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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. Nifedipine has similar action to?
Nitrates
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
proarrhythmic
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

2. How is Ribavirin used clinically?
loop diuretics - thiazides
for RSV
G6PD deficient individuals
Quinidine - Amiodarone - Procainamide - Disopyramide

3. For Warfarin What is the Site of action
Liver
Blocks Influenza A and RubellA; causes problems with the cerebellA
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Sulfonamides - Trimethoprim

4. Toxicities associated with Acyclovir?
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Delirium - Tremor - Nephrotoxicity
AluMINIMUM amount of feces.

5. MOA: Block mRNA synthesis
Binds to the Pyrophosphate Binding Site of the enzyme
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Rifampin
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

6. What is the clinical use of Tacrolimus (FK506)?
Potent immunosuppressive used in organ transplant recipients.
Imipenem
Pentavalent Antimony
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

7. Does Warfarin have a long - medium - or short half life?
Long.
Ganciclovir is more toxic to host enzymes
Chronic gout.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

8. What are four conditions in Which H2 Blockers are used clinically?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Cardiac glycoside (inotropic agent).
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

9. Mnemonic for Foscarnet?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Large anionic polymer - acidic
Foscarnet = pyroFosphate analog
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

10. Mannitol - mechanism?
- Physostigmine salicylate
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Treatment of infertility.
- Niacin - Ca++ channel blockers - adenosine - vancomycin

11. Are penicillinase resistant
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Inhibits DNA dependent RNA polymerase
hypertension - angina - arrhythmias
Methicillin - Nafcillin - and Dicloxacillin

12. What is the MOA of Amantadine?
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Epinephirine(Alpha1 -2 and Beta 1 -2)
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Succinylcholine

13. What is a common side effect of Misoprostol?
Carbenicillin - Piperacillin - and Ticarcillin
Diarrhea
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
fetal renal toxicity - hyperkalemia

14. What microorganisms are clinical indications for Tetracycline therapy?

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15. Resistance mechanisms for Vancomycin
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Ibuprofen - Naproxen - and Indomethacin
Pyridoxine (B6) administration

16. What is the MOA for the Macrolides?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Methylxanthine.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

17. ACE inhibitors - toxicity?
new arrhythmias - hypotension
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)

18. What are four Sulfonylureas?
severe hypertension - CHF
Non - Nucleosides
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

19. ACE inhibitors - clinical use?
Slow - limited by half lives of clotting factors
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Reversible block of histamine H2 receptors
hypertension - CHF - diabetic renal disease

20. What is the MOA for the Aminoglycosides?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Phosphorylation by a Viral Kinase
- ED 50 is less than the Km (less than 50% of receptors)

21. Antiarrhythmic class II- toxicity?
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
- Vinca alkaloids(inhibit MT) - Paclitaxel
cholestyramine - colestipol

22. What anticholinesterase crosses the blood - brain - barrier?
Imipenem
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
physostigmine
proximal convoluted tubule - thin descending limb - and collecting duct

23. What are are the Sulfonylureas (general description) and What is their use?
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
- Isoniazid
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

24. Mg+- clinical use?
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.
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
effective in torsade de pointes and digoxin toxicity
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

25. Cocaine casues vasoconstriction and local anesthesia by What mechanism
Hydralazine and Minoxidil
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Ipratropium
Indirect agonist - uptake inhibitor

26. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Prevents the release of Ca from SR of skeletal muscle
Blocks Norepi - but not Dopamine
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

27. How is Leishmaniasis treated?
- Oxalic acid - Acidosis & nephrotoxicity
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Pentavalent Antimony
effective in torsade de pointes and digoxin toxicity

28. What antimuscarinic agent is used in asthma and COPD?
Ipratropium
Pseudomonas species and Gram - rods
CMV - esp in Immunocompromised patients
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

29. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Heparin catalyzes the activation of antithrombin III.
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Onchocerciasis ('river blindness'-- rIVER- mectin)

30. List the mechanism - clinical use - & toxicity of Methotrexate.
hyperaldosteronism - K+ depletion - CHF
- Oral Contraceptives
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression

31. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
Aminoglycosides
Mebendazole/Thiabendazole - Pyrantel Pamoate
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Binds to the Pyrophosphate Binding Site of the enzyme

32. What are Methicillin - Nafcillin - and Dicloxacillin used for clinically?
Staphlococcus aureus
CMV - esp in Immunocompromised patients
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

33. Beta Blockers - BP?
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
decrease

34. MOA of Succinylcholine
toxic
Prevents the release of Ca from SR of skeletal muscle
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
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.

35. What type of gout is treated with Allopurinol?
Severe Gram - rod infections.
Chronic gout.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

36. What are the clinical uses for Ticlopidine - Clopidogrel?
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

37. What parasitic condition is treated with Ivermectin?

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38. Beta Blockers - CV toxicity?
bradycardia - AV block - CHF
It affects beta receptors equally and is used in AV heart block (rare).
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Activates antithrombin III

39. What is the main clinical use for the thrombolytics?
With an amino acid change of D- ala D- ala to D- ala D- lac
AluMINIMUM amount of feces.
It must be Phosphorylated by Viral Thymidine Kinase
Early myocardial infarction.

40. Which drug(s) cause this reaction: Tubulointerstitial Nephritis (5)?
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Minor hepatotoxicity - Drug interactions (activates P450)
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Digitoxin 70% Digoxin 20-40%

41. Adverse effects of Captopril?
- Protamine
decrease conduction velocity - increase ERP - increase PR interval
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Polymyxins

42. Which drug(s) cause this reaction: Cinchonism (2)?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
- Quinidine - quinine
for RSV

43. What are the clinical uses for 3rd Generation Cephalosporins?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Hypersensitivity reactions
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
- Tricyclic antidepressants

44. What is Nifurtimox administered for?

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45. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
- Chloramphenicol
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Cyclooxygenases (COX I - COX II).
- Clindamycin

46. What is the MOA of Polymyxins?
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Tendonitis and Tendon rupture
bradycardia - AV block - CHF
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

47. Describe Phase II metabolism in liver(3)?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Reversible block of histamine H2 receptors
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

48. What is the mechanism of action of the Sulfonylureas?
Foscarnet = pyroFosphate analog
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
pulmonary edema - dehydration
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

49. What are Fluoroquinolones indicated for? (3)
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Gram + cocci - Gram - rods - and Anerobes

50. Toxic effects of TMP include?
Digitoxin 168hrs Digoxin 40 hrs
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
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.
Megaloblastic anemia - Leukopenia - Granulocytopenia

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USMLE Step 1 Pharmacology

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