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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 clinical utility of cocaine?
The only local anesthetic with vasoconstrictive properties.
Bacitracin - Vancomycin
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

2. What is the MOA for Trimethoprim (TMP)?
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Bethanechol - Neostigmine - physostigmine
Scopolamine
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic

3. 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
Prevents the release of Ca from SR of skeletal muscle
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

4. Secretion of What drug is inhibited by Probenacid used to treat chronic gout?
Rapid (seconds)
Indomethacin is used to close a patent ductus arteriosus.
Penicillin.
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

5. How is Acyclovir used clinically?
- N- acetylcystine
effective in torsade de pointes and digoxin toxicity
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

6. Spironolactone - mechanism?
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
competitive inhibirot of aldosterone in the cortical collecting tubule
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species

7. What are Aminoglycosides synergistic with?
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.
- Ammonium Chloride
Rheumatoid and osteoarthritis.
Beta - lactam antibiotics

8. How is Amantadine used clinically?

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9. What is a possible result of overdose of Acetaminophen?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
- Tetracycline - amiodarone - sulfonamides

10. Explain pH dependent urinary drug elimination?
Dopamine
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Local anesthetic.
Rifampin (DOC) - minocycline

11. List the mechanism - clinical use - & toxicity of Tamoxifen.
BM suppression (neutropenia - anemia) - Peripheral neuropathy
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
Binds to the Pyrophosphate Binding Site of the enzyme
Leukotrienes increasing bronchial tone.

12. List the specific antidote for this toxin: Opioids
Antileukotriene; blocks leukotriene receptors.
- B51Naloxone / naltrexone (Narcan)
toxic
Prevents the release of ACh - Which results in muscle paralysis.

13. Digitalis - site of action?
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
Doxycycline - because it is fecally eliminated
Na/K ATPase
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.

14. What is the MOA of Ribavirin?
Dermatophytes (tinea - ringworm)
IV vitamin K and fresh frozen plasma
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
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.

15. Hydrochlorothiazide - mechanism?
Acetylcholinesterase; ACh is broken down into choline and acetate.
- B51Naloxone / naltrexone (Narcan)
Mg = Must go to the bathroom.
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

16. Antimicrobial prophylaxis for a history of recurrent UTIs
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
TMP- SMZ
Decreased uptake or Increased transport out of cell

17. Ca2+ sensitizers'- site of action?
penicillinase resistant
troponin - tropomyosin system
It must be Phosphorylated by Viral Thymidine Kinase
Pentamidine

18. Toxic effects of TMP include?
Butyrophenone (neuroleptic).
Antifungal.
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Megaloblastic anemia - Leukopenia - Granulocytopenia

19. How is Amphotericin B administered for fungal meningitis?
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Inhibits cGMP phosphodiesterase - casuing increased cGMP - smooth muscle relaxation in the corpus cavernosum - increased blood flow - and penile erection.
Intrathecally

20. List the mechanism - clinical use - & toxicity of Vincristine.

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21. Amprotericin B ___________ the BBB
Nevirapine - Delavirdine
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)
Does not cross
Cell membrane Ca2+ channels of cardiac sarcomere

22. Aztreonam ________ to penicillinase
is resistant
Malaria (P. falciparum)
Inhibits xanthine oxidase - decresing conversion of xanthine to uric acid.
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.

23. For Heparin What is the Mechanism of action
Aplastic anemia (dose independent) - Gray Baby Syndrome
Activates antithrombin III
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.

24. What is an acronym to remember Anti - TB drugs?
RESPIre
Anaerobes
Yes - it does not cross the placenta.
sedation - sleep alterations

25. Name three ACE inhibitors?
Penicillin - G
sedation - depression - nasal stuffiness - diarrhea
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
Captopril - Enalapril - Lisinopril

26. Adverse effects of Hydrochlorothiazide?
hypokalemia - slight hyperlipidemia - hyperuricemia - lassitude - hypercalcemia - hyperglycemia
Beta1 more than B2
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Impairs the synthesis of vitamin K- dependent clotting factors

27. Which of epi - norepi - or isoproterenol results in bradycardia?
Norepinephrine
Oral
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.
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

28. Cautions When using Amiodarone?
check PFTs - LFTs - and TFTs
Fever/Chills - Hypotension - Nephrotoxicity - Arrhythmias
Aminoglycosides
torsade de pointes - excessive Beta block

29. What is the MOA for the Cephalosporins?
ACIDazolamide' causes acidosis
Beta lactams - inhibit cell wall synthesis - Bactericidal
physostigmine
Digitoxin 70% Digoxin 20-40%

30. What effect would atropine have on the preganglionic sympathetic activation of sweat glands? Would this person sweat?
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
Polymyxins
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome

31. Antiarrhythmic class II- effects?
decrease the slope of phase 4 - increase PR interval (the AV node is particularly sensitive)
Saquinavir - Ritonavir - Indinavir - Nelfinavir
anuria - CHF
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

32. What is the memory key involving the '4 R's of Rifampin?'
decrease conduction velocity - increase ERP - increase PR interval
AV nodal cells
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
- Tricyclic antidepressants

33. What are are the Sulfonylureas (general description) and What is their use?
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
- Vinca alkaloids(inhibit MT) - Paclitaxel
Local anesthetic.
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity

34. What are three types of antacids and the problems that can result from their overuse?
Staphlococcus aureus
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
1. Aluminum hydroxide: constipation and hypophosphatemia 2. Magnesium hydroxide: diarrhea 3. Calcium carbonate: Hypercalcemia - rebound acid increase - All may cause hypokalemia
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention

35. What is Niclosamide used for?
Keratin containing tissues - e.g. - nails
Norepinephrine (Alpha1 -2 and beta 1)
Enterobacter
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis

36. What are common side effects of RT Inhibitors?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
aPTT (intrinsic pathway)
- B51Naloxone / naltrexone (Narcan)
- Ethanol - dialysis - & fomepizole

37. Mg+- clinical use?
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.
effective in torsade de pointes and digoxin toxicity
It acts presynaptically to increase NE release.
Pentavalent Antimony

38. List the specific antidote for this toxin: Antimuscarinic (anticholinergic)
- Tricyclic antidepressants
- N- acetylcystine
- Physostigmine salicylate
Neurotoxicity - Acute renal tubular necrosis

39. What is the clinical utility of clonidine?
- Bleomycin - amiodarone - busulfan
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis

40. What is the lab value used to monitor the effectiveness of Warfarin therapy?
Ipratropium
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
The PT.

41. List the mechanism - clinical use - & toxicity of 6 MP.
toxic
- inhibits HGPRT (pur. Syn.) - Luk - Lymph
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities
reversible SLE- like syndrome

42. Foscarnet does not require activation by a...
viral kinase
Penicillin.
atropine - homatropine - tropicamide
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal

43. What is the specific clinical use of Indomethacin in neonates?
Long.
Dopamine; causes its release from intact nerve terminals
No - it inhibits the release of Nor Epi
Indomethacin is used to close a patent ductus arteriosus.

44. List the specific antidote for this toxin: Amphetamine
Succinylcholine
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
- Ammonium Chloride
- Atropine & pralidoxime

45. Which drug(s) cause this reaction: Osteoporosis (2)?
Severe Gram - rod infections.
- Corticosteroids - heparin
Beta antagonist.
Fast vs. Slow Acetylators

46. How is Vancomycin used clinically?
For serious - Gram + multidrug - resistant organisms
first dose orthostatic hypotension - dizziness - headache
hypertension - angina - arrhythmias
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.

47. List the specific antidote for this toxin: Cyanide
- Nitrate - hydroxocobalamin thiosulfate
Choline acetyltransferase
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
collecting ducts

48. ACE inhibitors - clinical use?
Ceftriaxone
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Neomycin
hypertension - CHF - diabetic renal disease

49. What is the mechanism of action of Mifepristone (RU486)?
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
Neomycin
Competitive inibitor of progestins at progesterone receptors.

50. What anticholinesterase crosses the blood - brain - barrier?
1. Hot flashes 2. Ovarian enlargement 3. Multiple simultaneous pregnancies 4. Visual disturbances
1. Renal damage 2. Aplastic anemia 3. GI distress
physostigmine
Epinephirine(Alpha1 -2 and Beta 1 -2)

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USMLE Step 1 Pharmacology

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