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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. Ethacrynic Acid - clinical use?
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
edrophonium (extremely short acting anticholinesterase)
Diuresis in pateints with sulfa allergy
Pseudomembranous colitis (C. difficile) - fever - diarrhea

2. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
Dermatophytes (tinea - ringworm)
Bethanechol - Neostigmine - physostigmine
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Same as penicillin. Extended spectrum antibiotics

3. List the mechanism - clinical use - & toxicity of Bleomycin.
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Flumazenil
- DNA intercalator - testicular & lymphomas - Pulmonary fibrosis mild myelosuppression.
Anaerobes

4. What is the mechanism of action of Acetaminophen?
Those patients who are taking nitrates.
- Fluoroquinolones
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.

5. Name two organisms Vancomycin is commonly used for?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Protease inhibitor.
Because they require some residual islet function.
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

6. What is the chemical name for Ganciclovir?
carbonic anhydrase inhibitors - K+ sparing diuretics
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
DHPG (dihydroxy-2- propoxymethyl guanine)
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

7. What is the mechanism of action of Colchicine used to treat acute gout?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
Dopamine
Sotalol - Ibutilide - Bretylium - Amiodarone
Cephalosporins

8. What are the clinical uses for Aztreonam?
Edrophonium
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
- Antipsychotics

9. What is the category of drug names ending in - caine (e.g. Lidocaine)
Local anesthetic.
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
reversible SLE- like syndrome
Antibiotic - protein synthesis inhibitor.

10. What are two clinical uses of Azathioprine?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
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.)
blocks SR Ca2+ channels
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)

11. How is Amphotericin B administered for fungal meningitis?
Intrathecally
It must be Phosphorylated by Viral Thymidine Kinase
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

12. What is the MOA of Imipenem?
- Tricyclic antidepressants
carbonic anhydrase inhibitors - K+ sparing diuretics
- B51Naloxone / naltrexone (Narcan)
Acts as a wide spectrum carbapenem

13. For Heparin What is the Lab value to monitor
aPTT (intrinsic pathway)
Pyridoxine (B6) administration
sedation - positive Coombs' test
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

14. Bretyllium - toxicity?
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
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
atropine - homatropine - tropicamide

15. Does Heparin have a long - medium - or short half life?
DOC in diagnosing and abolishing AV nodal arrhythmias
decrease conduction velocity - increase ERP - increase PR interval
Short.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

16. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
GI upset
Pentamidine
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.
- Formaldehyde & formic acid - severe acidosis & retinal damage

17. Side effects of Isoniazid (INH)?
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
DOC in diagnosing and abolishing AV nodal arrhythmias
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome
Rapid (seconds)

18. What process does Zafirlukast interfere with?
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Pralidoxime regenerates active cholinesterase.
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Leukotrienes increasing bronchial tone.

19. Foscarnet toxicity?
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.
- Methylene blue
Gram + cocci - Gram - rods - and Anerobes
Nephrotoxicity

20. Ryanodine - site of action?
PT
ACE inhibitor.
blocks SR Ca2+ channels
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia

21. Adverse effects of beta - blockers?
Dopamine
- NaHCO3
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)
Bacitracin - Vancomycin

22. Hydralazine - clinical use?
severe hypertension - CHF
Tricyclic antidepressant.
Alpha -1 antagonist
It acts presynaptically to increase NE release.

23. The MOA for Chloramphenicol is?
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
Inhibition of 50S peptidyl transferase - Bacteriostatic
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Aminoglycosides - Tetracyclines

24. These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
Chronic gout.
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
- Ammonium Chloride
Amphetamine and Ephedrine

25. What is the mechanism of action and clinical use of the antiandrogen Flutamide?
Cyclooxygenases (COX I - COX II).
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
-100% oxygen - hyperbaric
- polymyxins

26. For Warfarin What is the Route of administration
proarrhythmic
Pretreat with antihistamines and a slow infusion rate
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Oral

27. List the mechanism - clinical use - & toxicity of Methotrexate.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Succinylcholine
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression

28. For Warfarin What is the Site of action
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Liver
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness

29. Why would you use pralidoxime after exposure to an organophosphate?
Beta -2 agonist.
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Pralidoxime regenerates active cholinesterase.
cardiac muscle: Verapamil>Diltiazem>Nifedipine

30. What is a common side effect of Colchicine used to treat acute gout - especially When given orally?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
GET on the Metro
GI side effects. (Indomethacin is less toxic - more commonly used.)
Antibiotic - protein synthesis inhibitor.

31. What is a mnemonic to remember Amantadine's function?
torsade de pointes
Blocks Influenza A and RubellA; causes problems with the cerebellA
propanolol - esmolol - metoprolol - atenolol - timolol
- Alkalinize urine & dialysis

32. Why does atropine dilate the pupil?
Captopril - Enalapril - Lisinopril
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

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

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34. Adverse effects of ganglionic blockers?
Methicillin - Nafcillin - and Dicloxacillin
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
severe orthostatic hypotension - blurred vision - constipation - sexual dysfunction
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk

35. What are common toxic side effects of Sulfonamides? (5)
Aminoglycosides - Tetracyclines
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)

36. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
Quinidine - Amiodarone - Procainamide - Disopyramide
Hemolytic anemia
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

37. Which diuretics increase urine NaCl?
- Methylene blue
all of them
Verapamil - Diltiazem - Bepridil
Mg = Must go to the bathroom.

38. List the specific antidote for this toxin: Copper
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
- Penicillamine
Diarrhea
Benzodiazepine.

39. For Heparin What is the Mechanism of action
- polymyxins
Delirium - Tremor - Nephrotoxicity
Activates antithrombin III
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

40. Resistance mechanisms for Tetracycline
Chronic (weeks or months)
Decreased uptake or Increased transport out of cell
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.

41. ACE inhibitors - clinical use?
hypertension - CHF - diabetic renal disease
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased

42. How does botulinum toxin result in respiratory arrest?
When pts have Low CD4+ (< 500 cells/cubic mm) or a High Viral Load
Prevents the release of ACh - Which results in muscle paralysis.
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
VACUUM your Bed Room'

43. What is the effect of guanethidine on adrenergic NE release?
- Formaldehyde & formic acid - severe acidosis & retinal damage
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
It inhibits release of NE.
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.

44. Which drug(s) cause this reaction: Hot flashes?
check PFTs - LFTs - and TFTs
- Tamoxifen
Acute gout.
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

45. Toxicities associated with Acyclovir?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Pentavalent Antimony
Delirium - Tremor - Nephrotoxicity

46. Verapamil has similar action to?
atropine - homatropine - tropicamide
Beta Blockers
torsade de pointes - excessive Beta block
Indirect agonist - uptake inhibitor

47. Which drug(s) cause this reaction: Thrombotic complications?
Sotalol - Ibutilide - Bretylium - Amiodarone
- Atropine & pralidoxime
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
- Oral Contraceptives

48. Are penicillinase resistant
Methicillin - Nafcillin - and Dicloxacillin
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Inhibit Ergosterol synthesis
- Daunorubicin & Doxorubicin

49. What is the possible mechanism and effect of Metformin in treating diabetes?
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Acetylcholinesterase; ACh is broken down into choline and acetate.
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
aPTT (intrinsic pathway)

50. Why does NE result in bradycardia?
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Minor hepatotoxicity - Drug interactions (activates P450)
is resistant
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis

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USMLE Step 1 Pharmacology

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