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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 action of insulin in the liver - in muscle - and in adipose tissue?
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.
- Deferoxamine
Inhalational general anesthetic.
No - it inhibits the release of Nor Epi

2. What is Imipenem always administered with?
Dermatophytes (tinea - ringworm)
Mg = Must go to the bathroom.
Cilastatin
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

3. Where does Griseofulvin deposit?
Interferes with microtubule function - disrupts mitosis - inhibits growth
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
It must be Phosphorylated by Viral Thymidine Kinase
Keratin containing tissues - e.g. - nails

4. What drugs target anticholinesterase
Albuterol - tertbutaline
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Pentamidine
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate

5. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
sedation - sleep alterations
Ca2+ (Loops Lose calcium)
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
Acetylcholinesterase; ACh is broken down into choline and acetate.

6. What type of gout is treated with Allopurinol?
Chronic gout.
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
- Oxalic acid - Acidosis & nephrotoxicity

7. What is treated with Chloroquine - Quinine - Mefloquine?
Suramin
Malaria (P. falciparum)
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

8. What is the mecanism of action of Sucralfate?
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.
- Antipsychotics
Epinephirine(Alpha1 -2 and Beta 1 -2)
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

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

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10. How do the Protease Inhibitors work?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Inhibt Assembly of new virus by Blocking Protease Enzyme
Acetylcholinesterase; ACh is broken down into choline and acetate.
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)

11. Antiarrhythmic class IC- effects?
H2 antagonist
AluMINIMUM amount of feces.
Suramin
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

12. What is an additional side effect of Methicillin?
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
- NaHCO3
-100% oxygen - hyperbaric
Interstitial nephritis

13. For Warfarin What is the Onset of action
Slow - limited by half lives of clotting factors
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Used in combination therapy with SMZ to sequentially block folate synthesis

14. What is the mechanism of action of Cyclosporine?
Interferes with microtubule function - disrupts mitosis - inhibits growth
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.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
- Methotrexate - 5 FU - 6 mercaptopurine

15. What is the difference between the affinity for beta receptors between albuterol/terbutaline and dantroline?
Carbachol - pilocarpine - physostigmine - echothiophate
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
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.
Forms toxic metabolites in the bacterial cell - Bactericidal

16. Name the common Aminoglycosides (5)
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
- Phenytoin
blocks SR Ca2+ channels
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

17. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
AmOxicillin has greater Oral bioavailability
1. Weight gain 2. Hepatotoxicity (troglitazone)
- Penicillamine
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

18. What is the mechanism of action of Sildenafil (Viagra)?
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
local anesthetic. CNS stimulation or depression. CV depression.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

19. MOA: Block cell wall synthesis by inhib. Peptidoglycan cross - linking (7)
- Steroids - Tamoxifen
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Increase target cell response to insulin.
scopolamine

20. What is the mechanism of action of the Sulfonylureas?
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

21. What can result due to antacid overuse?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
- Atropine & pralidoxime
Hypersensitivity reactions
- Phenytoin

22. Resistance mechanisms for Sulfonamides
Competitive inibitor of progestins at progesterone receptors.
Penicillin - G
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

23. How are Interferons (INF) used clinically?

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24. What is the mechanism of Tacrolimus (FK506)?
Systemic mycoses
cortical collecting tubule
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
The only local anesthetic with vasoconstrictive properties.

25. How do we stop angina?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Keratin containing tissues - e.g. - nails
- acetylation - glucuron. - & sulfation - Conjugation - Polar product
Succinylcholine

26. What are two indirect acting adrenergic agonists?
amphetamine and ephedrine
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
The only local anesthetic with vasoconstrictive properties.

27. What is the clinical use for Warfarin?
- Quinidine - quinine
Pentamidine
Chronic anticoagulation.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

28. What are common side effects of RT Inhibitors?
- B51Naloxone / naltrexone (Narcan)
BM suppression (neutropenia - anemia) - Peripheral neuropathy
all of them
decrease conduction velocity - increase ERP - increase PR interval

29. List the specific antidote for this toxin: Cyanide
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
AmOxicillin has greater Oral bioavailability
AluMINIMUM amount of feces.
- Nitrate - hydroxocobalamin thiosulfate

30. How is Leishmaniasis treated?
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.
Pentavalent Antimony
dry mouth - sedation - severe rebound hypertension
hypertension - CHF - diabetic renal disease

31. Antiarrhythmic class IA effects?
Oral
AluMINIMUM amount of feces.
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.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.

32. Ca2+ channel blockers - toxicity?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Intrathecally
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
cardiac depression - peripheral edema - flushing - dizziness - constipation

33. What is the MOA for the Tetracyclines?
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Captopril - Enalapril - Lisinopril
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Protease Inhibitors and Reverse Transcriptase Inhibitors

34. What is the MOA of Polymyxins?
Protease Inhibitors and Reverse Transcriptase Inhibitors
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Gram + and Anerobes
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

35. Name several common Macrolides (3)
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
new arrhythmias - hypotension
Erythromycin - Azithromycin - Clarithromycin
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.

36. Antimicrobial prophylaxis for Syphilis
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
Verapamil - Diltiazem - Bepridil
Benzathine penicillin G
Botulinum

37. List the specific antidote for this toxin: Iron
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. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
- Deferoxamine
- Class III antiarrhythmics (sotalol) - class IA (quinidine)

38. What is the mechanism of action of Probenacid used to treat chronic gout?
Sulfonamides - Trimethoprim
GET on the Metro
Inhibits reabsorption of uric acid.
Benzodiazepine.

39. How is Amantadine used clinically?

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40. How do you treat coma in the ER (4)?
sedation - positive Coombs' test
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Bleeding.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression

41. What side effect of using atropine to induce pupillary dilation would you expect?
amphetamine and ephedrine
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).
- Ethosuxamide - sulfonamides - lamotrigine
TCA

42. Name two LPL stimulators.
hypertension - angina - arrhythmias
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
AV nodal cells
Gemfibrozil - Clofibrate

43. Name five Antiarrhythmic drugs in class II?
- Shifts the curve to the right - increases Km
propanolol - esmolol - metoprolol - atenolol - timolol
As an anticholinesterase it increases endogenous ACh and thus increases strength.
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

44. Name some common Tetracyclines (4)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Reversible block of histamine H2 receptors

45. What are the Macrolides used for clinically?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Captopril - Enalapril - Lisinopril
toxic
Chronic gout.

46. Cocaine casues vasoconstriction and local anesthesia by What mechanism
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Indirect agonist - uptake 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.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels

47. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Phosphorylation by a Viral Kinase
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )

48. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
CL= (rate of elimination of drug/ Plasma drug conc.)
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Constant FRACTION eliminated per unit time.(exponential)

49. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Prevents the release of ACh - Which results in muscle paralysis.
cardiac depression - peripheral edema - flushing - dizziness - constipation
aPTT (intrinsic pathway)
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

50. How does botulinum toxin result in respiratory arrest?
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
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.
Topical and Oral - for Oral Candidiasis (Thrush)
Prevents the release of ACh - Which results in muscle paralysis.

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USMLE Step 1 Pharmacology

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