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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. Why are the Sulfonylureas inactive in IDDM (type -1)?
Because they require some residual islet function.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Fast vs. Slow Acetylators
Antileukotriene; blocks leukotriene receptors.

2. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
blocks SR Ca2+ channels
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Clavulanic acid
Dopamine; causes its release from intact nerve terminals

3. What should not be taken with Tetracyclines? / Why?
Doxycycline - because it is fecally eliminated
thiazides - amiloride
Amphetamine and Ephedrine
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut

4. Triamterene and amiloride - mechanism?
cyanide toxicity (releases CN)
- Chloramphenicol
- Atropine & pralidoxime
block Na+ channels in the cortical collecting tubule

5. What is the mechanism of action of Acetaminophen?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Antibiotic - protein synthesis inhibitor.
Diarrhea
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)

6. What are four conditions in Which H2 Blockers are used clinically?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
decrease conduction velocity - increase ERP - increase PR interval
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Nitrates

7. Why does atropine dilate the pupil?
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Headache - flushing - dyspepsia - blue - green color vision.
Sulfonamides - Trimethoprim

8. If a patient is given hexamethonium - What would happen to his/her heart rate?
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.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Decreased uptake or Increased transport out of cell
is resistant

9. What do Aminoglycosides require for uptake?
- EDTA - dimercaprol - succimer - & penicillamine
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- Isoniazid
Oxygen

10. What are two Alpha - glucosidase inhibitors?
1. Acarbose 2. Miglitol
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Chronic gout.
all of them

11. ___________ are Teratogenic
Aminoglycosides
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Beta antagonist.
Methicillin - Nafcillin - and Dicloxacillin

12. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Babiturate.
Tricyclic antidepressant.
Gram + - Gram - - Norcardia - Chlamydia
Hypersensitivity reactions

13. What is the MOA of the RT Inhibitors?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
It must be Phosphorylated by Viral Thymidine Kinase
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal

14. How is Vancomycin used clinically?
It inhibits release of NE.
For serious - Gram + multidrug - resistant organisms
Activates antithrombin III
Chronic gout.

15. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Choline acetyltransferase
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

16. What is the category of drug names ending in - caine (e.g. Lidocaine)
Local anesthetic.
cardiac depression - peripheral edema - flushing - dizziness - constipation
Inhibits CMV DNA polymerase
Minor hepatotoxicity - Drug interactions (activates P450)

17. Ibutilide - toxicity?
torsade de pointes
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
No
Blocks Norepi - but not Dopamine

18. Name four Antiarrhythmic drugs in class IA.
Bethanechol - Neostigmine - physostigmine
Sulfonamides - Trimethoprim
Quinidine - Amiodarone - Procainamide - Disopyramide
Norepinephrine

19. What are two Glitazones?
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Impairs the synthesis of vitamin K- dependent clotting factors
1. Pioglitazone 2. Rosiglitazone.
GI distress - Skin rash - and Seizures at high plasma levels

20. A 57 yo heart failure pt develops cardiac decompensation - What drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
Protamine sulfate
anticholinesterase glaucoma
Dopamine
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

21. List the specific antidote for this toxin: Acetaminophen
Cilastatin
Nephrotoxicity
Edrophonium
- N- acetylcystine

22. Antiarrhythmic class IB- effects?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
The only local anesthetic with vasoconstrictive properties.
- Daunorubicin & Doxorubicin

23. How do we stop angina?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
DHPG (dihydroxy-2- propoxymethyl guanine)
sedation - sleep alterations

24. What is the possible mechanism and effect of Metformin in treating diabetes?
- Oral Contraceptives
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Succinylcholine
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

25. Which drug(s) cause this reaction: Torsade de pointes (2)?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Protease Inhibitors and Reverse Transcriptase Inhibitors
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

26. Mannitol - clinical use?
Small lipid - soluble molecule
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin

27. What is the clincial use for Misoprostol?
Diuresis in pateints with sulfa allergy
anticholinesterase glaucoma
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
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

28. What is the memory key for the effect of magnesium hydroxide overuse?
Mg = Must go to the bathroom.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Competitive inibitor of progestins at progesterone receptors.
Benzathine penicillin G

29. MOA: Block protein synthesis at 50s subunit
- N- acetylcystine
Yes - it does not cross the placenta.
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Activates antithrombin III

30. Common toxicities associated with Fluoroquinolones?
Hypersensitivity reactions
GI upset
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Ipratropium

31. What is the lab value used to monitor the effectiveness of Heparin therapy?
H2 antagonist
Digitoxin>95% Digoxin 75%
The PTT.
DOC in diagnosing and abolishing AV nodal arrhythmias

32. List the specific antidote for this toxin: Carbon monoxide
Long.
-100% oxygen - hyperbaric
- Glucocorticoid withdrawal
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut

33. What is a common side effect of Colchicine used to treat acute gout - especially When given orally?
GI side effects. (Indomethacin is less toxic - more commonly used.)
- Antipsychotics
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
No

34. What are the Anti - TB drugs?
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
cyanide toxicity (releases CN)

35. Adverse effects of Clonidine?
ACE inhibitor.
dry mouth - sedation - severe rebound hypertension
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.

36. What is the mechanism of action of Clomiphene?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
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.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)

37. What is the memory key for Isoniazid (INH) toxicity?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
NO
Clavulanic acid
INH: Injures Neurons and Hepatocytes

38. What is the mechanism of Tacrolimus (FK506)?
DHPG (dihydroxy-2- propoxymethyl guanine)
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
- Act on same receptor - Full has greater efficacy

39. How do the Protease Inhibitors work?
Inhibt Assembly of new virus by Blocking Protease Enzyme
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

40. What are two toxicities of the Glitazones?
decrease conduction velocity - increase ERP - increase PR interval
No - hemicholinum block the uptake of Choline and thus Ach synthesis
1. Weight gain 2. Hepatotoxicity (troglitazone)
- polymyxins

41. What are three types of antacids and the problems that can result from their overuse?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Pentamidine
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

42. Resistance mechanisms for Sulfonamides
decrease
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Rifampin (DOC) - minocycline
- Quinidine - quinine

43. List the specific antidote for this toxin: Tricyclic antidepressants
- NaHCO3
Aminoglycosides
cholestyramine - colestipol
Modification via Acetylation

44. Name the common Fluoroquinolones (6)
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
IV vitamin K and fresh frozen plasma
- Lithium

45. Which H2 Blocker has the most toxic effects and What are they?
Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal excretion of creatinine. Other H2 blockers are relatively free of these effects.
Indirect agonist - uptake inhibitor
Binds ergosterol - Disrupts fungal membranes
compensatory tachycardia - fluid retention - lupus - like syndrome

46. Hydralazine - toxicity?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
compensatory tachycardia - fluid retention - lupus - like syndrome
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

47. What is the category of drug names ending in - cillin (e.g. Methicillin)
Babiturate.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Penicillin.

48. Which of epi - norepi - or isoproterenol results in bradycardia?
Norepinephrine
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Quinidine - Amiodarone - Procainamide - Disopyramide
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA

49. ADH antagonists - site of action?
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
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.
collecting ducts
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

50. How is Griseofulvin used clinically?
Increases coumadin metabolism
Same as penicillin. Act as narrow spectrum antibiotics
Gemfibrozil - Clofibrate
Oral treatment of superficial infections

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USMLE Step 1 Pharmacology

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