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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

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1. Which drug(s) cause this reaction: Gray baby syndrome?
- EDTA - dimercaprol - succimer - & penicillamine
TCA
- Chloramphenicol
Inhibits Viral DNA polymerase

2. Adverse effects of ganglionic blockers?
Sotalol - Ibutilide - Bretylium - Amiodarone
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
- Vinca alkaloids(inhibit MT) - Paclitaxel
ACIDazolamide' causes acidosis

3. What are the clinical uses for 3rd Generation Cephalosporins?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
severe hypertension - CHF
Yes - it does not cross the placenta.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.

4. What organisms does Griseofulvin target?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Large anionic polymer - acidic
Dermatophytes (tinea - ringworm)

5. What are Aminoglycosides used for clinically?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Severe Gram - rod infections.
Triple sulfas or SMZ
Tricyclic antidepressant.

6. Common side effects associated with Clindamycin include?
- Haloperidol - chlorpromazine - reserpine - MPTP
Pseudomembranous colitis (C. difficile) - fever - diarrhea
No - warfarin - unlike heparin - can cross the placenta.
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression

7. What is combined with Ampicillin - Amoxicillin - Carbenicillin - Piperacillin - and Ticarcillin to enhance their spectrum?
Clavulanic acid
G6PD deficient individuals
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
Ceftriaxone

8. What is the mechanism of action of the thrombolytics?
Because they require some residual islet function.
With supplemental Folic Acid
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.)
Polymyxin B - Polymyxin E

9. What are the major toxic side effects of the Cephalosporins?
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
viral kinase
Imipenem
Succinylcholine

10. Name some common Tetracyclines (4)
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Rash - Pseudomembranous colitis
bradycardia - AV block - CHF
1. Antipyretic 2. Analgesic 3. Anti - inflammatory

11. What is the memory key for the action of Sildenafil (Viagra)?
Sildenafil fills the penis
- Tetracycline - amiodarone - sulfonamides
Indomethacin is used to close a patent ductus arteriosus.
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome

12. How are Interferons (INF) used clinically?

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13. How is Vancomycin used clinically?
Constant FRACTION eliminated per unit time.(exponential)
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
- Daunorubicin & Doxorubicin
For serious - Gram + multidrug - resistant organisms

14. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
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.)
not a sulfonamide - but action is the same as furosemide

15. What are the Macrolides used for clinically?
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
No

16. What is Clindamycin used for clinically?
No
Pregnant women - Children; because animal studies show Damage to Cartilage
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Epinephrine

17. What is the clinical use for Penicillin?
INH: Injures Neurons and Hepatocytes
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
- Phenytoin
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes

18. Common toxicities associated with Griseofulvin?
Teratogenic - Carcinogenic - Confusion - Headaches
Hydralazine and Minoxidil
Chronic (weeks or months)
anticholinesterase glaucoma

19. What is the specific clinical use of Indomethacin in neonates?
Indomethacin is used to close a patent ductus arteriosus.
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Inhibit Ergosterol synthesis
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.

20. Decrease Digitoxin dose in renal failure?
cyanide toxicity (releases CN)
Methylxanthine.
NO
H2 antagonist

21. What is the lab value used to monitor the effectiveness of Warfarin therapy?
- Bleomycin - amiodarone - busulfan
The PT.
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

22. For Heparin What is the Mechanism of action
Activates antithrombin III
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.
Gram + and Anerobes
Antileukotriene; blocks leukotriene receptors.

23. What is the mechanism of action of NSAIDs other than Aspirin?
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B

24. What type of gout is treated with Allopurinol?
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Chronic gout.
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Keratin containing tissues - e.g. - nails

25. How are the HIV drugs used clinically?

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26. What is the category of drug names ending in - tidine (e.g. Cimetidine)
Botulinum
Epinephrine
Nephrotoxicity
H2 antagonist

27. Adverse effects of Hydrochlorothiazide?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)

28. What two vasodilators require simultaneous treatment with beta blockers to prevent reflex tachycardia and diuretics to prevent salt retention?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Wide spectrum of systemic mycoses: Cryptococcus - Blastomyces - Coccidioides - Aspergillus - Histoplasma - Candida - Mucor
Hydralazine and Minoxidil
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)

29. What is the chemical name for Ganciclovir?
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.
DHPG (dihydroxy-2- propoxymethyl guanine)
Treatment of infertility.
H2 antagonist

30. What is the MOA for Nystatin?
Binds ergosterol - Disrupts fungal membranes
Large anionic polymer - acidic
Cilastatin
local anesthetic. CNS stimulation or depression. CV depression.

31. What is the mecanism of action of the COX-2 inhibitors (celecoxib - rofecoxib)?
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.
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
AluMINIMUM amount of feces.
- Steroids - Tamoxifen

32. Ca2+ sensitizers'- site of action?
troponin - tropomyosin system
Dermatophytes (tinea - ringworm)
torsade de pointes - excessive Beta block
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

33. What is the MOA for Amphotericin B?
ACE inhibitor.
Nifedipine - Verapamil - Diltiazem
Phosphorylation by a Viral Kinase
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

34. What side effect of using atropine to induce pupillary dilation would you expect?
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
- Tamoxifen
- Ammonium Chloride
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

35. Spironolactone - mechanism?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
competitive inhibirot of aldosterone in the cortical collecting tubule
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

36. K+ sparing diuretics - toxicity?
Na/K ATPase
Ceftriaxone
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)

37. How do you treat coma in the ER (4)?
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Binding to the presynaptic alpha 2 release modulating receptors
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.
local anesthetic. CNS stimulation or depression. CV depression.

38. Beta Blockers - CV toxicity?
bradycardia - AV block - CHF
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Chagas' disease - American Trypanosomiasis (Trypanosoma cruzi)
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

39. List the specific antidote for this toxin: Anticholinesterases (organophosphate.)
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
Epinephrine
- Atropine & pralidoxime
It inhibits release of NE.

40. What conditions are treated with Metronidazole?
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
VACUUM your Bed Room'
Modification via Acetylation - Adenylation - or Phosphorylation

41. List the mechanism - clinical use - & toxicity of 5 FU.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
- S- phase anti - metabolite Pyr analogue - Colon - solid tumors - & BCC/ - Irreversible myelosuppression
Those patients who are taking nitrates.
depresses ectopic pacemakers - especially in digoxin toxicity

42. Why is pyridostigmine effective in the treatment of myasthenia gravis?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
- Chloramphenicol
As an anticholinesterase it increases endogenous ACh and thus increases strength.
sedation - depression - nasal stuffiness - diarrhea

43. What are the nondepolarizing neuromuscular blocking drugs?
- Tetracycline - amiodarone - sulfonamides
Neomycin
- Tetracycline
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

44. What class of drug is echothiophate? What is its indication?
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Inhibt Assembly of new virus by Blocking Protease Enzyme
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
anticholinesterase glaucoma

45. MOA: Block nucleotide synthesis
- Oxalic acid - Acidosis & nephrotoxicity
Prevents the release of ACh - Which results in muscle paralysis.
anticholinesterase glaucoma
Sulfonamides - Trimethoprim

46. Amprotericin B ___________ the BBB
TMP- SMZ (DOC) - aerosolized pentamidine
Does not cross
- Bleomycin - amiodarone - busulfan
Binds ergosterol - Disrupts fungal membranes

47. Which diuretics increase urine Ca2+?
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
Nephrotoxicity
loop diuretics - spironolactone
- Tricyclic antidepressants

48. Toxic effects of TMP include?
Amphotericin B - Nystatin - Fluconazole/azoles
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Megaloblastic anemia - Leukopenia - Granulocytopenia
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.

49. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
Only in limited amounts
- Formaldehyde & formic acid - severe acidosis & retinal damage
depresses ectopic pacemakers - especially in digoxin toxicity
These B-2 agonists cause respiratory smooth muscle to relax.

50. What are the clinical uses for Ticlopidine - Clopidogrel?
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium
TMP- SMZ
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Severe Gram - rod infections.

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USMLE Step 1 Pharmacology

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