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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Antiarrhythmic class IA effects?
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
- ED 50 is less than the Km (less than 50% of receptors)
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Neurotoxicity - Acute renal tubular necrosis

2. What is an occasional side effect of Aztreonam?
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
GI upset
1. Meningococcal carrier state 2. Chemoprophylaxis in contacts of children with H. influenzae type B
post MI and digitalis induced arrhythmias

3. What is treated with Chloroquine - Quinine - Mefloquine?
- B51Naloxone / naltrexone (Narcan)
Malaria (P. falciparum)
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

4. Which drug(s) cause this reaction: Gray baby syndrome?
Chronic anticoagulation.
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.
fetal renal toxicity - hyperkalemia
- Chloramphenicol

5. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
These B-2 agonists cause respiratory smooth muscle to relax.
Disulfiram - like reaction with EtOH - Headache
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Beta antagonist.

6. Which drug(s) cause this reaction: Fanconi's syndrome?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
- Tetracycline
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
- Dimercaprol - succimer

7. How is Trimethoprim used clinically?
proximal convoluted tubule - thin descending limb - and collecting duct
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Used in combination therapy with SMZ to sequentially block folate synthesis
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

8. What is the effect of norepinephrine on bp and pulse pressure?
Rash - Pseudomembranous colitis
- Penicillin
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

9. 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.
Staphlococcus aureus
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
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.)

10. What is the only depolarizing neuromuscular blocking agent?
Antileukotriene; blocks synthesis by lipoxygenase.
- Tetracycline
Anaerobic infections (e.g. - B. fragilis - C. perfringens)
Succinylcholine

11. Ca2+ channel blockers - clinical use?
hypertension - angina - arrhythmias
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms

12. What is the memory key for the action of Sildenafil (Viagra)?
Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not effective during an acute attack.
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).
Sildenafil fills the penis
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

13. What is the clinical utility of clonidine?
VACUUM your Bed Room'
- Methylene blue
Carbenicillin - Piperacillin - and Ticarcillin
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).

14. What is the clinical utility of cocaine?
Methylxanthine.
The only local anesthetic with vasoconstrictive properties.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
blocks SR Ca2+ channels

15. If a patient is given hexamethonium - What would happen to his/her heart rate?
collecting ducts
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
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.

16. What are common toxicities related to Vancomycin therapy?

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17. What is the category of drug names ending in - tidine (e.g. Cimetidine)
thiazides - amiloride
H2 antagonist
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins

18. What is the effect of epinephrine infusion on bp and pulse pressure?
Useful in muscle paralysis during surgery or mechanical ventilation.
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
Acute (hours)

19. What neurotransmitter does Amantadine affect? How does it influence this NT?
Severe Gram - rod infections.
Dopamine; causes its release from intact nerve terminals
Teratogenic - Carcinogenic - Confusion - Headaches
It must be Phosphorylated by Viral Thymidine Kinase

20. Which cancer drugs work at the level of proteins(2)?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
- Vinca alkaloids(inhibit MT) - Paclitaxel
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
all of them

21. What is the category of drug names ending in - triptyline (e.g. Amitriptyline)
Tricyclic antidepressant.
very short acting
prevention of nodal arrhythmias (SVT)
Prevents the release of Ca from SR of skeletal muscle

22. List the mechanism - clinical use - & toxicity of Cyclophosphamide.
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
1) Chloramphenical = bacteriostatic 2) Erythromycin = bacteriostatic 3) Lincomycin = bacteriostatic 4)cLindamycin = bacteriostatic
Give an antichloinesterase - neostigmine - edrophonium - etc

23. What is the specific clinical use of Indomethacin in neonates?
dry mouth - sedation - severe rebound hypertension
Indomethacin is used to close a patent ductus arteriosus.
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

24. Common toxicities associated with Fluoroquinolones?
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Hemolytic anemia
DHPG (dihydroxy-2- propoxymethyl guanine)
GI upset - Superinfections - Skin rashes - Headache - Dizziness

25. Foscarnet toxicity?
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Neutropenia
Nephrotoxicity
Spironolactone - Triamterene - Amiloride (the K+ STAys)

26. What is the mechanism of action of Ticlopidine - Clopidogrel
Gemfibrozil - Clofibrate
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas

27. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
- Glucagon
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
TCA
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

28. Which drug(s) cause this reaction: Cinchonism (2)?
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
- Quinidine - quinine
vasodilator - increases cGMP to induce smooth muscle relaxation (arterioles>veins; afterload reduction)
It inhibits release of NE.

29. ACE inhibitors - mechanism?
Liver
all of them
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

30. Which drug(s) cause this reaction: Extrapyramidal side effects (3)?
Interstitial nephritis
- Chlorpromazine - thioridazine - haloperidol
Inhibits CMV DNA polymerase
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

31. Does Warfarin have a long - medium - or short half life?
Long.
Short.
Ganciclovir is more toxic to host enzymes
- inhibits HGPRT (pur. Syn.) - Luk - Lymph

32. Resistance mechanisms for Vancomycin
- Niacin - Ca++ channel blockers - adenosine - vancomycin
- Cloazapine - carbamazapine - colchicine - PTU
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
AV nodal cells

33. What is the category of drug names ending in - oxin (e.g. Digoxin)
Cardiac glycoside (inotropic agent).
- Ethosuxamide - sulfonamides - lamotrigine
1. Acarbose 2. Miglitol
hypertension - angina - arrhythmias

34. What antimuscarinic drug is useful for the tx of asthma
Competitive inibitor of progestins at progesterone receptors.
Aminoglycosides
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Ipratropium

35. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Babiturate.
- Glucocorticoid withdrawal
Phenothiazine (neuroleptic - antiemetic).

36. What are three possible toxicities of NSAID usage?
1. Renal damage 2. Aplastic anemia 3. GI distress
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.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Ceftriaxone

37. 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.
Immediate anticoagulation for PE - stroke - angina - MI - DVT.
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

38. What is the difference between the affinity for beta receptors between albuterol/terbutaline and dantroline?
- Constant AMOUNT eliminated per unit time. - Etoh & ASA
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
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.
Fast vs. Slow Acetylators

39. For Warfarin What is the Onset of action
Slow - limited by half lives of clotting factors
With supplemental Folic Acid
cyanide toxicity (releases CN)
Scopolamine

40. What are the phases of succinylcholine neuromuscular blockade?
CL= (rate of elimination of drug/ Plasma drug conc.)
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

41. Toxicities associated with Acyclovir?
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Delirium - Tremor - Nephrotoxicity
It must be Phosphorylated by Viral Thymidine Kinase
Abortifacient.

42. For Warfarin What is the Lab value to monitor
It must be Phosphorylated by Viral Thymidine Kinase
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Does not cross
PT

43. Mg+- clinical use?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
1. Pioglitazone 2. Rosiglitazone.
effective in torsade de pointes and digoxin toxicity

44. Are penicillinase resistant
torsade de pointes - excessive Beta block
prevention of nodal arrhythmias (SVT)
Methicillin - Nafcillin - and Dicloxacillin
Prophylaxis for Influenza A - Rubella; Parkinson's disease

45. Acetazolamide causes?

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46. What conditions are treated with Metronidazole?
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
PT
Lipoxygenase
Nucleosides

47. What is the category of drug names ending in - tropin (e.g. Somatotropin)
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Cilastatin
- Normalize K+ - Lidocaine - & Anti - dig Mab
Pituitary hormone.

48. Hydrochlorothiazide - mechanism?
is resistant
Binds ergosterol - Disrupts fungal membranes
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)
Inhibits NaCl reabsorption in the early distal tubule. Decreases Ca2+ excretion.

49. Classes of antihypertensive drugs?
Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of arachidonic acid to prostaglandins.
AZT - to reduce risk of Fetal Transmission
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia

50. Name the common Non - Nucleoside Reverse Transcriptase Inhibitors
Foscarnet = pyroFosphate analog
Nevirapine - Delavirdine
Acetaminophen has antipyretic and analgesic properties - but lacks anti - inflammatory properties.
Pyridoxine (B6) administration