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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. What are the clinical indications for Azole therapy?
- Oral Contraceptives
Topical and Oral - for Oral Candidiasis (Thrush)
Systemic mycoses
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

2. Which drug increases Sys BP w/o affecting Pulse Pressure
Paranteral (IV - SC)
With supplemental Folic Acid
thick ascending limb
Epinephrine

3. What are the indications for using amphetamine?

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4. How are Interferons (INF) used clinically?

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5. For Warfarin What is the Lab value to monitor
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Phenothiazine (neuroleptic - antiemetic).
PT

6. Which diuretics increase urine NaCl?
Mebendazole/Thiabendazole - Pyrantel Pamoate
Nephrotoxicity
all of them
Pentamidine

7. List the mechanism - clinical use - & toxicity of Nitrosureas.
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
- Alkalate DNA - Brain tumors - CNS toxicity
Delirium - Tremor - Nephrotoxicity
No

8. What is the clincial use for Misoprostol?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Acute gout.
- Antipsychotics

9. Which drug(s) cause this reaction: Hepatitis?
- Isoniazid
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
- Vinca alkaloids(inhibit MT) - Paclitaxel
sedation - positive Coombs' test

10. Which drug(s) cause this reaction: Diabetes insipidus?
- Glucocorticoid withdrawal
RESPIre
- Lithium
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

11. Toxicities associated with Acyclovir?
- EDTA - dimercaprol - succimer - & penicillamine
Nitrates
Delirium - Tremor - Nephrotoxicity
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

12. Which drug(s) cause this reaction: Atropine - like side effects?
Increases coumadin metabolism
- Tricyclic antidepressants
Erythromycin - Azithromycin - Clarithromycin
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

13. What is the memory key for the action of Sildenafil (Viagra)?
Sildenafil fills the penis
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
Epinephrine

14. What is Nifurtimox administered for?

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15. IV Penicillin
sedation - positive Coombs' test
Short.
Penicillin - G
Vd= (Amt. of drug in body/ Plasma drug conc.)

16. What is the memory key for Metronidazole's clinical uses?
proximal convoluted tubule
HTN - CHF - calcium stone formation - nephrogenic DI.
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.)
GET on the Metro

17. Name four HMG- CoA reductase inhibitors.
AZT - to reduce risk of Fetal Transmission
anticholinesterase glaucoma
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)

18. What is the mechanism of action of Allopurinol used to treat chronic gout?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
anuria - CHF
Succinylcholine
With supplemental Folic Acid

19. Name two classes of drugs for HIV therapy
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Protease Inhibitors and Reverse Transcriptase Inhibitors
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Quinolones

20. What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
PT
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Edrophonium

21. How can the t1/2 of INH be altered?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Fast vs. Slow Acetylators
Dopamine; causes its release from intact nerve terminals
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion

22. How is Ganciclovir activated?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Triple sulfas or SMZ
Phosphorylation by a Viral Kinase
It affects beta receptors equally and is used in AV heart block (rare).

23. List the mechanism - clinical use - & toxicity of Etoposide.
- Penicillamine
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
Paranteral (IV - SC)
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

24. What conditions are treated with Metronidazole?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

25. Which drug(s) cause this reaction: Fanconi's syndrome?
- Tetracycline
Rare.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Sotalol - Ibutilide - Bretylium - Amiodarone

26. Resistance mechanisms for Chloramphenicol
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Chronic (weeks or months)
Modification via Acetylation
- Alkalinize urine & dialysis

27. Why is carbachol and pilocarpine useful in treatment of glaucoma?
Liver
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Aplastic anemia (dose independent) - Gray Baby Syndrome

28. Name two bile acid resins.
cholestyramine - colestipol
ACIDazolamide' causes acidosis
- Daunorubicin & Doxorubicin
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

29. What is the MOA of Foscarnet?
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Ciprofloxacin - Norfloxacin - Ofloxacin - Grepafloxacin - Enoxacin - Nalidixic acid
Inhibits Viral DNA polymerase
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

30. What is the category of drug names ending in - pril (e.g. Captopril)
- Deferoxamine
sedation - depression - nasal stuffiness - diarrhea
ACE inhibitor.
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

31. Adverse effect of Nitroprusside?
Antifungal.
cyanide toxicity (releases CN)
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

32. What are the Anti - TB drugs?
Carbachol - pilocarpine - physostigmine - echothiophate
Premature infants - because they lack UDP- glucuronyl transferase
- aminoglycosides - loop diuretics - cisplatin
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

33. What is the MOA for Metronidazole?
Forms toxic metabolites in the bacterial cell - Bactericidal
Blocks Influenza A and RubellA; causes problems with the cerebellA
Ipratropium
dry mouth - sedation - severe rebound hypertension

34. Name several common Macrolides (3)
Methylxanthine.
propanolol - esmolol - metoprolol - atenolol - timolol
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Erythromycin - Azithromycin - Clarithromycin

35. Digoxin v. Digitoxin: bioavailability?
fetal renal toxicity - hyperkalemia
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Digitoxin>95% Digoxin 75%
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

36. Which cancer drugs effect nuclear DNA (4)?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
- Vitamin K & fresh frozen plasma
- Ethanol - dialysis - & fomepizole
The PT.

37. What are common toxicities related to Vancomycin therapy?

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38. List the specific antidote for this toxin: Opioids
- Isoniazid
- B51Naloxone / naltrexone (Narcan)
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.
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

39. List the mechanism - clinical use - & toxicity of Bleomycin.
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Inhalational general anesthetic.
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis

40. What is the MOA for the Macrolides?
- Tetracycline
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Paranteral (IV - SC)
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

41. What is the effect of epinephrine infusion on bp and pulse pressure?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
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.
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia

42. Mnemonic for Foscarnet?
Foscarnet = pyroFosphate analog
Protease Inhibitors and Reverse Transcriptase Inhibitors
Inhalational general anesthetic.
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

43. List the specific antidote for this toxin: Digitalis
Chronic Hepatitis A and B - Kaposi's Sarcoma
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
CL= (rate of elimination of drug/ Plasma drug conc.)
- Normalize K+ - Lidocaine - & Anti - dig Mab

44. Classes of antihypertensive drugs?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
For serious - Gram + multidrug - resistant organisms
- Hydralazine - Procainamide - INH - phenytoin

45. MOA: Block peptidoglycan synthesis
Ataxia - Dizziness - Slurred speech
Bacitracin - Vancomycin
Nitrates
Digitoxin>95% Digoxin 75%

46. While at a tail gait party - you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature - What should you do?
Botulinum
Antileukotriene; blocks leukotriene receptors.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Dermatophytes (tinea - ringworm)

47. What is the MOA for Vancomycin?
Inhibits reabsorption of uric acid.
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Inhibits cell wall mucopeptide formation - Bactericidal
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)

48. What drug is used to treat Trematode/fluke (e.g. - Schistosomes - Paragonimus - Clonorchis) or Cysticercosis
Praziquantel
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Benzodiazepine.

49. Antiarrhythmic class II- mechanism?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
DHPG (dihydroxy-2- propoxymethyl guanine)
Fast vs. Slow Acetylators

50. How is Chloramphenical used clinically?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
- Fluoroquinolones
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

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USMLE Step 1 Pharmacology

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