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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 five toxicities associated with Tacrolimus (FK506)?
Benzodiazepine.
Binds ergosterol - Disrupts fungal membranes
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

2. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Local anesthetic.
Clavulanic acid
Aplastic anemia (dose independent) - Gray Baby Syndrome
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

3. Which drug(s) cause this reaction: Atropine - like side effects?
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
- Daunorubicin & Doxorubicin
- Tricyclic antidepressants

4. Name two LPL stimulators.
Indomethacin is used to close a patent ductus arteriosus.
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Gemfibrozil - Clofibrate
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

5. What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
proximal convoluted tubule

6. List the specific antidote for this toxin: Salicylates
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
- Ethanol - dialysis - & fomepizole
Clavulanic acid
- Alkalinize urine & dialysis

7. Acetazolamide - clinical uses?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.

8. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Epinephirine(Alpha1 -2 and Beta 1 -2)
Beta adrenergic receptors and Ca2+ channels (stimulatory)
Phosphorylation by a Viral Kinase

9. Which of the following would atropine administration cause? Hypothermia - bradycardia - excess salivation - dry flushed skin - or diarrhea
Dry flushed skin - due to inhibition of sympathetic post - ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of What would be expected.
1. Antiandrogen 2. Nausea 3. Vomiting
collecting ducts
- Bleomycin - amiodarone - busulfan

10. What is the MOA of Foscarnet?
Short.
Inhibits Viral DNA polymerase
Treatment of infertility.
Acute (hours)

11. Clinical use of Isoniazid (INH)?
Ipratropium
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
sedation - depression - nasal stuffiness - diarrhea
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise

12. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

13. List the specific antidote for this toxin: Cyanide
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Hydralazine and Minoxidil
- Nitrate - hydroxocobalamin thiosulfate
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

14. What are the nondepolarizing neuromuscular blocking drugs?
Non - Nucleosides
Staphlococcus aureus
Scopolamine
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

15. Name some common Sulfonamides (4)
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
- Niacin - Ca++ channel blockers - adenosine - vancomycin
cholestyramine - colestipol
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

16. What are common side effects of Protease Inhibitors?
HTN - CHF - calcium stone formation - nephrogenic DI.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
GI discomfort
Interferes with microtubule function - disrupts mitosis - inhibits growth

17. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Antileukotriene; blocks synthesis by lipoxygenase.
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.
Acetylcholinesterase; ACh is broken down into choline and acetate.

18. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
dizziness - flushing - constipation (verapamil) - nausea
- Ethosuxamide - sulfonamides - lamotrigine
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.
Primaquine

19. Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
- Bleomycin - amiodarone - busulfan
Suramin
- Antipsychotics
Minor hepatotoxicity - Drug interactions (activates P450)

20. What are four H2 Blockers?
Staphlococcus aureus
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
- aminoglycosides - loop diuretics - cisplatin

21. For Heparin What is the Treatment for overdose
Protamine sulfate
It acts presynaptically to increase NE release.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
Beta antagonist.

22. What is the mechanism of Tacrolimus (FK506)?
Polymyxins
Inhibits cell wall mucopeptide formation - Bactericidal
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
AZT - to reduce risk of Fetal Transmission

23. Aztreonam is not usually...
Non - Nucleosides
toxic
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Mebendazole/Thiabendazole - Pyrantel Pamoate

24. Adverse effects of Methyldopa?

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25. MOA: Block nucleotide synthesis
Sulfonamides - Trimethoprim
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
AZT - to reduce risk of Fetal Transmission
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

26. List the specific antidote for this toxin: Opioids
- B51Naloxone / naltrexone (Narcan)
proximal convoluted tubule
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
It must be Phosphorylated by Viral Thymidine Kinase

27. What are are the Sulfonylureas (general description) and What is their use?
For serious - Gram + multidrug - resistant organisms
Binds to the Pyrophosphate Binding Site of the enzyme
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Sildenafil fills the penis

28. Why does atropine dilate the pupil?
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
cyanide toxicity (releases CN)
effective in torsade de pointes and digoxin toxicity
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.

29. Mannitol - contraindications?
dry mouth - sedation - severe rebound hypertension
- Haloperidol - chlorpromazine - reserpine - MPTP
hypertension - CHF - diabetic renal disease
anuria - CHF

30. As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt - What do you use
Succinylcholine
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
The PTT.

31. What is the clinical use for Sildenafil (Viagra)?
It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out - but the SA node has an intrinsic pace of 100 beats/min - Which is normally checked by vagal stimulation.
Erectile dysfunction.
Pregnant women - Children; because animal studies show Damage to Cartilage
Teratogenic - Carcinogenic - Confusion - Headaches

32. Guanethidine enhances the release of Norepi?
torsade de pointes - excessive Beta block
No - it inhibits the release of Nor Epi
- Ethanol - dialysis - & fomepizole
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

33. What should not be taken with Tetracyclines? / Why?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- Bleomycin - amiodarone - busulfan
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
- Ethanol - dialysis - & fomepizole

34. What do Aminoglycosides require for uptake?
- Vinca alkaloids(inhibit MT) - Paclitaxel
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Oxygen
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

35. MOA: Block protein synthesis at 30s subunit
Aminoglycosides - Tetracyclines
Edrophonium
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Inhibition of 50S peptidyl transferase - Bacteriostatic

36. Are not penicillinase resistant
- Oxalic acid - Acidosis & nephrotoxicity
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Carbenicillin - Piperacillin - and Ticarcillin
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

37. Why is pyridostigmine effective in the treatment of myasthenia gravis?
Antileukotriene; blocks synthesis by lipoxygenase.
As an anticholinesterase it increases endogenous ACh and thus increases strength.
anuria - CHF
Yes

38. What is the clinical use for Sucralfate?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Peptic ulcer disease.
Edrophonium
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).

39. What is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Modification via Acetylation - Adenylation - or Phosphorylation
The PT.
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

40. Esmolol - short or long acting?
very short acting
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Gram + and Anerobes
Vd= (Amt. of drug in body/ Plasma drug conc.)

41. Acetazolamide - mechanism?
- Penicillin
cardiac depression - peripheral edema - flushing - dizziness - constipation
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.

42. K+- clinical use?
depresses ectopic pacemakers - especially in digoxin toxicity
Inhibits reabsorption of uric acid.
Amphetamine and Ephedrine
Beta - lactam antibiotics

43. Nifedipine has similar action to?
Nitrates
GI side effects. (Indomethacin is less toxic - more commonly used.)
for RSV
Leukotrienes increasing bronchial tone.

44. What reversal agent could a Anes give to reverse the effects of Atropine
Bethanechol - Neostigmine - physostigmine
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
proarrhythmic

45. What are toxicities associated with Chloramphenicol?
Aplastic anemia (dose independent) - Gray Baby Syndrome
cardiac depression - peripheral edema - flushing - dizziness - constipation
Vd= (Amt. of drug in body/ Plasma drug conc.)
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

46. What is used to reverse the action of Heparin?
Nephrotoxicity
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Ipratropium
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts

47. What is the memory key for the effect of aluminum hydroxide overuse?
AluMINIMUM amount of feces.
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Phenothiazine (neuroleptic - antiemetic).
No - warfarin - unlike heparin - can cross the placenta.

48. What are Aminoglycosides used for clinically?
Pretreat with antihistamines and a slow infusion rate
Tendonitis and Tendon rupture
- Methylene blue
Severe Gram - rod infections.

49. ACE inhibitors - clinical use?
hypertension - CHF - diabetic renal disease
Yes
distal convoluted tubule (early)
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

50. What is the memory key for the effect of magnesium hydroxide overuse?
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
loop diuretics - spironolactone
Mg = Must go to the bathroom.

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USMLE Step 1 Pharmacology

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