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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. Antiarrhythmic class IV- effects?
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
decrease conduction velocity - increase ERP - increase PR interval
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
Ibuprofen - Naproxen - and Indomethacin

2. What is Imipenem always administered with?
Tricyclic antidepressant.
Babiturate.
Cilastatin
Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to negatively charged heparin).

3. What is the category - mechanism of action - and particular use of beclomethasone and prednisone in Asthma treatment?
Cephalosporins
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.)
Buy AT 30 - CELL at 50'
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome

4. What is the clinical utility of clonidine?
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Blocks Influenza A and RubellA; causes problems with the cerebellA
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
fetal renal toxicity - hyperkalemia

5. Common toxicities associated with Griseofulvin?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
aPTT (intrinsic pathway)
1. Tolbutamide 2. Chlorpropamide 3. Glyburide 4. Glipizide
Teratogenic - Carcinogenic - Confusion - Headaches

6. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Hypersensitivity reactions
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
- reduction - oxy - & hydrolysis - H2O sol. Polar product - P450
- Flumazenil

7. How can the toxic effects of TMP be ameliorated?
amphetamine and ephedrine
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
With supplemental Folic Acid
Decreases synthesis of Mycolic Acid

8. Name five Antiarrhythmic drugs in class II?
Hypersensitivity reactions
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
- Deferoxamine
propanolol - esmolol - metoprolol - atenolol - timolol

9. Procainamide - toxicity?
reversible SLE- like syndrome
post MI and digitalis induced arrhythmias
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
torsade de pointes

10. What is the category of drug names ending in - tidine (e.g. Cimetidine)
Foscarnet = pyroFosphate analog
Babiturate.
Sotalol - Ibutilide - Bretylium - Amiodarone
H2 antagonist

11. What is the effect of the Glitazones in diabetes treatment?
fetal renal damage - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
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.)
Increase target cell response to insulin.

12. Why would dopamine be useful in treating shock?
Verapamil - Diltiazem - Bepridil
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
Botulinum
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.)

13. Which drug(s) cause this reaction: Oto and Nephrotoxicity (3)?
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Inhibition of 50S peptidyl transferase - Bacteriostatic
Ataxia - Dizziness - Slurred speech
- aminoglycosides - loop diuretics - cisplatin

14. What is the MOA of Polymyxins?
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
Same as penicillin. Act as narrow spectrum antibiotics
sedation - positive Coombs' test
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide

15. What would be the effect on blood pressure with infusion of the alpha -2 agonist clonidine?
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
- B51Naloxone / naltrexone (Narcan)
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
Inhibit Ergosterol synthesis

16. Aztreonam ________ to penicillinase
Milk or Antacids - because divalent cations inhibit Tetracycline absorption in the gut
is resistant
Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.
- Dimercaprol - succimer

17. What is the clinical use for Clomiphene?
Treatment of infertility.
- Vinca alkaloids(inhibit MT) - Paclitaxel
nausea - headache - lupus - like syndrome - reflex tachycardia - angina - salt retention
1. Hydrocortisone 2. Predisone 3. Triamcinolone 4. Dexamethasone 5. Beclomethasone

18. A fellow passenger on a Carnival cruise ship looks pale and diaphoretic - What antimuscarinic agent would you give them?
scopolamine
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
1. Phospholipase A2 is prevented from releasing arachidonic acid 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes
Triple sulfas or SMZ

19. What are four clinical uses of glucocorticoids?

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20. Which drug(s) cause this reaction: Atropine - like side effects?
Decreased uptake or Increased transport out of cell
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Aminoglycosides
- Tricyclic antidepressants

21. What are the clinical uses for 3rd Generation Cephalosporins?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Babiturate.

22. What type of gout is treated with Allopurinol?
- Chloramphenicol
Digitoxin 70% Digoxin 20-40%
- Glucagon
Chronic gout.

23. Antiarrhythmic class IB- effects?
Gram + cocci - Haemophilus influenza - Enterobacter aerogenes - Neisseria species - P. mirabilis - E. coli - K. pneumoniae - Serratia marcescens ( HEN PEcKS )
Blocks Norepi - but not Dopamine
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system

24. What are the clinical uses for Imipenem/cilastatin?
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Gram + cocci - Gram - rods - and Anerobes
1. Pioglitazone 2. Rosiglitazone.
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk

25. What are three possible complications of Heparin therapy?
not a sulfonamide - but action is the same as furosemide
Blocks Influenza A and RubellA; causes problems with the cerebellA
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
loop diuretics - spironolactone

26. What is the MOA for the Cephalosporins?
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility
Beta lactams - inhibit cell wall synthesis - Bactericidal
Hydralazine and Minoxidil
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.

27. What are Aminoglycosides synergistic with?
BM suppression (neutropenia - anemia) - Peripheral neuropathy
Staphlococcus aureus
Beta - lactam antibiotics
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)

28. What are the classic symptoms of cholinesterase inhibitor poisoning (parathion or other organophosphates)?
Diarrhea - Urination - Miosis - Bronchospasm - Bradycardia - Excitation of skeletal muscle and CNS - Lacrimation - Sweating - and Salivation = DUMBBELS; also abdominal cramping
GI upset
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
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.

29. What additional side effects exist for Ampicillin?
- DNA intercalator - Hodgkin's - myeloma - sarcoma - and solid tumors - Cardiotoxicity & alopecia
- Tetracycline
Topical and Oral - for Oral Candidiasis (Thrush)
Rash - Pseudomembranous colitis

30. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
No - hemicholinum block the uptake of Choline and thus Ach synthesis
- Ethosuxamide - sulfonamides - lamotrigine
INH: Injures Neurons and Hepatocytes
Protease Inhibitors and Reverse Transcriptase Inhibitors

31. Toxicities associated with Acyclovir?
Ipratropium
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Delirium - Tremor - Nephrotoxicity
- Ethanol - dialysis - & fomepizole

32. Which drug(s) cause this reaction: Tubulointerstitial Nephritis (5)?
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor
- Hypersensitivity reactions - Hemolysis - Nephrotoxicity (tubulointerstitial nephritis) - Kernicterus in infants Displace other drugs from albumin (e.g. - warfarin)
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

33. What is the MOA of the RT Inhibitors?
GI distress - Tooth discoloration and Inhibition of bone growth in children - Fanconi's syndrome - Photosensitivity
Saquinavir - Ritonavir - Indinavir - Nelfinavir
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation

34. Which drug(s) cause this reaction: Anaphylaxis?
1. Heavy bleeding 2. GI effects (n/v - anorexia) 3. Abdominal pain
decrease AP duration - affects ischemic or depolarized Purkinje and ventricular system
- Penicillin
scopolamine

35. In What population does Gray Baby Syndrome occur? Why?
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
Premature infants - because they lack UDP- glucuronyl transferase
PT
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

36. Nifedipine has similar action to?
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity
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
Nitrates
- Penicillamine

37. What is the mechanism of action of Warfarin (Coumadin)?
Phosphorylation by a Viral Kinase
Chronic Hepatitis A and B - Kaposi's Sarcoma
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.
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

38. Antimicrobial prophylaxis for Gonorrhea
GI upset
Only in limited amounts
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
Ceftriaxone

39. Adverse effects of Losartan?
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions
fetal renal toxicity - hyperkalemia
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
- Flumazenil

40. What is the MOA for Amphotericin B?
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
Scopolamine
cardiac muscle: Verapamil>Diltiazem>Nifedipine

41. List the specific antidote for this toxin: Antimuscarinic (anticholinergic)
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
proximal convoluted tubule - thin descending limb - and collecting duct
- Physostigmine salicylate
Cryptococcal meningitis in AIDS patients and Candidal infections of all types

42. What is the clinical utility of cocaine?
Inhibits IMP Dehydrogenase (competitively) - and therefore blocks Guanine Nucleotide synthesis
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
The only local anesthetic with vasoconstrictive properties.
- Normalize K+ - Lidocaine - & Anti - dig Mab

43. What is the MOA for the Tetracyclines?
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Butyrophenone (neuroleptic).
Binds 30S subunit and prevents attachment of aminoacyl - tRNA - Bacteriostatic
Staphlococcus aureus and Clostridium difficile (pseudomembranous colitis)

44. Which drug(s) cause this reaction: Stevens - Johnson syn. (3)?
Hormone synthesis inhibition (Gynecomastia) - Liver dysfunction (Inhibits CYP450) - Fever - Chills
Tendonitis and Tendon rupture
- Ethosuxamide - sulfonamides - lamotrigine
Immediate anticoagulation for PE - stroke - angina - MI - DVT.

45. What is a prerequisite for Acyclovir activation?
- Upper respiratory tract infections - pneumonias - STDs: Gram+ cocci (streptococcal infect in pts allergic to penicillin) - Mycoplasma - Legionella - Chlamydia - Neisseria
It must be Phosphorylated by Viral Thymidine Kinase
torsade de pointes - excessive Beta block
Digoxin=urinary Digitoxin=biliary

46. What is the only depolarizing neuromuscular blocking agent?
Methylation of rRNA near Erythromycin's ribosome binding site
Indirect agonist - uptake inhibitor
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.
Succinylcholine

47. What parasites are treated with Pyrantel Pamoate (more specific)?
competitive inhibirot of aldosterone in the cortical collecting tubule
NO
Prevents the release of Ca from SR of skeletal muscle
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)

48. Which receptors does phenylephrine act upon?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
With supplemental Folic Acid
Gram + cocci - Gram - rods - and Anerobes

49. Which drug(s) cause this reaction: Cutaneous flushing (4)?
Tetracycline - Doxycycline - Demeclocycline - Minocycline
- Tamoxifen
edrophonium (extremely short acting anticholinesterase)
- Niacin - Ca++ channel blockers - adenosine - vancomycin

50. What antimicrobial class is Aztreonam syngergestic with?
Chronic gout.
Acetylcholine esterase
Aminoglycosides
Nephrotoxicity

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USMLE Step 1 Pharmacology

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