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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 loading dose formula?
Dopamine; causes its release from intact nerve terminals
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
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.

2. Which drug(s) cause this reaction: P450 induction(6)?
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Acetylcholinesterase; ACh is broken down into choline and acetate.
- aminoglycosides - loop diuretics - cisplatin
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).

3. What are two toxicities of the Sulfonylureas?
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Protease Inhibitors and Reverse Transcriptase Inhibitors
- Penicillamine

4. What antimicrobial class is Aztreonam syngergestic with?
Aminoglycosides
1. Weight gain 2. Hepatotoxicity (troglitazone)
Because they require some residual islet function.
Decreased uptake or Increased transport out of cell

5. Which diuretics decrease urine Ca2+?
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
Blocks Norepi - but not Dopamine
thiazides - amiloride
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

6. Ca2+ sensitizers'- site of action?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
troponin - tropomyosin system
Hypersensitivity reactions

7. List the mechanism - clinical use - & toxicity of Etoposide.
PT
Gram + - Gram - - Norcardia - Chlamydia
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

8. What is Metronidazole combined with for 'triple therapy'? Against What organism?
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Bismuth and Amoxicillin or Tetracycline; against Helobacter pylori
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)

9. How do you treat coma in the ER (4)?
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
vascular sm. Mus.: Nifedipine>Diltiazem>Verapamil
- Airway - Breathing - Circulation - Dextrose (thiamine & narcan) - ABCD
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).

10. What is the category of drug names ending in - tropin (e.g. Somatotropin)
Diuresis in pateints with sulfa allergy
Inhibits cell wall mucopeptide formation - Bactericidal
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Pituitary hormone.

11. Hydralazine - toxicity?
Diarrhea
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
compensatory tachycardia - fluid retention - lupus - like syndrome
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride

12. Common side effects associated with Clindamycin include?
Inhibits reabsorption of uric acid.
Amphotericin B - Nystatin - Fluconazole/azoles
Pseudomembranous colitis (C. difficile) - fever - diarrhea
NO AP duration effect. useful in V- tach that progresses to V- fib and in intractable SVT Last RESORT

13. Which drug(s) cause this reaction: Anaphylaxis?
depresses ectopic pacemakers - especially in digoxin toxicity
- Penicillin
Slow - limited by half lives of clotting factors
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

14. Name some common Sulfonamides (4)
1. Acarbose 2. Miglitol
Onchocerciasis ('river blindness'-- rIVER- mectin)
Acute gout.
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine

15. For Heparin What is the Onset of action
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal
Rapid (seconds)
torsade de pointes

16. List some specifics of lead poisoning(4)?
- A57Blue lines in gingiva & long bones - Encephalopathy & Foot drop - Abdominal colic / - Sideroblastic anemia
- Chlorpromazine - thioridazine - haloperidol
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
Carbachol - pilocarpine - physostigmine - echothiophate

17. In What population does Gray Baby Syndrome occur? Why?
thick ascending limb
Premature infants - because they lack UDP- glucuronyl transferase
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
fetal renal toxicity - hyperkalemia

18. Describe Phase I metabolism in liver(3)?
Teratogenic - Carcinogenic - Confusion - Headaches
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
Same as penicillin. Act as narrow spectrum antibiotics
Inhibits cell wall mucopeptide formation - Bactericidal

19. How do Sulfonamides act on bacteria?
blocks SR Ca2+ channels
Stimulates beta adrenergic receptors
Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic

20. Which drug(s) cause this reaction: Cough?
HTN - CHF - calcium stone formation - nephrogenic DI.
Enterobacter
Heparin catalyzes the activation of antithrombin III.
- ACE inhibitors (Losartan>no cough)

21. Why is pyridostigmine effective in the treatment of myasthenia gravis?
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
Prevents the release of Ca from SR of skeletal muscle
As an anticholinesterase it increases endogenous ACh and thus increases strength.

22. Steady state concentration is reached in __ number of half - lifes
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
hyperkalemia - endocrine effects (gynecomastia - anti - androgen)
Edrophonium
- Ammonium Chloride

23. Adverse effects of Nifedipine - verapamil?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Same as penicillin. Extended spectrum antibiotics
dizziness - flushing - constipation (verapamil) - nausea
Oxygen

24. What are common toxicities related to Vancomycin therapy?

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25. What is a Ribavirin toxicity?
Pseudomonas species and Gram - rods
1. Pioglitazone 2. Rosiglitazone.
Bleeding.
Hemolytic anemia

26. Name five Antiarrhythmic drugs in class II?
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
propanolol - esmolol - metoprolol - atenolol - timolol
- Glucagon
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

27. Adverse effects of Losartan?
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Hypersensitivity reactions
fetal renal toxicity - hyperkalemia
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

28. What cholinomimetics might your pt be taking for his glaucoma
Botulinum
INH: Injures Neurons and Hepatocytes
depresses ectopic pacemakers - especially in digoxin toxicity
Carbachol - pilocarpine - physostigmine - echothiophate

29. What is the only depolarizing neuromuscular blocking agent?
Headache - flushing - dyspepsia - blue - green color vision.
Succinylcholine
Nifedipine - Verapamil - Diltiazem
Carbenicillin - Piperacillin - and Ticarcillin

30. What are three clinical uses of the NSAIDs?
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
Pituitary hormone.
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
As PABA antimetabolites that inhibit Dihydropteroate Synthase - Bacteriostatic

31. Aztreonam is not usually...
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
toxic
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)
Oxygen

32. Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
Staphlococcus aureus
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Verapamil - Diltiazem - Bepridil
atropine - homatropine - tropicamide

33. Amiodarone - toxicity?
fetal renal toxicity - hyperkalemia
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

34. Preferential action of the Ca2+ channel blockers at cardiac muscle?
Blocks Norepi - but not Dopamine
cardiac muscle: Verapamil>Diltiazem>Nifedipine
CL= (rate of elimination of drug/ Plasma drug conc.)
Used in combination therapy with SMZ to sequentially block folate synthesis

35. Acetazolamide causes?

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36. What are two clinical uses of Azathioprine?
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
cyanide toxicity (releases CN)

37. What are two Alpha - glucosidase inhibitors?
1. Acarbose 2. Miglitol
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Vinca alkaloids(inhibit MT) - Paclitaxel
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

38. What is the category of drug names ending in - azine (e.g. Chlorpromazine)
physostigmine
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Phenothiazine (neuroleptic - antiemetic).

39. What are the clinical uses for 1st Generation Cephalosporins?
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Small lipid - soluble molecule
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
Gemfibrozil - Clofibrate

40. Which drug(s) cause this reaction: Adrenocortical Insufficiency
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
- Glucocorticoid withdrawal
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

41. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Oxygen
Edrophonium
Antifungal.

42. Mannitol - contraindications?
Bleeding.
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
anuria - CHF
Tubocurarine - atracurium - mivacurium - pancuronium - vecuronium - rapacuronium

43. 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?
Inhibits cell wall mucopeptide formation - Bactericidal
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
Constant FRACTION eliminated per unit time.(exponential)
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.

44. Which drug(s) cause this reaction: Gynecomastia (6)?
Pentamidine
new arrhythmias - hypotension
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

45. List the specific antidote for this toxin: Heparin
Same as penicillin. Act as narrow spectrum antibiotics
- Protamine
AZT - to reduce risk of Fetal Transmission
Buy AT 30 - CELL at 50'

46. What enzymes are inhibited by NSAIDs - acetaminophen and COX II inhibitors?
Cyclooxygenases (COX I - COX II).
troponin - tropomyosin system
- Shifts the curve to the right - increases Km
Modification via Acetylation

47. How would hemicholinium treatment affect cholinergic neurons?
These B-2 agonists cause respiratory smooth muscle to relax.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

48. Guanethidine enhances the release of Norepi?
- Steroids - Tamoxifen
No - it inhibits the release of Nor Epi
Scopolamine
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.

49. For Heparin What is the Route of administration
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Lipoxygenase
Altered bacterial Dihydropteroate Synthetase - Decreased uptake - or Increased PABA synthesis
Paranteral (IV - SC)

50. What is the mechanism of action of the thrombolytics?
competitive inhibirot of aldosterone in the cortical collecting tubule
Mycobacterium tuberculosis - the only agent used as solo prophylaxis against TB
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.)
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.)

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USMLE Step 1 Pharmacology

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