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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. Which drug(s) cause this reaction: Hepatitis?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Enterobacter
- Isoniazid

2. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
Heparin catalyzes the activation of antithrombin III.
Blood
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

3. What is the MOA for Rifampin?
Inhibits DNA dependent RNA polymerase
Antifungal.
Hypersensitivity reactions
It affects beta receptors equally and is used in AV heart block (rare).

4. What is the mechanism of action of Allopurinol used to treat chronic gout?
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

5. How is Griseofulvin used clinically?
Short.
Verapamil - Diltiazem - Bepridil
Oral treatment of superficial infections
Epinephirine(Alpha1 -2 and Beta 1 -2)

6. Antiarrhythmic class IC- toxicity?
Delirium - Tremor - Nephrotoxicity
proarrhythmic
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Chronic (weeks or months)

7. What are toxicities associated with Chloramphenicol?
Diuresis in pateints with sulfa allergy
Aplastic anemia (dose independent) - Gray Baby Syndrome
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

8. What is Metronidazole combined with for 'triple therapy'? Against What organism?
GI upset
Saquinavir - Ritonavir - Indinavir - Nelfinavir
competitive inhibirot of aldosterone in the cortical collecting tubule
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

9. Name four HMG- CoA reductase inhibitors.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
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.

10. List the specific antidote for this toxin: Salicylates
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
Long.
- Alkalinize urine & dialysis
Pituitary hormone.

11. What is combination TMP- SMZ used to treat?
Recurrent UTIs - Shigella - Salmonella - Pneumocystis carinii pneumonia
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
- Lithium
Oral

12. Do Tetracyclines penetrate the CNS?
Only in limited amounts
Imipenem
Pretreat with antihistamines and a slow infusion rate
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma

13. Which diuretics increase urine Ca2+?
Pseudomonas species and Gram - rods
Alpha -1 antagonist
Tendonitis and Tendon rupture
loop diuretics - spironolactone

14. What are toxic side effects for Metronidazole?
Ibuprofen - Naproxen - and Indomethacin
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
block Na+ channels in the cortical collecting tubule
Disulfiram - like reaction with EtOH - Headache

15. K+ sparing diuretics - toxicity?
proarrhythmic
Binding to the presynaptic alpha 2 release modulating receptors
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.

16. Which drug(s) cause this reaction: Drug induced Parkinson's (4) ?
- Haloperidol - chlorpromazine - reserpine - MPTP
dry mouth - sedation - severe rebound hypertension
proximal convoluted tubule - thin descending limb - and collecting duct
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

17. Antimicrobial prophylaxis for Syphilis
Benzathine penicillin G
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Neomycin

18. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
Vd= (Amt. of drug in body/ Plasma drug conc.)
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
for RSV

19. Preferential action of the Ca2+ channel blockers at cardiac muscle?
cardiac muscle: Verapamil>Diltiazem>Nifedipine
decrease conduction velocity - increase ERP - increase PR interval
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

20. What is the clinical use for Clomiphene?
Treatment of infertility.
Antileukotriene; blocks leukotriene receptors.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
proarrhythmic

21. How are Interferons (INF) used clinically?

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22. What is the MOA for Metronidazole?
Forms toxic metabolites in the bacterial cell - Bactericidal
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Tricyclic antidepressant.

23. Which drug(s) cause this reaction: Adrenocortical Insufficiency
Hydralazine and Minoxidil
physostigmine
sedation - positive Coombs' test
- Glucocorticoid withdrawal

24. Antiarrhythmic class IV- primary site of action?
Megaloblastic anemia - Leukopenia - Granulocytopenia
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
AV nodal cells
The PTT.

25. What is the MOA for the Macrolides?
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Beta Blockers

26. What are the nondepolarizing neuromuscular blocking drugs?
Topical and Oral - for Oral Candidiasis (Thrush)
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

27. Steady state concentration is reached in __ number of half - lifes
Norepinephrine
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas

28. 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?
- Clindamycin
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Bethanechol - Neostigmine - physostigmine
Inhalational general anesthetic.

29. Which cancer drugs inhibit nucleotide synthesis(3)?
Penicillin - G
Norepinephrine
- Methotrexate - 5 FU - 6 mercaptopurine
Beta adrenergic receptors and Ca2+ channels (stimulatory)

30. What conditions would you use dantrolene?
- Physostigmine salicylate
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
Acts as a wide spectrum carbapenem
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

31. Name the Protease Inhibitors (4)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Inhibition of 50S peptidyl transferase - Bacteriostatic
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Gemfibrozil - Clofibrate

32. What is the MOA of Griseofulvin?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
GI discomfort
Interferes with microtubule function - disrupts mitosis - inhibits growth
Epinephrine

33. List the specific antidote for this toxin: Lead
Penicillin.
- EDTA - dimercaprol - succimer - & penicillamine
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
- Ethanol - dialysis - & fomepizole

34. Does Ampicillin or Amoxicillin have a greater oral bioavailability?
Pretreat with antihistamines and a slow infusion rate
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
AmOxicillin has greater Oral bioavailability
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

35. What drugs target anticholinesterase
loop diuretics - thiazides
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Vd= (Amt. of drug in body/ Plasma drug conc.)
- Vitamin K & fresh frozen plasma

36. Adverse effects of Captopril?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
CMV - esp in Immunocompromised patients

37. What is the mechanism of action of Probenacid used to treat chronic gout?
Rash - Pseudomembranous colitis
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Inhibits reabsorption of uric acid.
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

38. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
Hypersensitivity reactions
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Impairs the synthesis of vitamin K- dependent clotting factors
- N- acetylcystine

39. What are the Anti - TB drugs?
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Onchocerciasis ('river blindness'-- rIVER- mectin)
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

40. What is the mechanism of action of Omeprazole - Lansoprazole?
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
No
- Tricyclic antidepressants
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

41. Acetazolamide causes?

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42. Name the common Azoles
- Disulfram & also sulfonylureas - metronidazole
Nitrates
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
Beta adrenergic receptors and Ca2+ channels (stimulatory)

43. What is an occasional side effect of Aztreonam?
Flecainide - Encainide - Propafenone
GI upset
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia

44. List the specific antidote for this toxin: Methemoglobin
block Na+ channels in the cortical collecting tubule
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
- Methylene blue
cortical collecting tubule

45. What process does Zafirlukast interfere with?
- Physostigmine salicylate
Leukotrienes increasing bronchial tone.
These B-2 agonists cause respiratory smooth muscle to relax.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

46. What is the mechanism of Tacrolimus (FK506)?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
GI discomfort
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

47. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
Those patients who are taking nitrates.
Decreased uptake or Increased transport out of cell
These B-2 agonists cause respiratory smooth muscle to relax.

48. What is the clinical use for Penicillin?
Digitoxin>95% Digoxin 75%
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Amphotericin B - Nystatin - Fluconazole/azoles

49. Bretyllium - toxicity?
Reversible block of histamine H2 receptors
Prevents the release of ACh - Which results in muscle paralysis.
new arrhythmias - hypotension
Oral

50. Acetaminophen has What two clinical uses and lacks What one clinical use of the NSAIDs?
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Succinylcholine
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)

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USMLE Step 1 Pharmacology

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