colchicine used to treat acute gout - especially When given orally?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
physostigmine
GI side effects. (Indomethacin is less toxic - more commonly used.)
fetal renal toxicity - hyperkalemia

50. List five common glucocorticoids.
1. Antiandrogen 2. Nausea 3. Vomiting
Blocks Influenza A and RubellA; causes problems with the cerebellA
prevention of nodal arrhythmias (SVT)
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone

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USMLE Step 1 Pharmacology

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