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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. When is Rifampin not used in combination with other drugs?
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Only in limited amounts

2. For Warfarin What is the Site of action
- Penicillin
Liver
Local anesthetic.
1. Antiandrogen 2. Nausea 3. Vomiting

3. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Cyclooxygenases (COX I - COX II).
Severe Gram - rod infections.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Pseudomonas species and Gram - rods

4. ACE inhibitors - mechanism?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
GI upset - Superinfections - Skin rashes - Headache - Dizziness
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole

5. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
bradycardia - AV block - CHF
Pyridoxine (B6) administration
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

6. Mannitol - contraindications?
Premature infants - because they lack UDP- glucuronyl transferase
anuria - CHF
- Normalize K+ - Lidocaine - & Anti - dig Mab
Because they require some residual islet function.

7. What are four H2 Blockers?
Tendonitis and Tendon rupture
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine

8. For Heparin What is the Structure
Beta adrenergic receptors and Ca2+ channels (stimulatory)
ACE inhibitor.
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.
Large anionic polymer - acidic

9. Which drug(s) cause this reaction: Cardiac toxicity?
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
- Ethanol - dialysis - & fomepizole
- Daunorubicin & Doxorubicin

10. Which drug(s) cause this reaction: Gynecomastia (6)?
Inhalational general anesthetic.
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
NO
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.

11. Ganciclovir associated toxicities?
Chronic gout.
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity
Stimulates beta adrenergic receptors
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

12. Mg+- clinical use?
GI discomfort
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
sedation - depression - nasal stuffiness - diarrhea
effective in torsade de pointes and digoxin toxicity

13. List the specific antidote for this toxin: Arsenic (all heavy metals)
- Dimercaprol - succimer
Blocks Influenza A and RubellA; causes problems with the cerebellA
- Glucagon
Systemic mycoses

14. Name five Antiarrhythmic drugs in class II?
Penicillin - G
propanolol - esmolol - metoprolol - atenolol - timolol
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

15. What are five possible toxic effects of Aspirin therapy?

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16. What is the receptor affinity and clinical use of isoproterenol?
Beta lactams - inhibit cell wall synthesis - Bactericidal
It affects beta receptors equally and is used in AV heart block (rare).
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
thiazides - amiloride

17. What process does Zafirlukast interfere with?
- Dimercaprol - succimer
- Bleomycin - amiodarone - busulfan
- Lithium
Leukotrienes increasing bronchial tone.

18. How can Vancomycin - induced 'Red Man Syndrome' be prevented?
Pretreat with antihistamines and a slow infusion rate
not a sulfonamide - but action is the same as furosemide
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
Chronic (weeks or months)

19. What are three possible toxicities of NSAID usage?
1. Renal damage 2. Aplastic anemia 3. GI distress
CMV Retinitis in IC pts When Ganciclovir fails
These B-2 agonists cause respiratory smooth muscle to relax.
Pralidoxime regenerates active cholinesterase.

20. How is Amphotericin B used clinically?
- N- acetylcystine
Does not cross
Benzodiazepine.
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

21. What is the category of drug names ending in - tropin (e.g. Somatotropin)
ACE inhibitor.
Polymyxins
Beta Blockers
Pituitary hormone.

22. Adverse effects of Loop Diuretics?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

23. What are the Macrolides used for clinically?
Gram + and Anerobes
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Increase target cell response to insulin.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

24. Which diuretics cause alkalosis?
blocks SR Ca2+ channels
loop diuretics - thiazides
Topical and Oral - for Oral Candidiasis (Thrush)
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

25. What is the MOA of Aztreonam?
loop diuretics - spironolactone
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

26. Name three Antiarrhythmic drugs in class IV.
- Deferoxamine
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Acts as a wide spectrum carbapenem
Verapamil - Diltiazem - Bepridil

27. Verapamil has similar action to?
Beta Blockers
- Tetracycline
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

28. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
sedation - depression - nasal stuffiness - diarrhea
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Polymyxins
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout

29. What are the major toxic side effects of Imipenem/cilastatin?
- Lithium
Gram + cocci - Gram - rods - and Anerobes
Neurotoxicity - Acute renal tubular necrosis
GI distress - Skin rash - and Seizures at high plasma levels

30. Name four HMG- CoA reductase inhibitors.
Hemolytic anemia
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
G6PD deficient individuals
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

31. How can the toxic effects of TMP be ameliorated?
Antifungal.
With supplemental Folic Acid
not a sulfonamide - but action is the same as furosemide
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)

32. What are Polymyxins used for?
Resistant Gram - infections
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Norepinephrine

33. Why does atropine dilate the pupil?
Cephalosporins
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens

34. What is the clinical use for Sucralfate?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Peptic ulcer disease.
Protamine sulfate
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

35. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Digitoxin 70% Digoxin 20-40%
Chronic gout.
thick ascending limb
Norepinephrine (Alpha1 -2 and beta 1)

36. ADH antagonists - site of action?
collecting ducts
- Physostigmine salicylate
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

37. Digoxin v. Digitoxin: half life?
Digitoxin 168hrs Digoxin 40 hrs
Antibiotic - protein synthesis inhibitor.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

38. A group of pts are rushed into the ER complaining of excessive sweating - tearing - salivation - HA - N and V - muscle twitching - difficulty breathing and diarrhea. What drug would be the most effective immediate tx
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Beta -2 agonist.
Tetracycline - Doxycycline - Demeclocycline - Minocycline
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

39. What is the mecanism of action of Sucralfate?
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Gemfibrozil - Clofibrate
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
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.

40. Which drug increases Sys BP w/o affecting Pulse Pressure
- Vinca alkaloids(inhibit MT) - Paclitaxel
Epinephrine
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
- Hydralazine - Procainamide - INH - phenytoin

41. Adverse effects of beta - blockers?
Penicillin.
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Oral
Lidocaine - Mexiletine - Tocainide

42. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Beta lactams - inhibit cell wall synthesis - Bactericidal
Digoxin=urinary Digitoxin=biliary
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

43. What type of neurological blockade would hexamethonium create?
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
- Daunorubicin & Doxorubicin
VACUUM your Bed Room'
Botulinum

44. What is the clinical use for Nystatin?
- Tetracycline
Topical and Oral - for Oral Candidiasis (Thrush)
Gemfibrozil - Clofibrate
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

45. What neurotransmitter does Amantadine affect? How does it influence this NT?
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
- Ethosuxamide - sulfonamides - lamotrigine
Gram + cocci - Gram - rods - and Anerobes
Dopamine; causes its release from intact nerve terminals

46. What type of gout is treated with Colchicine?
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
Blocks Norepi - but not Dopamine
Ceftriaxone
Acute gout.

47. How are the HIV drugs used clinically?

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48. What microorganisms are Aminoglycosides ineffective against?
Anaerobes
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor

49. What drug is used to diagnose myasthenia gravis?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
HTN - CHF - calcium stone formation - nephrogenic DI.
edrophonium (extremely short acting anticholinesterase)

50. What musculo - skeletal side effects in Adults are associated with Floroquinolones?
Tendonitis and Tendon rupture
Inhibits Viral DNA polymerase
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Delirium - Tremor - Nephrotoxicity

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USMLE Step 1 Pharmacology

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