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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 are common toxicities related to Vancomycin therapy?

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2. Name two classes of drugs for HIV therapy
1. RNA pol inhibitor 2. Revs up P450 3. Red/orange body fluids 4. Rapid resistance if used alone
Severe Gram - rod infections.
Protease Inhibitors and Reverse Transcriptase Inhibitors
Albuterol - tertbutaline

3. Which drug(s) cause this reaction: Pulmonary fibrosis(3)?
Beta adrenergic receptors and Ca2+ channels (stimulatory)
- Bleomycin - amiodarone - busulfan
In 4 half - lifes= (94%) T1/2 = (0.7x Vd)/CL
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased

4. The MOA for Chloramphenicol is?
Inhibition of 50S peptidyl transferase - Bacteriostatic
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic
Slow - limited by half lives of clotting factors

5. What is action of insulin in the liver - in muscle - and in adipose tissue?
Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma - asthma - or hypotension.
1. In liver - increases storage of glucose as glycogen. 2. In muscle - stimulates glycogen and protein synthesis - and K+ uptake. 3. In adipose tissue - facilitates triglyceride storage.
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
Chronic anticoagulation.

6. Loop diuretics (furosemide)- site of action?
Phosphorylation by a Viral Kinase
Ipratropium
thick ascending limb
Dopamine

7. What is the category - desired effect - and possible mechanism of Theophylline in treating Asthma?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
cyanide toxicity (releases CN)
Protamine sulfate
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

8. Acetazolamide - clinical uses?
Sildenafil fills the penis
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.
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
GET on the Metro

9. What is a possible result of overdose of Acetaminophen?
Ipratropium
Only in limited amounts
Polymyxins
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.

10. Antimicrobial prophylaxis for PCP
NE acts presynaptically on alpha -2 receptors to inhibit its own release. ACh also acts presynaptically through M1 receptors to inhibit NE release.
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
TMP- SMZ (DOC) - aerosolized pentamidine
Digitoxin>95% Digoxin 75%

11. MOA: Disrupt bacterial/fungal cell membranes
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
Polymyxins

12. What is the mechanism of Azathioprine?
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.

13. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
pulmonary edema - dehydration
Reversible block of histamine H2 receptors
- Disulfram & also sulfonylureas - metronidazole
Blocking muscarinic receptors in the circular fibers of the eye - results in unopposed action of radial muscles to dilate.

14. Name three Antiarrhythmic drugs in class IC.
Acute gout.
Flecainide - Encainide - Propafenone
Nevirapine - Delavirdine
Gram + cocci - Gram - rods - and Anerobes

15. For Warfarin What is the Onset of action
effective in torsade de pointes and digoxin toxicity
- Class III antiarrhythmics (sotalol) - class IA (quinidine)
Slow - limited by half lives of clotting factors
Digitoxin>95% Digoxin 75%

16. Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease - why??
cross - allergenic
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
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
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow

17. For Warfarin What is the Lab value to monitor
very short acting
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
PT
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

18. What is the category of drug names ending in - phylline (e.g. Theophylline)
- Vitamin K & fresh frozen plasma
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Methylxanthine.
- ED 50 is less than the Km (less than 50% of receptors)

19. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
Captopril - Enalapril - Lisinopril
H2 antagonist
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
Same as penicillin. Extended spectrum antibiotics

20. If a patient is given hexamethonium - What would happen to his/her heart rate?
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.
Give an antichloinesterase - neostigmine - edrophonium - etc
Chronic anticoagulation.
CMV Retinitis in IC pts When Ganciclovir fails

21. What parasitic condition is treated with Ivermectin?

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22. MOA: Block nucleotide synthesis
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
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.
GI intolerance (nausea - diarrhea) - Hyperglycemia - Lipid abnormalities - Thrombocytopenia (Indinavir)
Sulfonamides - Trimethoprim

23. What is a Ribavirin toxicity?
Hemolytic anemia
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.

24. Adenosine - clinical use?
Spironolactone - Triamterene - Amiloride (the K+ STAys)
DOC in diagnosing and abolishing AV nodal arrhythmias
Nephrotoxicity
carbonic anhydrase inhibitors - K+ sparing diuretics

25. What is the MOA for Carbenicillin - Piperacillin - and Ticarcillin?
Leukotrienes increasing bronchial tone.
Same as penicillin. Extended spectrum antibiotics
Rapid (seconds)
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.

26. Which diuretics increase urine NaCl?
1. Weight gain 2. Hepatotoxicity (troglitazone)
GI discomfort
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
all of them

27. MOA: Disrupt fungal cell membranes
collecting ducts
hyperchloremic metabolic acidosis - neuropathy - NH3 toxicity - sulfa allergy
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Amphotericin B - Nystatin - Fluconazole/azoles

28. What are the Anti - TB drugs?
Rifampin - Ethambutol - Streptomycin - Pyrazinamide - Isoniazid (INH)
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
Pseudomonas species and Gram - rods

29. What is Nifurtimox administered for?

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30. List the specific antidote for this toxin: Tricyclic antidepressants
- NaHCO3
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
carbonic anhydrase inhibitors - K+ sparing diuretics

31. Toxic effects of TMP include?
Megaloblastic anemia - Leukopenia - Granulocytopenia
- Vinca alkaloids(inhibit MT) - Paclitaxel
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Cell membrane Ca2+ channels of cardiac sarcomere

32. How is Acyclovir used clinically?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
- partial agonist can have increased - decreased - /A21or equal potency as full agonist. - Potency is an independent factor.

33. Antimicrobial prophylaxis for Gonorrhea
Polymyxins
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
Ceftriaxone
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia

34. What is the loading dose formula?
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
Dermatophytes (tinea - ringworm)
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.

35. What enzyme is responsible for the degredation of Ach
None. No - because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
pulmonary fibrosis - corneal deposits - hepatotoxicity - skin deposits resulting in photodermatitis - neurologic effects - consitpation - CV (bradycardia - heart block - CHF) - and hypo - or hyperthyroidism.
Inhibits reabsorption of uric acid.
Acetylcholine esterase

36. Which drug(s) cause this reaction: Disulfram - like reaction (4) ?
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Chronic anticoagulation.
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression
AZT

37. Verapamil has similar action to?
DOC in diagnosing and abolishing AV nodal arrhythmias
Beta Blockers
Competitive inibitor of progestins at progesterone receptors.
Blastomyces - Coccidioides - Histoplasma - C. albicans; Hypercortisolism

38. Which Aminoglycoside is used for Bowel Surgery ?
decrease conduction velocity - increase ERP - increase PR interval
Hypersensitivity reactions
Neomycin
Ipratropium

39. What is the mechanism of action of Colchicine used to treat acute gout?
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
Norepinephrine (Alpha1 -2 and beta 1)
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.
- acetylation - glucuron. - & sulfation - Conjugation - Polar product

40. Mg+- clinical use?
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Primaquine
effective in torsade de pointes and digoxin toxicity
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.

41. What is the effect of norepinephrine on bp and pulse pressure?
proximal convoluted tubule
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

42. What is the difference in receptor affinity of epinephrine at low doses? High doses?

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43. Which drug(s) cause this reaction: Adrenocortical Insufficiency
- Clindamycin
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
Increase target cell response to insulin.
- Glucocorticoid withdrawal

44. Which drug(s) cause this reaction: G6PD hemolysis(8)?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Activates cholinergic receptors on bladder and bowel smooth muscle - alleviating post - op and neurogenic ileus and urinary retention.
Blocks translocation - binds to the 23S rRNA of the 50S subunit - Bacteriostatic

45. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Pyridoxine (B6) administration
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
Resistant Gram - infections
Bleeding.

46. How do you calculate maintenance dose?
Pyridoxine (B6) administration
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
- Vitamin K & fresh frozen plasma

47. What are the products and their toxicities of the metabolism of Methanol by / alcohol dehydrogenase?
Antiprotozoal: Giardia - Entamoeba - Trichomonas - Gardnerella vaginalis Anaerobes: Bacteroides - Clostridium
Beta lactams - inhibit cell wall synthesis - Bactericidal
Decreased uptake or Increased transport out of cell
- Formaldehyde & formic acid - severe acidosis & retinal damage

48. Which drug(s) cause this reaction: P450 induction(6)?
- Barbiturates - phenytoin - carbamazipine - rifampin - griseofulvin - quinidine
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
torsade de pointes - excessive Beta block
The PT.

49. Is resistant to penicillinase?
Anaerobes
Pralidoxime regenerates active cholinesterase.
Decreased uptake or Increased transport out of cell
Imipenem

50. A 12yo patient was treated for a reaction to a bee sting - What drug provides the best coverage of sympathomimetic receptors?
Epinephirine(Alpha1 -2 and Beta 1 -2)
Same as penicillin. Extended spectrum antibiotics
Stimulating beta receptors stimulates heart rate - but beta receptor induced vasodilation reduces peripheral resistance.
Ceftriaxone

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USMLE Step 1 Pharmacology

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