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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. For Warfarin What is the Site of action
- Phenytoin
Liver
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
HTN - CHF - calcium stone formation - nephrogenic DI.

2. What is a common side effect of Misoprostol?
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Pretreat with antihistamines and a slow infusion rate
Diarrhea
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

3. What is the MOA for Clindamycin?
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
- Atropine & pralidoxime
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Hypersensitivity reactions

4. How would hemicholinium treatment affect cholinergic neurons?
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
- Haloperidol - chlorpromazine - reserpine - MPTP
bradycardia - AV block - CHF
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.

5. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
- EDTA - dimercaprol - succimer - & penicillamine
These B-2 agonists cause respiratory smooth muscle to relax.
not a sulfonamide - but action is the same as furosemide
torsade de pointes - excessive Beta block

6. Can Warfarin be used during pregnancy?
No - warfarin - unlike heparin - can cross the placenta.
Treatment of infertility.
- Normalize K+ - Lidocaine - & Anti - dig Mab
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

7. Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
IV vitamin K and fresh frozen plasma
Chronic anticoagulation.

8. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
- Vitamin K & fresh frozen plasma
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
- Haloperidol - chlorpromazine - reserpine - MPTP

9. Which individuals are predisposed to Sulfonamide - induced hemolysis?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
G6PD deficient individuals
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
hypertension - CHF - diabetic renal disease

10. Ethacrynic Acid - toxicity?
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
AV nodal cells
- ACE inhibitors (Losartan>no cough)

11. ACE inhibitors - clinical use?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
hypertension - CHF - diabetic renal disease
amphetamine and ephedrine
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

12. Which drug(s) cause this reaction: Gynecomastia (6)?
Inhibits cell wall mucopeptide formation - Bactericidal
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Digoxin=urinary Digitoxin=biliary
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

13. What is the category and mechanism of action of Zileuton in Asthma treatment?
Ca2+ (Loops Lose calcium)
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions
Antileukotriene; blocks synthesis by lipoxygenase.
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

14. Adverse effects of Nifedipine - verapamil?
Bleeding.
cardiac depression - peripheral edema - flushing - dizziness - constipation
dizziness - flushing - constipation (verapamil) - nausea
Pregnant women - Children; because animal studies show Damage to Cartilage

15. Which diuretics increase urine NaCl?
all of them
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
GI distress - Skin rash - and Seizures at high plasma levels
Nephrotoxicity

16. What is the clinical use of Tacrolimus (FK506)?
The only local anesthetic with vasoconstrictive properties.
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Inhibits DNA dependent RNA polymerase
Potent immunosuppressive used in organ transplant recipients.

17. What parasitic condition is treated with Ivermectin?

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18. Which drug(s) cause this reaction: SLE- like syndrome?
aPTT (intrinsic pathway)
Penicillin - G
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
- Hydralazine - Procainamide - INH - phenytoin

19. What are two Glitazones?
TMP- SMZ (DOC) - aerosolized pentamidine
1. Pioglitazone 2. Rosiglitazone.
Hydralazine and Minoxidil
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid

20. Which RT inhibitor causes Megaloblastic Anemia?
AZT
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Prevents the release of ACh - Which results in muscle paralysis.

21. What is the mechanism of action of NSAIDs other than Aspirin?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Intrathecally
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut

22. Name three Antiarrhythmic drugs in class IC.
Flecainide - Encainide - Propafenone
Saquinavir - Ritonavir - Indinavir - Nelfinavir
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Imipenem

23. Acetazolamide - site of action?
proximal convoluted tubule
Stimulates beta adrenergic receptors
Methylation of rRNA near Erythromycin's ribosome binding site
prevention of nodal arrhythmias (SVT)

24. What is a possible result of overdose of Acetaminophen?
hypertension - CHF - diabetic renal disease
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

25. What is the category of drug names ending in - caine (e.g. Lidocaine)
not a sulfonamide - but action is the same as furosemide
Local anesthetic.
Delirium - Tremor - Nephrotoxicity
- Act on same receptor - Full has greater efficacy

26. Does Warfarin have a long - medium - or short half life?
- Methylene blue
Ganciclovir is more toxic to host enzymes
Long.
Chronic gout.

27. Adverse effect of Nitroprusside?
Alpha -1 antagonist
cyanide toxicity (releases CN)
- Isoniazid
For serious - Gram + multidrug - resistant organisms

28. List the specific antidote for this toxin: Digitalis
loop diuretics - thiazides
DOC in diagnosing and abolishing AV nodal arrhythmias
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
- Normalize K+ - Lidocaine - & Anti - dig Mab

29. Which drug(s) cause this reaction: Fanconi's syndrome?
- Tetracycline
Diuresis in pateints with sulfa allergy
Pseudomembranous colitis (C. difficile) - fever - diarrhea
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval

30. Why would dopamine be useful in treating shock?
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
bradycardia - AV block - CHF
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Delirium - Tremor - Nephrotoxicity

31. What are common serious side effects of Aminoglycosides and What are these associated with?
Cilastatin
- Haloperidol - chlorpromazine - reserpine - MPTP
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

32. Which drug(s) cause this reaction: Hot flashes?
proximal convoluted tubule
bradycardia - AV block - CHF
Heparin catalyzes the activation of antithrombin III.
- Tamoxifen

33. List the specific antidote for this toxin: Warfarin
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.
- Vitamin K & fresh frozen plasma
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic

34. What are two conditions in Which COX-2 inhibitors might be used?
Pretreat with antihistamines and a slow infusion rate
Stimulates beta adrenergic receptors
Rheumatoid and osteoarthritis.
Clavulanic acid

35. Decrease Digitoxin dose in renal failure?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Acts as a wide spectrum carbapenem
NO

36. Steady state concentration is reached in __ number of half - lifes
Interferes with microtubule function - disrupts mitosis - inhibits growth
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

37. How does angiotensin II affect NE release?
GI disturbances.
Fast vs. Slow Acetylators
It acts presynaptically to increase NE release.
Increase target cell response to insulin.

38. What are the Macrolides used for clinically?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Penicillin - G
Inhibit Ergosterol synthesis
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.

39. What are the major toxic side effects of Imipenem/cilastatin?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
-100% oxygen - hyperbaric
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
GI distress - Skin rash - and Seizures at high plasma levels

40. Beta Blockers - CV toxicity?
Blocks Norepi - but not Dopamine
Teratogenic - Carcinogenic - Confusion - Headaches
bradycardia - AV block - CHF
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia

41. What is the clinical utility of cocaine?
The only local anesthetic with vasoconstrictive properties.
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
- Nitrate - hydroxocobalamin thiosulfate
Liver

42. List the mechanism - clinical use - & toxicity of Tamoxifen.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Nucleosides
Intrathecally

43. What is the main clinical use for the thrombolytics?
Sildenafil fills the penis
Early myocardial infarction.
These B-2 agonists cause respiratory smooth muscle to relax.
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

44. List the mechanism - clinical use - & toxicity of Cisplatin.
- Nitrate - hydroxocobalamin thiosulfate
sedation - depression - nasal stuffiness - diarrhea
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.

45. What are four unwanted effects of Clomiphene use?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
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
Ipratropium

46. What effect would atropine have on a patient with peptic ulcer disease?
Alpha -1 antagonist
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Methicillin - Nafcillin - and Dicloxacillin

47. What is the clinical use for Heparin?
cholestyramine - colestipol
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Gram + - Gram - - Norcardia - Chlamydia

48. What is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
With supplemental Folic Acid
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

49. Resistance mechanisms for Sulfonamides
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Fast vs. Slow Acetylators
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

50. For Heparin What is the Treatment for overdose
Protamine sulfate
Rapid (seconds)
prevention of nodal arrhythmias (SVT)
Ibuprofen - Naproxen - and Indomethacin

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USMLE Step 1 Pharmacology

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