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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. Which Tetracycline is used in patients with renal failure? / Why?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
RESPIre
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Doxycycline - because it is fecally eliminated

2. What is the mechanism of action of Misoprostol?
- Flumazenil
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Botulinum

3. Name three calcium channel blockers?
Carbenicillin - Piperacillin - and Ticarcillin
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Nifedipine - Verapamil - Diltiazem

4. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
physostigmine
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.

5. What is used to reverse the action of Heparin?
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
Sildenafil fills the penis
- Alkalate DNA - Brain tumors - CNS toxicity
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

6. How is Rifampin used clinically?
Methylxanthine.
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

7. What is the mechanism of action of the thrombolytics?
Beta - lactam antibiotics
Epinephrine
Paranteral (IV - SC)
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.)

8. What is the mecanism of action of the COX-2 inhibitors (celecoxib - rofecoxib)?
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.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
- N- acetylcystine
Abortifacient.

9. MOA: Block DNA topoisomerases
Quinolones
Digitoxin 168hrs Digoxin 40 hrs
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
- Daunorubicin & Doxorubicin

10. What is the MOA for Nystatin?
Cardiac glycoside (inotropic agent).
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
Binds ergosterol - Disrupts fungal membranes

11. What is the mechanism of action of NSAIDs other than Aspirin?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Oxygen

12. Which drug(s) cause this reaction: Hot flashes?
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
hypertension - angina - arrhythmias
- Tamoxifen

13. Adverse effects of Prazosin?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
first dose orthostatic hypotension - dizziness - headache
Modification via Acetylation
Nephrotoxicity

14. What is a sign of toxicity with the use of thrombolytics?
Bleeding.
Dermatophytes (tinea - ringworm)
No
- Clindamycin

15. Aztreonam is not ________ with penicillins
- Hydralazine - Procainamide - INH - phenytoin
Protease inhibitor.
- ACE inhibitors (Losartan>no cough)
cross - allergenic

16. What cholinomimetics might your pt be taking for his glaucoma
Carbachol - pilocarpine - physostigmine - echothiophate
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Interferes with microtubule function - disrupts mitosis - inhibits growth

17. K+ sparing diuretics - site of action?
Acetylcholinesterase; ACh is broken down into choline and acetate.
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
cortical collecting tubule
- Protamine

18. What can result due to antacid overuse?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Decreased uptake or Increased transport out of cell
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

19. How does a noncompetitive antagonist effect an agonist?
propanolol - esmolol - metoprolol - atenolol - timolol
Onchocerciasis ('river blindness'-- rIVER- mectin)
- Shifts the curve down - reduces Vmax
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.

20. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Albuterol - tertbutaline
- Ethanol - dialysis - & fomepizole

21. Mannitol - toxicity?
pulmonary edema - dehydration
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Reversible block of histamine H2 receptors
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

22. How does resistance to Vancomycin occur?
GI discomfort
With an amino acid change of D- ala D- ala to D- ala D- lac
cross - allergenic
No - hemicholinum block the uptake of Choline and thus Ach synthesis

23. What is a prerequisite for Acyclovir activation?
Nitrates
1. Weight gain 2. Hepatotoxicity (troglitazone)
proximal convoluted tubule - thin descending limb - and collecting duct
It must be Phosphorylated by Viral Thymidine Kinase

24. Why would you use pralidoxime after exposure to an organophosphate?
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Epinephrine
Pralidoxime regenerates active cholinesterase.

25. What is the memory key for Metronidazole's clinical uses?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
GET on the Metro
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Rheumatoid and osteoarthritis.

26. List the specific antidote for this toxin: Acetaminophen
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
- N- acetylcystine
Minor hepatotoxicity - Drug interactions (activates P450)
cross - allergenic

27. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
depresses ectopic pacemakers - especially in digoxin toxicity
Nevirapine - Delavirdine
Interferes with microtubule function - disrupts mitosis - inhibits growth
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450

28. What is the clinical use for Penicillin?
Praziquantel
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Beta lactams - inhibit cell wall synthesis - Bactericidal
- Steroids - Tamoxifen

29. Which diuretics decrease urine Ca2+?
sedation - depression - nasal stuffiness - diarrhea
Increases coumadin metabolism
thiazides - amiloride
compensatory tachycardia - fluid retention - lupus - like syndrome

30. What is Nifurtimox administered for?

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31. How can the toxic effects of TMP be ameliorated?
Same as penicillin. Extended spectrum antibiotics
Spironolactone - Triamterene - Amiloride (the K+ STAys)
AZT
With supplemental Folic Acid

32. What is the memory key for the effect of magnesium hydroxide overuse?
Mg = Must go to the bathroom.
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Beta antagonist.
block Na+ channels in the cortical collecting tubule

33. How does botulinum toxin result in respiratory arrest?
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Prevents the release of ACh - Which results in muscle paralysis.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

34. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Erectile dysfunction.
- Formaldehyde & formic acid - severe acidosis & retinal damage
Gram + and Anerobes

35. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
AZT - to reduce risk of Fetal Transmission
Methylxanthine.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

36. What is the MOA of Isoniazid (INH)?
Amphetamine and Ephedrine
- EDTA - dimercaprol - succimer - & penicillamine
Decreases synthesis of Mycolic Acid
Lidocaine - Mexiletine - Tocainide

37. Mannitol - site of action?
Edrophonium
Those patients who are taking nitrates.
Severe Gram - rod infections.
proximal convoluted tubule - thin descending limb - and collecting duct

38. Ca2+ channel blockers - site of action?
Cell membrane Ca2+ channels of cardiac sarcomere
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Binds to the Pyrophosphate Binding Site of the enzyme
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

39. Furosemide - clinical use?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Hypersensitivity reactions
- Niacin - Ca++ channel blockers - adenosine - vancomycin
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

40. Name four HMG- CoA reductase inhibitors.
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
No

41. Hydralazine - class and mechanism?
Mebendazole/Thiabendazole - Pyrantel Pamoate
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Inhibit viral DNA polymerase

42. What are common toxicities associated with Tetracyclines?

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43. Hydrochlorothiazide - clinical use?
HTN - CHF - calcium stone formation - nephrogenic DI.
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

44. What is the mechanism of action of Aspirin?
Binds to the Pyrophosphate Binding Site of the enzyme
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

45. How is Amphotericin B used clinically?
Beta - lactam antibiotics
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

46. How is Trimethoprim used clinically?
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Used in combination therapy with SMZ to sequentially block folate synthesis
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

47. What are the side effects of Polymyxins?
is resistant
Epinephirine(Alpha1 -2 and Beta 1 -2)
Neurotoxicity - Acute renal tubular necrosis
decrease conduction velocity - increase ERP - increase PR interval

48. Which Aminoglycoside is used for Bowel Surgery ?
DHPG (dihydroxy-2- propoxymethyl guanine)
Neomycin
Pregnant women - Children; because animal studies show Damage to Cartilage
Benzodiazepine.

49. Beta Blockers - CNS toxicity?
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.
G6PD deficient individuals
sedation - sleep alterations
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias

50. Which cancer drugs work at the level of proteins(2)?
- Vinca alkaloids(inhibit MT) - Paclitaxel
With an amino acid change of D- ala D- ala to D- ala D- lac
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

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USMLE Step 1 Pharmacology

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