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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Hydralazine - toxicity?
- Corticosteroids - heparin
compensatory tachycardia - fluid retention - lupus - like syndrome
prevention of nodal arrhythmias (SVT)
thick ascending limb

2. Describe first - order kinetics?
blocks SR Ca2+ channels
atropine - homatropine - tropicamide
cortical collecting tubule
Constant FRACTION eliminated per unit time.(exponential)

3. What do Aminoglycosides require for uptake?
Oxygen
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Hypersensitivity reactions
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia

4. Which diuretics cause alkalosis?
Mebendazole/Thiabendazole - Pyrantel Pamoate
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Those patients who are taking nitrates.
loop diuretics - thiazides

5. Beta Blockers - CNS toxicity?
Choline acetyltransferase
sedation - sleep alterations
GI distress - Skin rash - and Seizures at high plasma levels
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

6. List the specific antidote for this toxin: Arsenic (all heavy metals)
hypertension - CHF - diabetic renal disease
- Dimercaprol - succimer
Erythromycin - Azithromycin - Clarithromycin
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.

7. Which drug(s) cause this reaction: Hepatitis?
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
cross - allergenic
Fast vs. Slow Acetylators
- Isoniazid

8. What is the MOA of Ganciclovir?
No - warfarin - unlike heparin - can cross the placenta.
- Tetracycline
Inhibits CMV DNA polymerase
Acetylcholinesterase; ACh is broken down into choline and acetate.

9. What is the possible mechanism and effect of Metformin in treating diabetes?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
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.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.

10. Classes of antihypertensive drugs?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
for RSV
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Large anionic polymer - acidic

11. For Heparin What is the Structure
Large anionic polymer - acidic
Aminoglycosides
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Pseudomembranous colitis (C. difficile) - fever - diarrhea

12. In What population does Gray Baby Syndrome occur? Why?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Premature infants - because they lack UDP- glucuronyl transferase
Acts as a wide spectrum carbapenem
Beta -2 agonist.

13. List the mechanism - clinical use - & toxicity of Doxorubicin.

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14. For Heparin What is the Ability to inhibit coagulation in vitro
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Yes
Acetylcholine esterase
Nephrotoxicity

15. Which cancer drugs inhibit nucleotide synthesis(3)?
- Methotrexate - 5 FU - 6 mercaptopurine
Forms toxic metabolites in the bacterial cell - Bactericidal
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Indomethacin is used to close a patent ductus arteriosus.

16. What is used to reverse the action of Heparin?
Pregnant women - Children; because animal studies show Damage to Cartilage
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
- Nitrate - hydroxocobalamin thiosulfate

17. For Heparin What is the Lab value to monitor
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
aPTT (intrinsic pathway)
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Foscarnet = pyroFosphate analog

18. What are the major structural differences between Penicillin and Cephalosporin?
Cilastatin
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)
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

19. Why would a patient with cog - wheel rigidity and a shuffling gait be given benztropine?
Paranteral (IV - SC)
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

20. How are the Latent Hypnozoite (Liver) forms of Malaria (P. vivax - P.ovale) treated?
Primaquine
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
- Ethosuxamide - sulfonamides - lamotrigine
Imipenem

21. What is the mechanism of action of Warfarin (Coumadin)?
Warfarin interferes with the normal synthesis and gamma - carboxylation of vitamin K- dependent clotting factors II - VII - IX - and X - Protein C and S via vitamin K antagonism.
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
- polymyxins
fetal renal toxicity - hyperkalemia

22. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Indirect agonist - uptake inhibitor
Scopolamine
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.
Norepinephrine (Alpha1 -2 and beta 1)

23. What is the effect of epinephrine infusion on bp and pulse pressure?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
- Antipsychotics
depresses ectopic pacemakers - especially in digoxin toxicity

24. Antiarrhythmic class II- mechanism?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis

25. Ibutilide - toxicity?
Erectile dysfunction.
torsade de pointes
- Niacin - Ca++ channel blockers - adenosine - vancomycin
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

26. List the specific antidote for this toxin: Salicylates
penicillinase resistant
GI side effects. (Indomethacin is less toxic - more commonly used.)
Give an antichloinesterase - neostigmine - edrophonium - etc
- Alkalinize urine & dialysis

27. Ethacrynic Acid - toxicity?
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Competitive inibitor of progestins at progesterone receptors.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

28. Explain potency in relation to full and partial agonists(2).
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Same as penicillin. Act as narrow spectrum antibiotics
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD

29. How does angiotensin II affect NE release?
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
It acts presynaptically to increase NE release.
Beta - lactamase cleavage of Beta - lactam ring

30. Thiazides - site of action?
thiazides - amiloride
distal convoluted tubule (early)
Constant FRACTION eliminated per unit time.(exponential)
- B51Naloxone / naltrexone (Narcan)

31. Reserpine will block the syntheis of this drug and but not its precursor.
troponin - tropomyosin system
- Phenytoin
Blocks Norepi - but not Dopamine
Increase target cell response to insulin.

32. What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Norepinephrine (Alpha1 -2 and beta 1)
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

33. Which drug(s) cause this reaction: Tendonitis and rupture?
Babiturate.
- Fluoroquinolones
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Digitoxin 70% Digoxin 20-40%

34. Which drug(s) cause this reaction: Tardive dyskinesia?
Same as penicillin. Extended spectrum antibiotics
Modification via Acetylation
IV vitamin K and fresh frozen plasma
- Antipsychotics

35. How is Amphotericin B used clinically?
- Haloperidol - chlorpromazine - reserpine - MPTP
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
It acts presynaptically to increase NE release.

36. Which receptors does phenylephrine act upon?
Ganciclovir is more toxic to host enzymes
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

37. K+ sparing diuretics - clinical use?
Pregnant women - Children; because animal studies show Damage to Cartilage
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)
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
hyperaldosteronism - K+ depletion - CHF

38. Why is carbachol and pilocarpine useful in treatment of glaucoma?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
- Isoniazid
- Ethanol - dialysis - & fomepizole

39. How would you reverse the effect of a neuromuscular blocking agent?
Protease Inhibitors and Reverse Transcriptase Inhibitors
Give an antichloinesterase - neostigmine - edrophonium - etc
Acute gout.
Verapamil - Diltiazem - Bepridil

40. What is the clinical use of Mifepristone (RU486)?
As an anticholinesterase it increases endogenous ACh and thus increases strength.
sedation - positive Coombs' test
Abortifacient.
- Niacin - Ca++ channel blockers - adenosine - vancomycin

41. Adverse effects of Methyldopa?

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42. Nifedipine has similar action to?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Atropine & pralidoxime
Nitrates
YES

43. For Warfarin What is the Treatment for overdose
first dose orthostatic hypotension - dizziness - headache
Binds to the Pyrophosphate Binding Site of the enzyme
IV vitamin K and fresh frozen plasma
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

44. What is combination TMP- SMZ used to treat?
Decreased uptake or Increased transport out of cell
Dopamine; causes its release from intact nerve terminals
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
propanolol - esmolol - metoprolol - atenolol - timolol

45. Name the common Azoles
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping

46. What are the side effects of Polymyxins?
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Neurotoxicity - Acute renal tubular necrosis

47. How would you treat African Trypanosomiasis (sleeping sickness)?
Sildenafil fills the penis
Oral
Suramin
- Niacin - Ca++ channel blockers - adenosine - vancomycin

48. What is a common side effect of Colchicine used to treat acute gout - especially When given orally?
Gemfibrozil - Clofibrate
GI side effects. (Indomethacin is less toxic - more commonly used.)
Constant FRACTION eliminated per unit time.(exponential)
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention

49. What are four clinical activities of Aspirin?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
- Normalize K+ - Lidocaine - & Anti - dig Mab
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Aminoglycosides

50. Which diuretics increase urine K+?
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.
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
- Shifts the curve down - reduces Vmax
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)