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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 category of drug names ending in - zosin (e.g. Prazosin)
Paranteral (IV - SC)
Alpha -1 antagonist
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

2. What microorganisms is Aztreonam not effective against?
Yes
Gram + and Anerobes
GI disturbances.
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas

3. What are the clinical uses for Aztreonam?
GI distress - Skin rash - and Seizures at high plasma levels
Activates antithrombin III
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Impairs the synthesis of vitamin K- dependent clotting factors

4. What are four clinical uses of glucocorticoids?

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5. MOA: Bactericidal antibiotics
Used in combination therapy with SMZ to sequentially block folate synthesis
- Ethosuxamide - sulfonamides - lamotrigine
Because they require some residual islet function.
Penicillin - Cephalosporins - Vancomycin - Aminoglycosides - Fluoroquinolones - Metronidazole

6. How does angiotensin II affect NE release?
It acts presynaptically to increase NE release.
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Clavulanic acid
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

7. What is the MOA of Aztreonam?
- Tetracycline - amiodarone - sulfonamides
Beta - lactam antibiotics
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
impotence - asthma - CV effects (bradycardia - CHF - AV block) - CNS effects (sedation - sleep alterations)

8. In coma situations you rule out What (7)?

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9. What are three common NSAIDS other than Aspirin?
No - hemicholinum block the uptake of Choline and thus Ach synthesis
Ibuprofen - Naproxen - and Indomethacin
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
Sildenafil fills the penis

10. Foscarnet toxicity?
The PT.
With supplemental Folic Acid
Nephrotoxicity
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

11. Name three Antiarrhythmic drugs in class IB.
Polymyxins
Sotalol - Ibutilide - Bretylium - Amiodarone
Lidocaine - Mexiletine - Tocainide
not a sulfonamide - but action is the same as furosemide

12. What is the MOA of the RT Inhibitors?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Premature infants - because they lack UDP- glucuronyl transferase
Ataxia - Dizziness - Slurred speech

13. What is the effect of epinephrine infusion on bp and pulse pressure?
block Na+ channels in the cortical collecting tubule
Beta - lactam antibiotics
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic

14. Why are Methicillin - Nafcillin - and Dicloxacillin penicillinase resistant?
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Slow - limited by half lives of clotting factors
Diarrhea
Due to the presence of a bulkier R group

15. Name some common Sulfonamides (4)
Rifampin (DOC) - minocycline
With an amino acid change of D- ala D- ala to D- ala D- lac
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.

16. Name four HMG- CoA reductase inhibitors.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Stimulates beta adrenergic receptors
Blood
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

17. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
Potent immunosuppressive used in organ transplant recipients.
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Hypersensitivity reactions

18. List the specific antidote for this toxin: TPA & Streptokinase
Bleeding.
- Aminocaproic acid
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
hypertension - angina - arrhythmias

19. What is a common drug interaction associated with Griseofulvin?
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Nephrotoxicity
- Niacin - Ca++ channel blockers - adenosine - vancomycin
Increases coumadin metabolism

20. MOA: Block mRNA synthesis
Rifampin
Severe Gram - rod infections.
Useful in muscle paralysis during surgery or mechanical ventilation.
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

21. What are four advantages of newer low - molecular - weight heparins (Enoxaparin)?
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).
Botulinum
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

22. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Inhibits cell wall mucopeptide formation - Bactericidal
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

23. What class of drug is echothiophate? What is its indication?
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic
anticholinesterase glaucoma

24. For Heparin What is the Site of action
Blood
Paranteral (IV - SC)
bradycardia - AV block - CHF
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

25. MOA: Block protein synthesis at 50s subunit
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Aminoglycosides
Nifedipine - Verapamil - Diltiazem
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)

26. Why would you use pralidoxime after exposure to an organophosphate?
aPTT (intrinsic pathway)
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
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.
Pralidoxime regenerates active cholinesterase.

27. What is the clinical use for Nystatin?
Dopamine; causes its release from intact nerve terminals
Topical and Oral - for Oral Candidiasis (Thrush)
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.

28. When is Rifampin not used in combination with other drugs?
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
torsade de pointes
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
Forms toxic metabolites in the bacterial cell - Bactericidal

29. Adverse effects of Guanethidine?
Premature infants - because they lack UDP- glucuronyl transferase
Lipoxygenase
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

30. What type of gout is treated with Colchicine?
Acute gout.
For serious - Gram + multidrug - resistant organisms
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
Ipratropium

31. Name the common Aminoglycosides (5)
Ipratropium
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Neomycin
Lovastatin - Pravastatin - Simvastatin - Atorvastatin

32. What is the MOA of Imipenem?
Treatment of infertility.
It affects beta receptors equally and is used in AV heart block (rare).
Acts as a wide spectrum carbapenem
- Vinca alkaloids(inhibit MT) - Paclitaxel

33. Explain potency in relation to full and partial agonists(2).
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
These B-2 agonists cause respiratory smooth muscle to relax.
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

34. What are the clinical uses for 3rd Generation Cephalosporins?
new arrhythmias - hypotension
Gemfibrozil - Clofibrate
AluMINIMUM amount of feces.
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)

35. What antimuscarinic agent is used in asthma and COPD?
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
Triple sulfas or SMZ
Ipratropium
Chronic anticoagulation.

36. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
atropine - homatropine - tropicamide
1. Significant: nephrotoxicity 2. Peripheral neuropathy 3. Hypertension 4. Pleural effusion 5. Hyperglycemia.
Ceftriaxone
Rapid (seconds)

37. How would you reverse the effect of a neuromuscular blocking agent?
- Haloperidol - chlorpromazine - reserpine - MPTP
cardiac depression - peripheral edema - flushing - dizziness - constipation
- Flumazenil
Give an antichloinesterase - neostigmine - edrophonium - etc

38. What is the formula for Volume of distribution (Vd)
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
1. Buffalo hump 2. Moon facies 3. Truncal obesity 4. Muscle wasting 5. Thin skin 6. Easy bruisability 7. Osteoporosis 8. Adrenocortical atrophy 9. Peptic ulcers
Pyridoxine (B6) administration
Vd= (Amt. of drug in body/ Plasma drug conc.)

39. What antimuscarinic drug is useful for the tx of asthma
- Ethanol - dialysis - & fomepizole
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Constant FRACTION eliminated per unit time.(exponential)
Ipratropium

40. What is the MOA for Rifampin?
Inhibits DNA dependent RNA polymerase
YES
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.
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.

41. What is the MOA for the Macrolides?
NO HYPERURICEMIA - NO SULFA AllERGY; same as furosemide otherwise
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic

42. Which drug(s) cause this reaction: P450 inhibition(6)?
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
- Alkalinize urine & dialysis
Botulinum
Hypersensitivity reactions

43. Which drug(s) cause this reaction: Torsade de pointes (2)?
- Ammonium Chloride
They inhibit reuptake of NE at the nerve terminal (as does cocaine).
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy

44. Which antimicrobials inhibit protein synthesis at the 50S subunit? (4)
penicillinase resistant
Digoxin=urinary Digitoxin=biliary
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic

45. The MOA for Chloramphenicol is?
- S- phase anti - metabolite folate analogue - Luk - Lymp - sarc - RA - & psoriasis / - Reversible myelosuppression
Inhibition of 50S peptidyl transferase - Bacteriostatic
- Glucagon
G6PD deficient individuals

46. Why does NE result in bradycardia?
Reversible block of histamine H2 receptors
Methylxanthine.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
- aminoglycosides - loop diuretics - cisplatin

47. What is the clinical use of Tacrolimus (FK506)?
blocks SR Ca2+ channels
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
Potent immunosuppressive used in organ transplant recipients.
Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and expression of COX-2.

48. Antiarrhythmic class IC- effects?
Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Binds ergosterol - Disrupts fungal membranes

49. What Sulfonamides are used for simple UTIs?
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.
Acute (hours)
Triple sulfas or SMZ
Activates antithrombin III

50. Antiarrhythmic class IA effects?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
scopolamine

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USMLE Step 1 Pharmacology

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