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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 is the MOA for Amphotericin B?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Polymyxins
edrophonium (extremely short acting anticholinesterase)

2. MOA: Block protein synthesis at 50s subunit
- Oxalic acid - Acidosis & nephrotoxicity
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Resistant Gram - infections

3. Which diuretics decrease urine Ca2+?
proximal convoluted tubule
Cardiac glycoside (inotropic agent).
- Ammonium Chloride
thiazides - amiloride

4. Mg+- clinical use?
effective in torsade de pointes and digoxin toxicity
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
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.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B

5. Explain potency in relation to full and partial agonists(2).
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Dopamine
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Chronic (weeks or months)

6. Norepi feedbacks and inhibits the presynaptic receptor by What mechanism
hypertension - CHF - diabetic renal disease
Binding to the presynaptic alpha 2 release modulating receptors
effective in torsade de pointes and digoxin toxicity
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride

7. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
- Haloperidol - chlorpromazine - reserpine - MPTP
dizziness - flushing - constipation (verapamil) - nausea
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
Antileukotriene; blocks synthesis by lipoxygenase.

8. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
- Ethosuxamide - sulfonamides - lamotrigine
Hypersensitivity reactions
amphetamine and ephedrine
not a sulfonamide - but action is the same as furosemide

9. What are four Sulfonylureas?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Penicillin.
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide

10. Which drug(s) cause this reaction: Cinchonism (2)?
- Quinidine - quinine
viral kinase
Ca2+ (Loops Lose calcium)
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)

11. What are three toxicities of Propylthiouracil?
Same as penicillin. Extended spectrum antibiotics
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
- EDTA - dimercaprol - succimer - & penicillamine
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)

12. What are the major toxic side effects of Imipenem/cilastatin?
GI distress - Skin rash - and Seizures at high plasma levels
Local anesthetic.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

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

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14. What type of patient should not take Misoprostol and why?
Methylxanthine.
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB

15. What is a prerequisite for Acyclovir activation?
post MI and digitalis induced arrhythmias
1. Pioglitazone 2. Rosiglitazone.
It must be Phosphorylated by Viral Thymidine Kinase
Bethanechol - Neostigmine - physostigmine

16. What is the mecanism of action - effective period - and ineffective period of use for Cromolyn in treating Asthma?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin

17. The COX-2 inhibitors (celecoxib - rofecoxib) have similar side effects to the NSAIDs with What one exception?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
- Vinca alkaloids(inhibit MT) - Paclitaxel
BM suppression (neutropenia - anemia) - Peripheral neuropathy

18. Which of these three drugs will cause a reflex bradycardia in your pt (Norepi - Epi - or Isoporterenol)
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
Dermatophytes (tinea - ringworm)
Norepinephrine
INH: Injures Neurons and Hepatocytes

19. What is the mechanism of action of the thrombolytics?
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.)
Oral
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
- Shifts the curve down - reduces Vmax

20. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
It acts presynaptically to increase NE release.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Blood
Increases coumadin metabolism

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

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22. List the specific antidote for this toxin: Tricyclic antidepressants
IV vitamin K and fresh frozen plasma
- NaHCO3
NO
Aminoglycosides

23. What conditions would you use dantrolene?
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Rheumatoid and osteoarthritis.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
CMV - esp in Immunocompromised patients

24. 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?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
H2 antagonist
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction

25. What is the mechanism of action of Allopurinol used to treat chronic gout?
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Diuresis in pateints with sulfa allergy
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

26. What is the mechanism of action of Aspirin?
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
- Alkalinize urine & dialysis
atropine - homatropine - tropicamide
Rifampin (DOC) - minocycline

27. List the specific antidote for this toxin: Benzodiazepines
- Flumazenil
Modification via Acetylation
Small lipid - soluble molecule
Because they require some residual islet function.

28. Adverse effects of Losartan?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Acetylcholine esterase
BM suppression (neutropenia - anemia) - Peripheral neuropathy
fetal renal toxicity - hyperkalemia

29. Adverse effects of Hydralazine?
Tricyclic antidepressant.
- Oxalic acid - Acidosis & nephrotoxicity
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

30. Esmolol - short or long acting?
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
Inhibition of 50S peptidyl transferase - Bacteriostatic
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
very short acting

31. Loop diuretics (furosemide)- site of action?
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
thick ascending limb
Nucleosides

32. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Antifungal.
Increases coumadin metabolism
AZT
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

33. Adverse effects of Prazosin?
first dose orthostatic hypotension - dizziness - headache
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Local anesthetic.
- Ethanol - dialysis - & fomepizole

34. What is the MOA for Vancomycin?
Acute gout.
Inhibits cell wall mucopeptide formation - Bactericidal
Early myocardial infarction.
- Tetracycline - amiodarone - sulfonamides

35. List the mechanism - clinical use - & toxicity of Cisplatin.
Doxycycline - because it is fecally eliminated
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

36. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
proarrhythmic
GI disturbances.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

37. What is the memory key for the effect of magnesium hydroxide overuse?
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Mg = Must go to the bathroom.
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic

38. Antimicrobial prophylaxis for a history of recurrent UTIs
TMP- SMZ
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Chronic Hepatitis A and B - Kaposi's Sarcoma
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

39. How is Foscarnet used clinically?
It must be Phosphorylated by Viral Thymidine Kinase
- Isoniazid
Aminoglycosides - Tetracyclines
CMV Retinitis in IC pts When Ganciclovir fails

40. What are the side effects of Rifampin?
Same as penicillin. Extended spectrum antibiotics
Minor hepatotoxicity - Drug interactions (activates P450)
Resistant Gram - infections
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

41. A common side effects of Interferon (INF) treatment is?
With an amino acid change of D- ala D- ala to D- ala D- lac
Local anesthetic.
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Neutropenia

42. Common toxicities associated with Fluoroquinolones?
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Sotalol - Ibutilide - Bretylium - Amiodarone
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
GI upset - Superinfections - Skin rashes - Headache - Dizziness

43. What are five toxicities associated with Tacrolimus (FK506)?
Bleeding.
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Penicillin - V

44. What is the MOA for Acyclovir?
AZT - to reduce risk of Fetal Transmission
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Inhibit viral DNA polymerase
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

45. What is the mechanism of action of Heparin?
Heparin catalyzes the activation of antithrombin III.
Amphotericin B - Nystatin - Fluconazole/azoles
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

46. What is the formula for Clearance (CL)
Binds ergosterol - Disrupts fungal membranes
GET on the Metro
GI discomfort
CL= (rate of elimination of drug/ Plasma drug conc.)

47. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
for RSV

48. Hydralazine - clinical use?
INH: Injures Neurons and Hepatocytes
severe hypertension - CHF
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)
Inhibits reabsorption of uric acid.

49. What is the category of drug names ending in - cillin (e.g. Methicillin)
sedation - sleep alterations
Alpha -1 antagonist
Penicillin.
Increase target cell response to insulin.

50. What is the major toxic side effect of Penicillin?
It must be Phosphorylated by Viral Thymidine Kinase
Hypersensitivity reactions
effective in torsade de pointes and digoxin toxicity
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

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USMLE Step 1 Pharmacology

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