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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. Mannitol - toxicity?
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
pulmonary edema - dehydration
NO
Activates antithrombin III

2. What are the clinical uses for 2nd Generation Cephalosporins?
- Ethosuxamide - sulfonamides - lamotrigine
Sotalol - Ibutilide - Bretylium - Amiodarone
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

3. List the mechanism - clinical use - & toxicity of Tamoxifen.
loop diuretics - spironolactone
Hypersensitivity reactions
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

4. Clinical use of Isoniazid (INH)?
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
Methylation of rRNA near Erythromycin's ribosome binding site
Sildenafil fills the penis
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)

5. What Sulfonamides are used for simple UTIs?
torsade de pointes - excessive Beta block
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Heparin catalyzes the activation of antithrombin III.
Triple sulfas or SMZ

6. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Tendonitis and Tendon rupture
ACIDazolamide' causes acidosis
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

7. What is a common side effect of Misoprostol?
Headache - flushing - dyspepsia - blue - green color vision.
Diarrhea
Alpha -1 antagonist
- NaHCO3

8. Resistance mechanisms for Sulfonamides
- Glucocorticoid withdrawal
Suramin
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.
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

9. What is the mechanism of action of NSAIDs other than Aspirin?
Indirect agonist - uptake inhibitor
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Acetylcholine esterase
- N- acetylcystine

10. What are four clinical uses of glucocorticoids?

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11. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
Blocks Norepi - but not Dopamine
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
scopolamine
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

12. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
Imipenem
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow

13. What are Fluoroquinolones indicated for? (3)
Onchocerciasis ('river blindness'-- rIVER- mectin)
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Potent immunosuppressive used in organ transplant recipients.
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

14. Where does Griseofulvin deposit?
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Keratin containing tissues - e.g. - nails
Large anionic polymer - acidic
Sildenafil fills the penis

15. Spironolactone - mechanism?
competitive inhibirot of aldosterone in the cortical collecting tubule
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Ipratropium
Aminoglycosides

16. Secretion of What drug is inhibited by Probenacid used to treat chronic gout?
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
Penicillin.
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.
Tetracycline - Doxycycline - Demeclocycline - Minocycline

17. What enzyme is responsible for the degredation of Ach
Acetylcholine esterase
Binding to the presynaptic alpha 2 release modulating receptors
- Isoniazid
for RSV

18. Verapamil has similar action to?
Beta Blockers
Increase target cell response to insulin.
Yes - it does not cross the placenta.
Modification via Acetylation

19. What type of gout is treated with Allopurinol?
Lidocaine - Mexiletine - Tocainide
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Chronic gout.

20. Which drug(s) cause this reaction: Tendonitis and rupture?
- Fluoroquinolones
- Antipsychotics
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

21. What is the MOA of the RT Inhibitors?
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
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.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

22. List the specific antidote for this toxin: Opioids
GI disturbances.
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- B51Naloxone / naltrexone (Narcan)
Phenothiazine (neuroleptic - antiemetic).

23. What patients are at risk for life threatening hypotension When taking Sildenafil (Viagra)?
- Corticosteroids - heparin
Beta Blockers
Those patients who are taking nitrates.
INH: Injures Neurons and Hepatocytes

24. Mannitol - site of action?
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
No - it inhibits the release of Nor Epi
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
proximal convoluted tubule - thin descending limb - and collecting duct

25. ACE inhibitors - clinical use?
hypertension - CHF - diabetic renal disease
Inhibits DNA dependent RNA polymerase
viral kinase
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

26. A common side effects of Interferon (INF) treatment is?
GI upset
- Quinidine - quinine
Neutropenia
Leukotrienes increasing bronchial tone.

27. Which cancer drugs work at the level of mRNA(2)?
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Inhibit viral DNA polymerase
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
- Steroids - Tamoxifen

28. What is the formula for Volume of distribution (Vd)
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)
Chronic (weeks or months)
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Vd= (Amt. of drug in body/ Plasma drug conc.)

29. What are two indirect acting adrenergic agonists?
No
thiazides - amiloride
Yes - it does not cross the placenta.
amphetamine and ephedrine

30. What are common toxicities associated with Tetracyclines?

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31. What is the major toxic side effect of Penicillin?
Alpha -1 antagonist
Prevents the release of Ca from SR of skeletal muscle
Hypersensitivity reactions
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

32. Why does NE result in bradycardia?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Early myocardial infarction.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
YES

33. What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
Aminoglycosides
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
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.

34. Ca2+ channel blockers - site of action?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
GI side effects. (Indomethacin is less toxic - more commonly used.)
Cell membrane Ca2+ channels of cardiac sarcomere
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state

35. What is the mechanism of action of Misoprostol?
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
Beta adrenergic receptors and Ca2+ channels (stimulatory)
carbonic anhydrase inhibitors - K+ sparing diuretics
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

36. What is action of insulin in the liver - in muscle - and in adipose tissue?
Gram + - Gram - - Norcardia - Chlamydia
Treatment of infertility.
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
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.

37. What is the MOA for the Macrolides?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Decreases synthesis of Mycolic Acid
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.
Diuresis in pateints with sulfa allergy

38. Which cancer drugs effect nuclear DNA (4)?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Inhibits CMV DNA polymerase
- Ammonium Chloride
Beta1 more than B2

39. How would you reverse the effect of a neuromuscular blocking agent?
sedation - sleep alterations
Same as penicillin. Extended spectrum antibiotics
Give an antichloinesterase - neostigmine - edrophonium - etc
These B-2 agonists cause respiratory smooth muscle to relax.

40. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
Rifampin (DOC) - minocycline
No
- Ethosuxamide - sulfonamides - lamotrigine
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

41. List the mechanism - clinical use - & toxicity of Methotrexate.
Pituitary hormone.
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Paranteral (IV - SC)
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression

42. For Warfarin What is the Structure
new arrhythmias - hypotension
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Small lipid - soluble molecule
competitive inhibirot of aldosterone in the cortical collecting tubule

43. List the specific antidote for this toxin: Methanol & Ethylene glycol
RESPIre
- Ethanol - dialysis - & fomepizole
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
- Corticosteroids - heparin

44. What is the MOA for Amphotericin B?
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.)
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH

45. What is the memory key for organisms treated with Tetracyclines?

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46. Which diuretics cause alkalosis?
loop diuretics - thiazides
cross - allergenic
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Lidocaine - Mexiletine - Tocainide

47. What is the category of drug names ending in - pril (e.g. Captopril)
Methicillin - Nafcillin - and Dicloxacillin
ACE inhibitor.
1. Pioglitazone 2. Rosiglitazone.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills

48. List the mechanism - clinical use - & toxicity of 5 FU.
Beta1 more than B2
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
AV nodal cells
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

49. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
- Methylene blue
Tricyclic antidepressant.
Tetracycline - Doxycycline - Demeclocycline - Minocycline

50. What are four unwanted effects of Clomiphene use?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
CMV Retinitis in IC pts When Ganciclovir fails
Aminoglycosides
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk

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USMLE Step 1 Pharmacology

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