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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 type of neurological blockade would hexamethonium create?
torsade de pointes
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Inhibits CMV DNA polymerase

2. Classes of antihypertensive drugs?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
Lipoxygenase
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

3. What is the MOA of Ganciclovir?
Ceftriaxone
Inhibits CMV DNA polymerase
Leukotrienes increasing bronchial tone.
proarrhythmic

4. What is a common side effect of Misoprostol?
With supplemental Folic Acid
- Fluoroquinolones
Inhibits DNA dependent RNA polymerase
Diarrhea

5. List the specific antidote for this toxin: Warfarin
- Vitamin K & fresh frozen plasma
Beta Blockers
Tricyclic antidepressant.
Hypersensitivity reactions

6. List the specific antidote for this toxin: Cyanide
prevention of nodal arrhythmias (SVT)
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
- Nitrate - hydroxocobalamin thiosulfate

7. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
ACE inhibitor.
Choline acetyltransferase
Digitoxin 168hrs Digoxin 40 hrs
Pseudomonas species and Gram - rods

8. What is the specific clinical use of Indomethacin in neonates?
- Act on same receptor - Full has greater efficacy
- Shifts the curve to the right - increases Km
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Indomethacin is used to close a patent ductus arteriosus.

9. Which antimicrobial classes inhibit protein synthesis at the 30S subunit? (2)
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Quinolones
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.

10. What is a sign of toxicity with the use of thrombolytics?
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Bleeding.
Babiturate.
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL

11. When is Rifampin not used in combination with other drugs?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
- Steroids - Tamoxifen
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

12. How is Rifampin used clinically?
thick ascending limb
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Leukotrienes increasing bronchial tone.

13. What is the formula for Clearance (CL)
cross - allergenic
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Norepinephrine
CL= (rate of elimination of drug/ Plasma drug conc.)

14. How does botulinum toxin result in respiratory arrest?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Prevents the release of ACh - Which results in muscle paralysis.
- Physostigmine salicylate
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

15. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
- Normalize K+ - Lidocaine - & Anti - dig Mab
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
- Disulfram & also sulfonylureas - metronidazole
Doxycycline - because it is fecally eliminated

16. Which diuretics cause acidosis?
AluMINIMUM amount of feces.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
carbonic anhydrase inhibitors - K+ sparing diuretics
- Aminocaproic acid

17. List the mechanism - clinical use - & toxicity of Cisplatin.
- Flumazenil
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
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.

18. Resistance mechanisms for Macrolides

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19. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- Ethosuxamide - sulfonamides - lamotrigine

20. What neurotransmitter does Amantadine affect? How does it influence this NT?
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
- Chloramphenicol
Dopamine; causes its release from intact nerve terminals
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.

21. Antiarrhythmic class IV- primary site of action?
Inhibition of 50S peptidyl transferase - Bacteriostatic
Succinylcholine
AV nodal cells
- Methylene blue

22. What are two clinical uses of Azathioprine?
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Quinolones

23. For Heparin What is the Site of action
Choline acetyltransferase
Blood
- Antipsychotics
ACIDazolamide' causes acidosis

24. 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.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Pyridoxine (B6) administration
In treatment of malignant hyperthermia - due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome - a toxicity of antipsychotic drugs.

25. Preferential action of the Ca2+ channel blockers at vascular smooth muscle?
Diarrhea
local anesthetic. CNS stimulation or depression. CV depression.
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil

26. Resistance mechanisms for Vancomycin
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
Diarrhea
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)

27. Which drug(s) cause this reaction: Anaphylaxis?
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.)
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
very short acting
- Penicillin

28. Resistance mechanisms for Cephalosporins/Penicillins
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Beta - lactamase cleavage of Beta - lactam ring
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
Binding to the presynaptic alpha 2 release modulating receptors

29. Which drug increases Sys BP w/o affecting Pulse Pressure
pulmonary edema - dehydration
Epinephrine
Tendonitis and Tendon rupture
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

30. What are signs of Sildenafil (Viagra) toxicity?
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Headache - flushing - dyspepsia - blue - green color vision.
Praziquantel
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules

31. How is Leishmaniasis treated?
No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
For serious - Gram + multidrug - resistant organisms
Pentavalent Antimony

32. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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33. Cocaine shares is mechanism of action with What antidepressant
Keratin containing tissues - e.g. - nails
Binding to the presynaptic alpha 2 release modulating receptors
TCA
severe hypertension - CHF

34. Adverse effect of Nitroprusside?
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
- polymyxins
- N- acetylcystine
cyanide toxicity (releases CN)

35. Acetazolamide - mechanism?
- ACE inhibitors (Losartan>no cough)
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
pulmonary edema - dehydration

36. List the mechanism - clinical use - & toxicity of Etoposide.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
- Infections - Trauma - Seizures - CO - Overdose - Metabolic - Alcohol (IT'S COMA)
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

37. What is the category of drug names ending in - terol (e.g. Albuterol)
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
Digoxin=urinary Digitoxin=biliary
Beta -2 agonist.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

38. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
dizziness - flushing - constipation (verapamil) - nausea
Tricyclic antidepressant.

39. What populations are Floroquinolones contraindicated in? Why?
- Cloazapine - carbamazapine - colchicine - PTU
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Pregnant women - Children; because animal studies show Damage to Cartilage
Pentavalent Antimony

40. For Warfarin What is the Ability to inhibit coagulation in vitro
- Antipsychotics
No
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

41. What type of gout is treated with Allopurinol?
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Chronic gout.
The PT.
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.

42. How can the toxic effects of TMP be ameliorated?
- Protamine
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
With supplemental Folic Acid
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

43. What is the category of drug names ending in - pril (e.g. Captopril)
Penicillin.
Methylation of rRNA near Erythromycin's ribosome binding site
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
ACE inhibitor.

44. For Warfarin What is the Duration of action
Ataxia - Dizziness - Slurred speech
Chronic (weeks or months)
-100% oxygen - hyperbaric
Increase target cell response to insulin.

45. What should not be taken with Tetracyclines? / Why?
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Same as penicillin. Extended spectrum antibiotics
TMP- SMZ

46. Antiarrhythmic Class III- effects?
Methylxanthine.
- Atropine & pralidoxime
GI upset - Superinfections - Skin rashes - Headache - Dizziness
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

47. What is the mechanism of action of the H2 Blockers?
Carbachol - pilocarpine - physostigmine - echothiophate
collecting ducts
Reversible block of histamine H2 receptors
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

48. What is a possible toxicity of Ticlopidine - Clopidogrel usage?
AmOxicillin has greater Oral bioavailability
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.
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.
Botulinum

49. What is the mechanism of action of Probenacid used to treat chronic gout?
TMP- SMZ (DOC) - aerosolized pentamidine
Inhibits reabsorption of uric acid.
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Staphlococcus aureus

50. MOA: Block nucleotide synthesis
proarrhythmic
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Sulfonamides - Trimethoprim
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

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USMLE Step 1 Pharmacology

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