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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 beta 2 agonist will help your 21yo Astma pt?
Butyrophenone (neuroleptic).
compensatory tachycardia - fluid retention - lupus - like syndrome
reversible SLE- like syndrome
Albuterol - tertbutaline

2. Classes of antihypertensive drugs?
Megaloblastic anemia - Leukopenia - Granulocytopenia
- Formaldehyde & formic acid - severe acidosis & retinal damage
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.
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

3. What is the category - desired effect - and adverse effect of Isoproterenol in the treatment of Asthma?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
amphetamine and ephedrine
GI upset - Superinfections - Skin rashes - Headache - Dizziness

4. Antimicrobial prophylaxis for a history of recurrent UTIs
AZT
- Quinidine - quinine
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
TMP- SMZ

5. Digitalis - site of action?
Na/K ATPase
Amphetamine and Ephedrine
- Bleomycin - amiodarone - busulfan
scopolamine

6. What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Botulinum
Ipratropium

7. What are the major structural differences between Penicillin and Cephalosporin?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
With an amino acid change of D- ala D- ala to D- ala D- lac
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)
Aminoglycosides

8. Cautions When using Amiodarone?
check PFTs - LFTs - and TFTs
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Paranteral (IV - SC)
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia

9. Name several common Macrolides (3)
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Erythromycin - Azithromycin - Clarithromycin
Phenothiazine (neuroleptic - antiemetic).

10. Which Tetracycline is used in patients with renal failure? / Why?
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Doxycycline - because it is fecally eliminated

11. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
pulmonary edema - dehydration
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
Tendonitis and Tendon rupture
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

12. Which drug(s) cause this reaction: Tubulointerstitial Nephritis (5)?
hypertension - CHF - diabetic renal disease
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
TMP- SMZ
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

13. Is resistant to penicillinase?
Suramin
Prevents the release of ACh - Which results in muscle paralysis.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Imipenem

14. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
Neomycin
- Atropine & pralidoxime
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
1. Renal damage 2. Aplastic anemia 3. GI distress

15. What is the mecanism of action of Sucralfate?
Oral treatment of superficial infections
GI disturbances.
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.
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

16. What anticholinesterase crosses the blood - brain - barrier?
physostigmine
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Used in combination therapy with SMZ to sequentially block folate synthesis
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

17. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
dry mouth - sedation - severe rebound hypertension
cyanide toxicity (releases CN)

18. Resistance mechanisms for Vancomycin
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
AZT - to reduce risk of Fetal Transmission
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

19. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
decrease conduction velocity - increase ERP - increase PR interval
- Ethosuxamide - sulfonamides - lamotrigine
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Ca2+ (Loops Lose calcium)

20. What are Fluoroquinolones indicated for? (3)
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
- Ethosuxamide - sulfonamides - lamotrigine
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome

21. List the specific antidote for this toxin: TPA & Streptokinase
Hemolytic anemia
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.
Acts as a wide spectrum carbapenem
- Aminocaproic acid

22. Which drug(s) cause this reaction: Gray baby syndrome?
- Chloramphenicol
CMV Retinitis in IC pts When Ganciclovir fails
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

23. Which drug(s) cause this reaction: Cinchonism (2)?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
- Quinidine - quinine
Quinolones
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

24. For Warfarin What is the Mechanism of action
Useful in muscle paralysis during surgery or mechanical ventilation.
Impairs the synthesis of vitamin K- dependent clotting factors
- aminoglycosides - loop diuretics - cisplatin
As an anticholinesterase it increases endogenous ACh and thus increases strength.

25. MOA: Block DNA topoisomerases
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Quinolones
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

26. Esmolol - short or long acting?
Phosphorylation by a Viral Kinase
atropine - homatropine - tropicamide
Norepinephrine (Alpha1 -2 and beta 1)
very short acting

27. What are three toxicities of Leuprolied?
1. Antiandrogen 2. Nausea 3. Vomiting
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

28. Acetazolamide - mechanism?
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Suramin
The only local anesthetic with vasoconstrictive properties.

29. What is the mechanism of Leuprolide?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
1. Weight gain 2. Hepatotoxicity (troglitazone)
Does not cross
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH

30. Name three Antiarrhythmic drugs in class IV.
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Verapamil - Diltiazem - Bepridil
For serious - Gram + multidrug - resistant organisms

31. Bretyllium - toxicity?
Fast vs. Slow Acetylators
new arrhythmias - hypotension
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Beta adrenergic receptors and Ca2+ channels (stimulatory)

32. What is the MOA for the Aminoglycosides?
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
physostigmine
Ataxia - Dizziness - Slurred speech
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

33. Explain potency in relation to full and partial agonists(2).
Amphotericin B - Nystatin - Fluconazole/azoles
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
- Penicillamine

34. Which drug increases Sys BP w/o affecting Pulse Pressure
- Glucagon
GET on the Metro
Epinephrine
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.

35. What is the MOA for Trimethoprim (TMP)?
Teratogenic - Carcinogenic - Confusion - Headaches
hypertension - CHF - diabetic renal disease
Alpha -1 antagonist
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

36. Common toxicities associated with Fluoroquinolones?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
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.
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Amphetamine and Ephedrine

37. What is a sign of toxicity with the use of thrombolytics?
- Fluoroquinolones
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Cephalosporins
Bleeding.

38. Why would you use pralidoxime after exposure to an organophosphate?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Hypersensitivity reactions
Pralidoxime regenerates active cholinesterase.
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

39. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
decrease
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Edrophonium
thiazides - amiloride

40. Antiarrhythmic class IV- effects?
AmOxicillin has greater Oral bioavailability
Pralidoxime regenerates active cholinesterase.
decrease conduction velocity - increase ERP - increase PR interval
cardiac depression - peripheral edema - flushing - dizziness - constipation

41. Which drug(s) cause this reaction: Gingival hyperplasia?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
- Phenytoin
The PTT.

42. What is a Ribavirin toxicity?
Hemolytic anemia
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
- Ammonium Chloride
Activates antithrombin III

43. What is the most common cause of Pt noncompliance with Macrolides?
Nevirapine - Delavirdine
GI discomfort
Inhibits CMV DNA polymerase
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

44. Resistance mechanisms for Tetracycline
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
For serious - Gram + multidrug - resistant organisms
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Decreased uptake or Increased transport out of cell

45. What is the MOA of Ribavirin?
- Shifts the curve down - reduces Vmax
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)
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
GI discomfort

46. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
Epinephirine(Alpha1 -2 and Beta 1 -2)
Prevents the release of ACh - Which results in muscle paralysis.
torsade de pointes - excessive Beta block
Clavulanic acid

47. What is the mechanism of action of the Sulfonylureas?
Norepinephrine
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
- Ethosuxamide - sulfonamides - lamotrigine
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.

48. What are the clinical indications for neostigmine?
YES
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

49. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
aPTT (intrinsic pathway)
Chronic gout.
1. Pioglitazone 2. Rosiglitazone.
Pseudomonas species and Gram - rods

50. ADH antagonists - site of action?
dizziness - flushing - constipation (verapamil) - nausea
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
collecting ducts
Ganciclovir is more toxic to host enzymes

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USMLE Step 1 Pharmacology

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