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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 do Aminoglycosides require for uptake?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
- B51Naloxone / naltrexone (Narcan)
Oxygen

2. Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Heparin catalyzes the activation of antithrombin III.
Competitive inibitor of progestins at progesterone receptors.
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

3. Antiarrhythmic class IV- clinical use?
- N- acetylcystine
prevention of nodal arrhythmias (SVT)
Neomycin
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.

4. Common toxicities associated with Griseofulvin?
Buy AT 30 - CELL at 50'
Give an antichloinesterase - neostigmine - edrophonium - etc
- Quinidine - quinine
Teratogenic - Carcinogenic - Confusion - Headaches

5. What are signs of Sildenafil (Viagra) toxicity?
decrease conduction velocity - increase ERP - increase PR interval
- Phenytoin
Antileukotriene; blocks synthesis by lipoxygenase.
Headache - flushing - dyspepsia - blue - green color vision.

6. Reserpine will block the syntheis of this drug and but not its precursor.
Blocks Norepi - but not Dopamine
collecting ducts
compensatory tachycardia - fluid retention - lupus - like syndrome
Stimulates beta adrenergic receptors

7. Ca2+ channel blockers - mechanism?
Neomycin
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

8. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
- Oxalic acid - Acidosis & nephrotoxicity
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
cross - allergenic
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

9. Antiarrhythmic Class III- effects?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

10. What is the category of drug names ending in - zosin (e.g. Prazosin)
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Does not cross
Alpha -1 antagonist
Neutropenia

11. List the mechanism - clinical use - & toxicity of Paclitaxel.
Ganciclovir is more toxic to host enzymes
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Pituitary hormone.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

12. What class of drug is echothiophate? What is its indication?
Norepinephrine (Alpha1 -2 and beta 1)
anticholinesterase glaucoma
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Chronic Hepatitis A and B - Kaposi's Sarcoma

13. How do spare receptors effect the Km?
- Formaldehyde & formic acid - severe acidosis & retinal damage
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
- ED 50 is less than the Km (less than 50% of receptors)
Protamine sulfate

14. Antiarrhythmic class II- toxicity?
Blood
IV vitamin K and fresh frozen plasma
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia

15. What are Polymyxins used for?
Resistant Gram - infections
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
It affects beta receptors equally and is used in AV heart block (rare).
Hypersensitivity reactions

16. List the specific antidote for this toxin: Methemoglobin
edrophonium (extremely short acting anticholinesterase)
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
- Methylene blue
Aminoglycosides

17. Which drug(s) cause this reaction: Hot flashes?
- Flumazenil
Verapamil - Diltiazem - Bepridil
Inhibits reabsorption of uric acid.
- Tamoxifen

18. Which drug(s) cause this reaction: P450 induction(6)?
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
GI side effects. (Indomethacin is less toxic - more commonly used.)
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine

19. List the specific antidote for this toxin: Copper
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
- Penicillamine
With supplemental Folic Acid
Inhibt Assembly of new virus by Blocking Protease Enzyme

20. Why is pyridostigmine effective in the treatment of myasthenia gravis?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
severe hypertension - CHF
very short acting
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

21. Adverse effects of Prazosin?
- Physostigmine salicylate
first dose orthostatic hypotension - dizziness - headache
Dopamine; causes its release from intact nerve terminals
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.

22. Why are the Sulfonylureas inactive in IDDM (type -1)?
Rheumatoid and osteoarthritis.
HTN - CHF - calcium stone formation - nephrogenic DI.
Cephalosporins
Because they require some residual islet function.

23. How does angiotensin II affect NE release?
It acts presynaptically to increase NE release.
- Bleomycin - amiodarone - busulfan
Acetylcholinesterase; ACh is broken down into choline and acetate.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

24. What is the MOA of Griseofulvin?
Interferes with microtubule function - disrupts mitosis - inhibits growth
Hypersensitivity reactions
Neutropenia
- Clindamycin

25. Name three ACE inhibitors?
Rash - Pseudomembranous colitis
- Tamoxifen
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Captopril - Enalapril - Lisinopril

26. Which individuals are predisposed to Sulfonamide - induced hemolysis?
G6PD deficient individuals
Nevirapine - Delavirdine
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

27. How would you reverse the effect of a neuromuscular blocking agent?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Give an antichloinesterase - neostigmine - edrophonium - etc
Prophylaxis for Influenza A - Rubella; Parkinson's disease

28. Name three Antiarrhythmic drugs in class IC.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Flecainide - Encainide - Propafenone
Beta - lactam antibiotics
AluMINIMUM amount of feces.

29. Which drug(s) cause this reaction: Tardive dyskinesia?
- Antipsychotics
compensatory tachycardia - fluid retention - lupus - like syndrome
Increases coumadin metabolism
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

30. What is the clinical use for Sildenafil (Viagra)?
Erectile dysfunction.
Lipoxygenase
Small lipid - soluble molecule
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction

31. What is the category and mechanism of action of Zileuton in Asthma treatment?
Antileukotriene; blocks synthesis by lipoxygenase.
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Increase target cell response to insulin.

32. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
Amphetamine and Ephedrine
Chronic gout.

33. List the specific antidote for this toxin: Benzodiazepines
- Methylene blue
Spironolactone - Triamterene - Amiloride (the K+ STAys)
carbonic anhydrase inhibitors - K+ sparing diuretics
- Flumazenil

34. What is the MOA of Polymyxins?
Liver
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
- Quinidine - quinine
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

35. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
thick ascending limb
Scopolamine
Neurotoxicity - Acute renal tubular necrosis
Foscarnet = pyroFosphate analog

36. What drugs target anticholinesterase
- Phenytoin
- Ethanol - dialysis - & fomepizole
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

37. What is Metronidazole used for clinically?
- EDTA - dimercaprol - succimer - & penicillamine
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
anuria - CHF

38. What are three unwanted effects of Mifepristone?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
1. Acarbose 2. Miglitol
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
AZT - to reduce risk of Fetal Transmission

39. Name two classes of drugs for HIV therapy
Onchocerciasis ('river blindness'-- rIVER- mectin)
Protease Inhibitors and Reverse Transcriptase Inhibitors
AmOxicillin has greater Oral bioavailability
- Chlorpromazine - thioridazine - haloperidol

40. Hydrochlorothiazide - mechanism?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Doxycycline - because it is fecally eliminated

41. Name the Protease Inhibitors (4)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Triple sulfas or SMZ
- Hydralazine - Procainamide - INH - phenytoin
Norepinephrine

42. What is the memory key for Metronidazole's clinical uses?
cardiac depression - peripheral edema - flushing - dizziness - constipation
GET on the Metro
- Clindamycin
- Ethanol - dialysis - & fomepizole

43. What is the clinical use for Nystatin?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Topical and Oral - for Oral Candidiasis (Thrush)
Beta lactams - inhibit cell wall synthesis - Bactericidal
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances

44. How are Sulfonamides employed clinically?
Gram + - Gram - - Norcardia - Chlamydia
Topical and Oral - for Oral Candidiasis (Thrush)
Dermatophytes (tinea - ringworm)
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

45. For Heparin What is the Route of administration
Antibiotic - protein synthesis inhibitor.
Paranteral (IV - SC)
CMV Retinitis in IC pts When Ganciclovir fails
Peptic ulcer disease.

46. Name the steps in drug approval(4)?
Protease Inhibitors and Reverse Transcriptase Inhibitors
Ibuprofen - Naproxen - and Indomethacin
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Neurotoxicity - Acute renal tubular necrosis

47. Why are Methicillin - Nafcillin - and Dicloxacillin penicillinase resistant?
Abortifacient.
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Due to the presence of a bulkier R group
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

48. For Heparin What is the Structure
Blood
Gram + and Anerobes
Large anionic polymer - acidic
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

49. Name the common Aminoglycosides (5)
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Rapid (seconds)
cyanide toxicity (releases CN)

50. Acetazolamide - mechanism?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Epinephirine(Alpha1 -2 and Beta 1 -2)
post MI and digitalis induced arrhythmias
Beta1 more than B2

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USMLE Step 1 Pharmacology

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