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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. MOA: Block peptidoglycan synthesis
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Bacitracin - Vancomycin
AV nodal cells
Ataxia - Dizziness - Slurred speech

2. How is Amantadine used clinically?

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3. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
- Formaldehyde & formic acid - severe acidosis & retinal damage
Early myocardial infarction.
Antifungal.

4. How can the toxic effects of TMP be ameliorated?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
With supplemental Folic Acid
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
- Aminocaproic acid

5. What are two indirect acting adrenergic agonists?
- Atropine & pralidoxime
amphetamine and ephedrine
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.
Interstitial nephritis

6. List the specific antidote for this toxin: Methemoglobin
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
- Methylene blue
Digitoxin 70% Digoxin 20-40%
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

7. Spironolactone - mechanism?
for RSV
competitive inhibirot of aldosterone in the cortical collecting tubule
atropine - homatropine - tropicamide
Tricyclic antidepressant.

8. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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9. K+ sparing diuretics - site of action?
- ACE inhibitors (Losartan>no cough)
Pralidoxime regenerates active cholinesterase.
Babiturate.
cortical collecting tubule

10. K+- clinical use?
depresses ectopic pacemakers - especially in digoxin toxicity
HTN - CHF - calcium stone formation - nephrogenic DI.
Pentavalent Antimony
With an amino acid change of D- ala D- ala to D- ala D- lac

11. What is the mechanism of action of NSAIDs other than Aspirin?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Useful in muscle paralysis during surgery or mechanical ventilation.
1. Renal damage 2. Aplastic anemia 3. GI distress
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

12. Digitalis - site of action?
- Methylene blue
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Na/K ATPase
Dopamine

13. MOA: Bactericidal antibiotics
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Resistant Gram - infections
Diarrhea

14. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
Severe Gram - rod infections.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
- Haloperidol - chlorpromazine - reserpine - MPTP
Used in combination therapy with SMZ to sequentially block folate synthesis

15. What is the MOA for Nystatin?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Binds ergosterol - Disrupts fungal membranes
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
AZT - to reduce risk of Fetal Transmission

16. What are common toxic side effects of Sulfonamides? (5)
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Oral
Acetylcholinesterase; ACh is broken down into choline and acetate.
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

17. Which drug(s) cause this reaction: Gray baby syndrome?
- Chloramphenicol
With an amino acid change of D- ala D- ala to D- ala D- lac
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)

18. What is the effect of norepinephrine on bp and pulse pressure?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Amphetamine and Ephedrine
CL= (rate of elimination of drug/ Plasma drug conc.)

19. Is resistant to penicillinase?
- Haloperidol - chlorpromazine - reserpine - MPTP
Succinylcholine
Imipenem
dry mouth - sedation - severe rebound hypertension

20. What are common serious side effects of Aminoglycosides and What are these associated with?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Chronic gout.
Inhibt Assembly of new virus by Blocking Protease Enzyme
- Dimercaprol - succimer

21. Adenosine - clinical use?
Digitoxin>95% Digoxin 75%
- Oral Contraceptives
DOC in diagnosing and abolishing AV nodal arrhythmias
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

22. MOA: Block nucleotide synthesis
Sulfonamides - Trimethoprim
Protease inhibitor.
Same as penicillin. Extended spectrum antibiotics
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.

23. What are the major toxic side effects of Imipenem/cilastatin?
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.
decrease conduction velocity - increase ERP - increase PR interval
GI distress - Skin rash - and Seizures at high plasma levels
- ACE inhibitors (Losartan>no cough)

24. List the specific antidote for this toxin: Cyanide
- Nitrate - hydroxocobalamin thiosulfate
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Beta adrenergic receptors and Ca2+ channels (stimulatory)

25. Digoxin v. Digitoxin: protein binding?
Beta - lactam antibiotics
AV nodal cells
Neutropenia
Digitoxin 70% Digoxin 20-40%

26. What is treated with Chloroquine - Quinine - Mefloquine?
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Malaria (P. falciparum)
not a sulfonamide - but action is the same as furosemide

27. What are three toxicities of Leuprolied?
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
1. Antiandrogen 2. Nausea 3. Vomiting
bradycardia - AV block - CHF
scopolamine

28. What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Yes - it does not cross the placenta.

29. What antimuscarinic agent is used in asthma and COPD?
Ipratropium
Polymyxins
Competitive inibitor of progestins at progesterone receptors.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

30. What are three common NSAIDS other than Aspirin?
Ibuprofen - Naproxen - and Indomethacin
block Na+ channels in the cortical collecting tubule
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
cyanide toxicity (releases CN)

31. How does Ganciclovir's toxicity relate to that of Acyclovir?
- Deferoxamine
Ganciclovir is more toxic to host enzymes
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).

32. Which of these three drugs will cause a reflex bradycardia in your pt (Norepi - Epi - or Isoporterenol)
Ca2+ (Loops Lose calcium)
Norepinephrine
It must be Phosphorylated by Viral Thymidine Kinase
Hypersensitivity reactions

33. Which drug(s) cause this reaction: Neuro and Nephrotoxic?
toxic
Beta -2 agonist.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
- polymyxins

34. What are five possible toxic effects of Aspirin therapy?

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35. Name some common Sulfonamides (4)
Tricyclic antidepressant.
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Inhibit Ergosterol synthesis
- Formaldehyde & formic acid - severe acidosis & retinal damage

36. Decrease Digitoxin dose in renal failure?
NO
CMV - esp in Immunocompromised patients
- Penicillamine
physostigmine

37. How would you reverse the effect of a neuromuscular blocking agent?
Give an antichloinesterase - neostigmine - edrophonium - etc
Quinolones
INH: Injures Neurons and Hepatocytes
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)

38. What is the mechanism of action of Misoprostol?
not a sulfonamide - but action is the same as furosemide
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Mebendazole/Thiabendazole - Pyrantel Pamoate
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

39. Name several common Macrolides (3)
Erythromycin - Azithromycin - Clarithromycin
sedation - sleep alterations
1. Pioglitazone 2. Rosiglitazone.
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased

40. Adverse effects of Reserpine?
hyperaldosteronism - K+ depletion - CHF
decrease conduction velocity - increase ERP - increase PR interval
Penicillin.
sedation - depression - nasal stuffiness - diarrhea

41. What is the mechanism of action of Clomiphene?
Norepinephrine
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Blocks Norepi - but not Dopamine
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.

42. What is the MOA of Foscarnet?
Inhibits Viral DNA polymerase
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Abortifacient.
hyperaldosteronism - K+ depletion - CHF

43. What are four clinical activities of Aspirin?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Dopamine
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
distal convoluted tubule (early)

44. Adverse effects of Loop Diuretics?
cyanide toxicity (releases CN)
hypertension - CHF - diabetic renal disease
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity

45. What are four clinical uses of glucocorticoids?

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46. What would be the effect on blood pressure with infusion of the alpha -2 agonist clonidine?
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Tricyclic antidepressant.
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.

47. List the specific antidote for this toxin: Amphetamine
- Ammonium Chloride
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
Chronic Hepatitis A and B - Kaposi's Sarcoma

48. Antiarrhythmic class IB- clinical uses?
post MI and digitalis induced arrhythmias
decrease
- polymyxins
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

49. Loop diuretics (furosemide)- site of action?
is resistant
Rapid (seconds)
thick ascending limb
Impairs the synthesis of vitamin K- dependent clotting factors

50. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
cholestyramine - colestipol
Carbenicillin - Piperacillin - and Ticarcillin
Pseudomonas species and Gram - rods
anticholinesterase glaucoma

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USMLE Step 1 Pharmacology

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