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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 the effect of norepinephrine on bp and pulse pressure?
1. Acarbose 2. Miglitol
Penicillin.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

2. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
DOC in diagnosing and abolishing AV nodal arrhythmias
Ipratropium
Methicillin - Nafcillin - and Dicloxacillin
Nevirapine - Delavirdine

3. Bretyllium - toxicity?
Acetylcholine esterase
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.
new arrhythmias - hypotension
- Protamine

4. What are the clinical uses for Aztreonam?
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Flecainide - Encainide - Propafenone
Blocks Influenza A and RubellA; causes problems with the cerebellA

5. What is the MOA for the Fluoroquinolones?
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
- Steroids - Tamoxifen
Inhibits DNA dependent RNA polymerase

6. Name some common Sulfonamides (4)
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
Foscarnet = pyroFosphate analog
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

7. What is the effect of TCA's on the adrenergic nerve?
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

8. List the specific antidote for this toxin: Methanol & Ethylene glycol
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Verapamil - Diltiazem - Bepridil
- Ethanol - dialysis - & fomepizole
Carbachol - pilocarpine - physostigmine - echothiophate

9. Cocaine casues vasoconstriction and local anesthesia by What mechanism
HTN - CHF - calcium stone formation - nephrogenic DI.
Indirect agonist - uptake inhibitor
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Hypersensitivity reactions

10. What is the category of drug names ending in - phylline (e.g. Theophylline)
- Formaldehyde & formic acid - severe acidosis & retinal damage
Methylxanthine.
Phenothiazine (neuroleptic - antiemetic).
Doxycycline - because it is fecally eliminated

11. What are the products and their toxicities of the metabolism of Ethylene Glycol by / alcohol dehydrogenase?
- NaHCO3
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- Oxalic acid - Acidosis & nephrotoxicity
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

12. What is the category of drug names ending in - azepam (e.g. Diazepam)
Protamine sulfate
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Benzodiazepine.
ARF - shock - drug overdose - decrease intracranial/intraocular pressure

13. Which drug(s) cause this reaction: Aplastic anemia (5)?
- Clindamycin
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

14. For Heparin What is the Ability to inhibit coagulation in vitro
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
- Physostigmine salicylate
Yes
Lidocaine - Mexiletine - Tocainide

15. What are the clinical indications for bethanechol?
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Systemic mycoses
bradycardia - AV block - CHF
Captopril - Enalapril - Lisinopril

16. Spironolactone - mechanism?
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
competitive inhibirot of aldosterone in the cortical collecting tubule
Premature infants - because they lack UDP- glucuronyl transferase
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.

17. Which drug(s) cause this reaction: Tendonitis and rupture?
- Fluoroquinolones
cardiac depression - peripheral edema - flushing - dizziness - constipation
- Antipsychotics
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

18. Adverse effects of Clonidine?
dry mouth - sedation - severe rebound hypertension
Headache - flushing - dyspepsia - blue - green color vision.
fetal renal toxicity - hyperkalemia
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents

19. List the specific antidote for this toxin: Digitalis
- Normalize K+ - Lidocaine - & Anti - dig Mab
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.)
Flecainide - Encainide - Propafenone
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow

20. Common toxicities associated with Griseofulvin?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Teratogenic - Carcinogenic - Confusion - Headaches
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.

21. List the mechanism - clinical use - & toxicity of 6 MP.
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
G6PD deficient individuals
cardiac muscle: Verapamil>Diltiazem>Nifedipine
Nucleosides

22. What are four thrombolytics?
Sotalol - Ibutilide - Bretylium - Amiodarone
1. Streptokinase 2. Urokinase 3. tPA (alteplase) - APSAC (anistreplase)
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
orthostatic and exercise hypotension - sexual dysfunction - diarrhea

23. Which diuretics increase urine Ca2+?
Beta Blockers
Beta1 more than B2
- Clindamycin
loop diuretics - spironolactone

24. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
physostigmine
Cyclooxygenases (COX I - COX II).
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.

25. What is the effect of the Glitazones in diabetes treatment?
Onchocerciasis ('river blindness'-- rIVER- mectin)
Increase target cell response to insulin.
proximal convoluted tubule
Quinolones

26. What is the category of drug names ending in - operidol (e.g. Haloperidol)
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
DOC in diagnosing and abolishing AV nodal arrhythmias
Butyrophenone (neuroleptic).
Bacitracin - Vancomycin

27. What is the category of drug names ending in - zosin (e.g. Prazosin)
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Alpha -1 antagonist
Inhibits Viral DNA polymerase
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

28. Resistance mechanisms for Cephalosporins/Penicillins
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Beta - lactamase cleavage of Beta - lactam ring
- Steroids - Tamoxifen
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.

29. What anticholinesterase crosses the blood - brain - barrier?
- Phase I (clinical tests) - Phase II - Phase III - PhaseIV (surveillance)
DHPG (dihydroxy-2- propoxymethyl guanine)
physostigmine
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

30. What is the only depolarizing neuromuscular blocking agent?
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Succinylcholine

31. List the specific antidote for this toxin: Methemoglobin
Because they require some residual islet function.
- Methylene blue
Methylxanthine.
Cephalosporin: 1) has a 6 member ring attached to the Beta lactam instead of a 5 member ring 2)has an extra functional group ( attached to the 6 member ring)

32. How are Sulfonamides employed clinically?
hypertension - CHF - diabetic renal disease
Gram + - Gram - - Norcardia - Chlamydia
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Rifampin (DOC) - minocycline

33. What is the MOA of Aztreonam?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
No - hemicholinum block the uptake of Choline and thus Ach synthesis

34. List the mechanism - clinical use - & toxicity of Prednisone.

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35. MOA: Block peptidoglycan synthesis
Bacitracin - Vancomycin
Sulfonamides - Trimethoprim
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
Pseudomonas species and Gram - rods

36. Why would you use pralidoxime after exposure to an organophosphate?
Pralidoxime regenerates active cholinesterase.
For serious - Gram + multidrug - resistant organisms
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

37. List the specific antidote for this toxin: Arsenic (all heavy metals)
- Dimercaprol - succimer
Well tolerated in general but occasionally - Nephrotoxicity - Ototoxicity - Thrombophlebitis - diffuse flushing='Red Man Syndrome'
Polymyxins
Pyridoxine (B6) administration

38. Mannitol - site of action?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
proximal convoluted tubule - thin descending limb - and collecting duct
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Prophylaxis for Influenza A - Rubella; Parkinson's disease

39. What are five advantages of Oral Contraceptives (synthetic progestins - estrogen)?
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
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
- polymyxins
Cardiac glycoside (inotropic agent).

40. Antiarrhythmic class IV- primary site of action?
Beta - lactamase cleavage of Beta - lactam ring
cross - allergenic
Flecainide - Encainide - Propafenone
AV nodal cells

41. For Heparin What is the Onset of action
Rapid (seconds)
With an amino acid change of D- ala D- ala to D- ala D- lac
Tetracycline - Doxycycline - Demeclocycline - Minocycline
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

42. Furosemide - class and mechanism?
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Gemfibrozil - Clofibrate

43. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

44. Which drug(s) cause this reaction: Diabetes insipidus?
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
- Lithium

45. How is Leishmaniasis treated?
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
Pentavalent Antimony
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

46. How is Amphotericin B administered for fungal meningitis?
Aminoglycosides
Small lipid - soluble molecule
Long.
Intrathecally

47. When is HIV therapy initiated?
Nitrates
Prevents the release of ACh - Which results in muscle paralysis.
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load

48. Which diuretics decrease urine Ca2+?
thiazides - amiloride
Rifampin (DOC) - minocycline
carbonic anhydrase inhibitors - K+ sparing diuretics
Modification via Acetylation - Adenylation - or Phosphorylation

49. What drug is given for Pneumocystis carinii prophylaxis?
Pentamidine
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
- aminoglycosides - loop diuretics - cisplatin
hypertension - CHF - diabetic renal disease

50. 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?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole
Prevents the release of ACh - Which results in muscle paralysis.
Cyclooxygenases (COX I - COX II).

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USMLE Step 1 Pharmacology

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