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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. List the specific antidote for this toxin: Lead
torsade de pointes
- EDTA - dimercaprol - succimer - & penicillamine
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
GI discomfort

2. What is the mecanism of action of Sucralfate?
Potent immunosuppressive used in organ transplant recipients.
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
GI side effects. (Indomethacin is less toxic - more commonly used.)
1. Reliable (<1% failure) 2. Lowers risk of endometrial and ovarian cancer 3. Decreased incidence of ectopic pregnancy 4. Lower risk of pelvic infections 5. Regulation of menses

3. Triamterene and amiloride - mechanism?
block Na+ channels in the cortical collecting tubule
Diuresis in pateints with sulfa allergy
Dobutamine has more of an affintiy for beta -1 than beta -2 - and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse - and is used in treatment of acute asthma.
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

4. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Tendonitis and Tendon rupture
- Shifts the curve down - reduces Vmax
first dose orthostatic hypotension - dizziness - headache
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

5. How does NE modulate its own release? What other neurotransmitter has this same effect?
IV vitamin K and fresh frozen plasma
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
Inhibits cell wall mucopeptide formation - Bactericidal
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.

6. What are the clinical indications for Azole therapy?
Systemic mycoses
Tendonitis and Tendon rupture
Digitoxin 168hrs Digoxin 40 hrs
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB

7. What are the indications for using amphetamine?

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8. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
atropine - homatropine - tropicamide
Beta1 more than B2
dizziness - flushing - constipation (verapamil) - nausea
Chronic gout.

9. Resistance mechanisms for Sulfonamides
anuria - CHF
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

10. How does botulinum toxin result in respiratory arrest?
Local anesthetic.
Prevents the release of ACh - Which results in muscle paralysis.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

11. What enzyme does Zileuton inhibit?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Lipoxygenase
Rheumatoid and osteoarthritis.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

12. Specifically - How does Foscarnet inhibit viral DNA pol?
Binds to the Pyrophosphate Binding Site of the enzyme
Does not cross
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.
penicillinase resistant

13. Furosemide - class and mechanism?
Antileukotriene; blocks synthesis by lipoxygenase.
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

14. Antimicrobial prophylaxis for Syphilis
Hypersensitivity reactions
Benzathine penicillin G
very short acting
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.)

15. What is Metronidazole used for clinically?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Digitoxin>95% Digoxin 75%
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
- Ethosuxamide - sulfonamides - lamotrigine

16. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
Enterobacter
Hypersensitivity reactions
Forms toxic metabolites in the bacterial cell - Bactericidal
Interstitial nephritis

17. Why is carbachol and pilocarpine useful in treatment of glaucoma?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
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.
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
- Corticosteroids - heparin

18. What is the category and mechanism of action of Zafirlukast in Asthma treatment?
Antileukotriene; blocks leukotriene receptors.
Inhibit viral DNA polymerase
Inhibits reabsorption of uric acid.
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

19. What is the MOA for the Fluoroquinolones?
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Norepinephrine
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

20. Which drug(s) cause this reaction: Cutaneous flushing (4)?
anuria - CHF
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Anaerobes

21. Name the Protease Inhibitors (4)
- Nitrate - hydroxocobalamin thiosulfate
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Blocks Norepi - but not Dopamine
Onchocerciasis ('river blindness'-- rIVER- mectin)

22. Name two bile acid resins.
Acute gout.
Systemic mycoses
cholestyramine - colestipol
- Formaldehyde & formic acid - severe acidosis & retinal damage

23. Common side effects associated with Clindamycin include?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

24. What is the major side effect for Ampicillin and Amoxicillin?
Beta antagonist.
Hypersensitivity reactions
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
As an anticholinesterase it increases endogenous ACh and thus increases strength.

25. Aztreonam is not ________ with penicillins
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
cross - allergenic
- Ethosuxamide - sulfonamides - lamotrigine
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

26. Which drug(s) cause this reaction: Fanconi's syndrome?
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
- Tetracycline
Protease inhibitor.

27. Foscarnet toxicity?
VACUUM your Bed Room'
Foscarnet = pyroFosphate analog
Cell membrane Ca2+ channels of cardiac sarcomere
Nephrotoxicity

28. What is the receptor affinity and clinical use of isoproterenol?
It affects beta receptors equally and is used in AV heart block (rare).
Epinephrine
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
Abortifacient.

29. Which drug(s) cause this reaction: Thrombotic complications?
- Oral Contraceptives
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
PT

30. What is the effect of the Glitazones in diabetes treatment?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Increase target cell response to insulin.
Bacitracin - Vancomycin

31. Furosemide increases the excretion of What ion?
IV vitamin K and fresh frozen plasma
Ca2+ (Loops Lose calcium)
Tricyclic antidepressant.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

32. What is the memory key for the action of Sildenafil (Viagra)?
Activates antithrombin III
Acute gout.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Sildenafil fills the penis

33. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Imipenem
Pyridoxine (B6) administration
Chronic anticoagulation.

34. What is the mechanism of action of Cyclosporine?
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.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Hypersensitivity reactions
- polymyxins

35. What is the mechanism of action of Allopurinol used to treat chronic gout?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Those patients who are taking nitrates.
Treatment of infertility.
Liver

36. List the specific antidote for this toxin: Beta Blockers
hypertension - angina - arrhythmias
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
- Glucagon
- Oxalic acid - Acidosis & nephrotoxicity

37. What is the mechanism of Leuprolide?
AZT
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
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

38. What populations are Floroquinolones contraindicated in? Why?
Inhibit Ergosterol synthesis
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Pregnant women - Children; because animal studies show Damage to Cartilage
Yes

39. What is the category of drug names ending in - tidine (e.g. Cimetidine)
Pralidoxime regenerates active cholinesterase.
H2 antagonist
Penicillin - G
GI distress - Skin rash - and Seizures at high plasma levels

40. Which drug(s) cause this reaction: Pseudomembranous colitis?
Pentamidine
CL= (rate of elimination of drug/ Plasma drug conc.)
- Clindamycin
Na/K ATPase

41. What are the side effects of Rifampin?
DHPG (dihydroxy-2- propoxymethyl guanine)
Minor hepatotoxicity - Drug interactions (activates P450)
- Oral Contraceptives
Scopolamine

42. What are the clinical uses for 3rd Generation Cephalosporins?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

43. List the specific antidote for this toxin: Antimuscarinic (anticholinergic)
- Physostigmine salicylate
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

44. List the specific antidote for this toxin: Opioids
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Norepinephrine (Alpha1 -2 and beta 1)
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
- B51Naloxone / naltrexone (Narcan)

45. List the mechanism - clinical use - & toxicity of 5 FU.
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
IV vitamin K and fresh frozen plasma
Indirect agonist - uptake inhibitor
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

46. Antiarrhythmic class IV- toxicity?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Verapamil - Diltiazem - Bepridil

47. Adverse effects of Methyldopa?

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48. List some specifics of lead poisoning(4)?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
- Glucagon
Pretreat with antihistamines and a slow infusion rate

49. How are the HIV drugs used clinically?

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50. How does Ganciclovir's toxicity relate to that of Acyclovir?
Ganciclovir is more toxic to host enzymes
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Acetylcholinesterase; ACh is broken down into choline and acetate.
These B-2 agonists cause respiratory smooth muscle to relax.

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USMLE Step 1 Pharmacology

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