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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. List the specific antidote for this toxin: Methanol & Ethylene glycol
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
- Ethanol - dialysis - & fomepizole
Cell membrane Ca2+ channels of cardiac sarcomere
Ataxia - Dizziness - Slurred speech

2. Ibutilide - toxicity?
torsade de pointes
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
- Tetracycline

3. Name several common Macrolides (3)
- Haloperidol - chlorpromazine - reserpine - MPTP
Amphotericin B - Nystatin - Fluconazole/azoles
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Erythromycin - Azithromycin - Clarithromycin

4. What are common toxicities associated with Tetracyclines?

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5. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
Hydralazine and Minoxidil
Prevents the release of ACh - Which results in muscle paralysis.

6. Mannitol - clinical use?
Inhibit Ergosterol synthesis
not a sulfonamide - but action is the same as furosemide
Cardiac glycoside (inotropic agent).
ARF - shock - drug overdose - decrease intracranial/intraocular pressure

7. What type of patient should not take Misoprostol and why?
Rare.
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
edrophonium (extremely short acting anticholinesterase)
- Penicillamine

8. What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and Spironolactone?
Ototoxicity - Hypokalemia - Dehydration - Allergy (sulfa) - Nephritis (interstitial) - Gout
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Mg = Must go to the bathroom.
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.

9. Name three Antiarrhythmic drugs in class IC.
Flecainide - Encainide - Propafenone
PT
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
CMV Retinitis in IC pts When Ganciclovir fails

10. What are the nondepolarizing neuromuscular blocking drugs?
- EDTA - dimercaprol - succimer - & penicillamine
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Indomethacin is used to close a patent ductus arteriosus.

11. Sotalol - toxicity?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
AV nodal cells
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
torsade de pointes - excessive Beta block

12. Adverse effects of Clonidine?
- Tricyclic antidepressants
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
dry mouth - sedation - severe rebound hypertension

13. Mannitol - mechanism?
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Inhibits CMV DNA polymerase

14. Beta Blockers - CV toxicity?
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
- Dimercaprol - succimer
bradycardia - AV block - CHF
- Isoniazid

15. What are toxicities associated with Chloramphenicol?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
all of them
Aplastic anemia (dose independent) - Gray Baby Syndrome
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.

16. What is the mechanism of action of the H2 Blockers?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Reversible block of histamine H2 receptors
Non - Nucleosides
Inhibition of 50S peptidyl transferase - Bacteriostatic

17. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Pyridoxine (B6) administration
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
AmOxicillin has greater Oral bioavailability
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

18. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Spironolactone - Triamterene - Amiloride (the K+ STAys)
Dermatophytes (tinea - ringworm)
- aminoglycosides - loop diuretics - cisplatin

19. What is the clinical use for Heparin?
Beta - lactam antibiotics
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
AluMINIMUM amount of feces.

20. What are the Anti - TB drugs?
scopolamine
Tricyclic antidepressant.
severe hypertension - CHF
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)

21. What is the chemical name for Ganciclovir?
Abortifacient.
Decreased uptake or Increased transport out of cell
Benzathine penicillin G
DHPG (dihydroxy-2- propoxymethyl guanine)

22. Hydrochlorothiazide - mechanism?
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
Only in limited amounts
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

23. What is the MOA for Methicillin - Nafcillin - and Dicloxacillin?
Digitoxin 168hrs Digoxin 40 hrs
Same as penicillin. Act as narrow spectrum antibiotics
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

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

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25. What is the mechanism of action of Cyclosporine?
narcolepsy - obesity - and attention deficit disorder (I wouldn't recommend this)
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.
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
GnRH analog with agonist properties When used in pulsatile fashion and antagonist properties When used in continuous fashion - causing a transient initial burst of LH and FSH

26. Ryanodine - site of action?
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.
blocks SR Ca2+ channels
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Prevents the release of Ca from SR of skeletal muscle

27. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
atropine - homatropine - tropicamide
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

28. What are common toxicities associated with Macrolides? (4)
Ataxia - Dizziness - Slurred speech
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
GET on the Metro

29. Antimicrobial prophylaxis for Meningococcal infection
Triple sulfas or SMZ
Rifampin (DOC) - minocycline
Amphotericin B - Nystatin - Fluconazole/azoles
Only in limited amounts

30. What is the formula for Volume of distribution (Vd)
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.
Minor hepatotoxicity - Drug interactions (activates P450)
Vd= (Amt. of drug in body/ Plasma drug conc.)
Praziquantel

31. What is a common side effect of Misoprostol?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
Diarrhea
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

32. What is the category of drug names ending in - azepam (e.g. Diazepam)
loop diuretics - thiazides
Beta Blockers
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Benzodiazepine.

33. Antimicrobial prophylaxis for PCP
Beta -2 agonist.
- NaHCO3
TMP- SMZ (DOC) - aerosolized pentamidine
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)

34. Does Heparin have a long - medium - or short half life?
penicillinase resistant
Short.
Modification via Acetylation - Adenylation - or Phosphorylation
Ataxia - Dizziness - Slurred speech

35. What are three toxicities of Leuprolied?
propanolol - esmolol - metoprolol - atenolol - timolol
YES
Large anionic polymer - acidic
1. Antiandrogen 2. Nausea 3. Vomiting

36. Which Aminoglycoside is used for Bowel Surgery ?
Prevents the release of Ca from SR of skeletal muscle
Neomycin
Digitoxin 70% Digoxin 20-40%
Antifungal.

37. What are two types of drugs that interfere with the action of Sucralfate and why?
Leukotrienes increasing bronchial tone.
Pretreat with antihistamines and a slow infusion rate
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.

38. Antimicrobial prophylaxis for Gonorrhea
Ceftriaxone
Lipoxygenase
Methylation of rRNA near Erythromycin's ribosome binding site
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.

39. What are Aminoglycosides used for clinically?
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
Severe Gram - rod infections.
Quinolones
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.)

40. What is Ketoconazole specifically used for?
Digitoxin>95% Digoxin 75%
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism
Cell membrane Ca2+ channels of cardiac sarcomere
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.

41. What is the mecanism of action of the COX-2 inhibitors (celecoxib - rofecoxib)?
No - it inhibits the release of Nor Epi
Flecainide - Encainide - Propafenone
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
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.

42. Quinidine - toxicity?
- Haloperidol - chlorpromazine - reserpine - MPTP
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Peptic ulcer disease.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

43. Digoxin v. Digitoxin: bioavailability?
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Digitoxin>95% Digoxin 75%
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods

44. What antimuscarinic agent is used in asthma and COPD?
Ipratropium
very short acting
GET on the Metro
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori

45. What are three clinical uses of the NSAIDs?
- Vinca alkaloids(inhibit MT) - Paclitaxel
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.

46. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Aminoglycosides
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Phenothiazine (neuroleptic - antiemetic).

47. What do you treat Nematode/roundworm (pinworm - whipworm) infections with?
- Ammonium Chloride
Beta1 more than B2
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Mebendazole/Thiabendazole - Pyrantel Pamoate

48. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Nevirapine - Delavirdine
Choline acetyltransferase
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.
sedation - positive Coombs' test

49. What is a sign of toxicity with the use of thrombolytics?
Bleeding.
NO
DOC in diagnosing and abolishing AV nodal arrhythmias
Systemic mycoses

50. Name the common Azoles
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
- NaHCO3
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole