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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. For Warfarin What is the Duration of action
Chronic (weeks or months)
GI disturbances.
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
1. Antiandrogen 2. Nausea 3. Vomiting

2. Adverse effects of Hydrochlorothiazide?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Albuterol - tertbutaline
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Beta adrenergic receptors and Ca2+ channels (stimulatory)

3. Explain potency in relation to full and partial agonists(2).
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Severe Gram - rod infections.
Reversible block of histamine H2 receptors
Aminoglycosides - Tetracyclines

4. Ibutilide - toxicity?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
blocks SR Ca2+ channels
- Protamine
torsade de pointes

5. What is the mechanism of action of Colchicine used to treat acute gout?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Enterobacter
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

6. How is Amphotericin B administered for fungal meningitis?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
- Methylene blue
Staphlococcus aureus
Intrathecally

7. What are the major toxic side effects of the Cephalosporins?
- Isoniazid
Prevents the release of Ca from SR of skeletal muscle
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
- Ethanol - dialysis - & fomepizole

8. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
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.
Short.
Carbenicillin - Piperacillin - and Ticarcillin

9. MOA: Disrupt bacterial/fungal cell membranes
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
torsade de pointes - excessive Beta block
Polymyxins
for RSV

10. List the specific antidote for this toxin: Carbon monoxide
-100% oxygen - hyperbaric
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

11. Antiarrhythmic Class III- effects?
Hemolytic anemia
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
GI side effects. (Indomethacin is less toxic - more commonly used.)
Treatment of infertility.

12. What Sulfonamides are used for simple UTIs?
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
proximal convoluted tubule
Triple sulfas or SMZ
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

13. What is a prerequisite for Acyclovir activation?
- ACE inhibitors (Losartan>no cough)
Scopolamine
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
It must be Phosphorylated by Viral Thymidine Kinase

14. For Heparin What is the Site of action
- Cloazapine - carbamazapine - colchicine - PTU
Nephrotoxicity
Blood
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

15. Why is there a drop in systolic - mean - and diastolic bp with infusion of isoproterenol?
post MI and digitalis induced arrhythmias
Alpha -1 antagonist
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors

16. What is Fluconazole specifically used for?
Rare.
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Foscarnet = pyroFosphate analog
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation

17. What are the clinical uses for Imipenem/cilastatin?
Anaerobes
No - it inhibits the release of Nor Epi
Gram + cocci - Gram - rods - and Anerobes
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

18. Adverse effects of Nifedipine - verapamil?
- aminoglycosides - loop diuretics - cisplatin
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
dizziness - flushing - constipation (verapamil) - nausea
- Deferoxamine

19. Which RT inhibitors cause a Rash?
Non - Nucleosides
Beta - lactam antibiotics
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

20. What is the category of drug names ending in - cycline (e.g. Tetracycline)
Choline acetyltransferase
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Antibiotic - protein synthesis inhibitor.

21. Why would dopamine be useful in treating shock?
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
penicillinase resistant

22. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Phosphorylation by a Viral Kinase
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium

23. How do Sulfonamides act on bacteria?
Keratin containing tissues - e.g. - nails
Inhibt Assembly of new virus by Blocking Protease Enzyme
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
- Tetracycline

24. What is the mechanism of action of Omeprazole - Lansoprazole?
not a sulfonamide - but action is the same as furosemide
all of them
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

25. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
bradycardia - AV block - CHF

26. What is the memory key for Isoniazid (INH) toxicity?
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Polymyxin B - Polymyxin E
Pentavalent Antimony
INH: Injures Neurons and Hepatocytes

27. How is Amphotericin B used clinically?
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Does not cross
- Haloperidol - chlorpromazine - reserpine - MPTP
- Tamoxifen

28. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
reversible SLE- like syndrome
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
carbonic anhydrase inhibitors - K+ sparing diuretics
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

29. Adverse effects of Losartan?
fetal renal toxicity - hyperkalemia
- Ethosuxamide - sulfonamides - lamotrigine
- B51Naloxone / naltrexone (Narcan)
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

30. What is the category and mechanism of action of Zileuton in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
Neurotoxicity - Acute renal tubular necrosis
Saquinavir - Ritonavir - Indinavir - Nelfinavir
- Clindamycin

31. What is the MOA of Polymyxins?
Does not cross
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Local anesthetic.

32. What is the mechanism of action of Cyclosporine?
Clavulanic acid
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Binds to cyclophilins (peptidyl proline cis - trans isomerase) - blocking the differentiation and activation of T cells mainly by inhibiting the production of IL-2 and its receptor.
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

33. Name two organisms Vancomycin is commonly used for?
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Antifungal.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

34. How do you treat coma in the ER (4)?
- Vitamin K & fresh frozen plasma
proximal convoluted tubule
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

35. Toxic effects of TMP include?
Imipenem
Megaloblastic anemia - Leukopenia - Granulocytopenia
loop diuretics - thiazides
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil

36. What is the most common cause of Pt noncompliance with Macrolides?
- Cloazapine - carbamazapine - colchicine - PTU
GI discomfort
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

37. Steady state concentration is reached in __ number of half - lifes
Inhibits DNA dependent RNA polymerase
Liver
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
very short acting

38. Cocaine casues vasoconstriction and local anesthesia by What mechanism
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Indirect agonist - uptake inhibitor
Ipratropium
Choline acetyltransferase

39. Which drug(s) cause this reaction: Cutaneous flushing (4)?
- Niacin - Ca++ channel blockers - adenosine - vancomycin
- N- acetylcystine
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
The only local anesthetic with vasoconstrictive properties.

40. What is the MOA of Griseofulvin?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Delirium - Tremor - Nephrotoxicity
Interferes with microtubule function - disrupts mitosis - inhibits growth

41. Can Heparin be used during pregnancy?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
- Haloperidol - chlorpromazine - reserpine - MPTP
Yes - it does not cross the placenta.

42. Mannitol - contraindications?
- Ethanol - dialysis - & fomepizole
anuria - CHF
Suramin
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

43. Which drug(s) cause this reaction: Fanconi's syndrome?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
- Tetracycline
- Tamoxifen
prevention of nodal arrhythmias (SVT)

44. A common side effects of Interferon (INF) treatment is?
Protamine sulfate
VACUUM your Bed Room'
Neutropenia
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

45. Name the common Nucleoside Reverse Transcriptase Inhibitors
thiazides - amiloride
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Alpha -1 antagonist
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

46. What is the effect of norepinephrine on bp and pulse pressure?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
Activates antithrombin III
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

47. For Warfarin What is the Onset of action
CL= (rate of elimination of drug/ Plasma drug conc.)
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Slow - limited by half lives of clotting factors

48. For Warfarin What is the Site of action
Epinephrine
- Oxalic acid - Acidosis & nephrotoxicity
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Liver

49. For Warfarin What is the Lab value to monitor
PT
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

50. What is the MOA for Nystatin?
Binds ergosterol - Disrupts fungal membranes
Norepinephrine (Alpha1 -2 and beta 1)
- Deferoxamine
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

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USMLE Step 1 Pharmacology

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