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USMLE Step 1 Pharmacology

Subjects : health-sciences, usmle-step-1

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1. List the specific antidote for this toxin: Carbon monoxide
-100% oxygen - hyperbaric
Ceftriaxone
Scopolamine
Pentavalent Antimony

2. Which RT inhibitors cause a Rash?
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Megaloblastic anemia - Leukopenia - Granulocytopenia
Non - Nucleosides
- Physostigmine salicylate

3. What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
- Flumazenil
severe hypertension - CHF
Useful in muscle paralysis during surgery or mechanical ventilation.
Acetylcholinesterase; ACh is broken down into choline and acetate.

4. Adverse effects of Loop Diuretics?
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
1. Predisposes to viral infections and lymphoma 2. Nephrotoxic (preventable with mannitol diuresis)
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
HTN - CHF - calcium stone formation - nephrogenic DI.

5. What is the mechanism of Azathioprine?
Blocks Norepi - but not Dopamine
- Disulfram & also sulfonylureas - metronidazole
Antimetabolite derivative of 6- mercaptopurine that interferes with the metablolism and synthesis of nucleic acid.
Doxycycline - because it is fecally eliminated

6. What is the mecanism of action of Sucralfate?
- Hydralazine - Procainamide - INH - phenytoin
Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds necrotic peptic ulcer tissue. Acts as a barrier to acid - pepsin - and bile.
new arrhythmias - hypotension
Aminoglycosides

7. Common toxicities associated with Fluoroquinolones?
viral kinase
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
GI upset - Superinfections - Skin rashes - Headache - Dizziness

8. What organisms does Griseofulvin target?
AZT
- Ethosuxamide - sulfonamides - lamotrigine
It acts presynaptically to increase NE release.
Dermatophytes (tinea - ringworm)

9. What is the clinical use for Ampicillin and Amoxicillin?
TMP- SMZ
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Extended spectrum penicillin: certain Gram + bacteria and Gram - rods
osmotic diuretic - increase tubular fluid osmolarity - thereby increasing urine flow

10. Mannitol - clinical use?
YES
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
atropine - homatropine - tropicamide

11. What are the clinical uses for 3rd Generation Cephalosporins?
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
atropine - homatropine - tropicamide
It affects beta receptors equally and is used in AV heart block (rare).

12. What is the clinical utility of cocaine?
- Nitrate - hydroxocobalamin thiosulfate
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux
The only local anesthetic with vasoconstrictive properties.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

13. What is the effect of norepinephrine on bp and pulse pressure?
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
Yes
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

14. What is the MOA of Aztreonam?
1. Kidney transplantation 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)
- EDTA - dimercaprol - succimer - & penicillamine
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

15. IV Penicillin
severe hypertension - CHF
Penicillin - G
Vibrio cholerae Acne Chlamydia Ureaplasma Urealyticum Mycoplasma pneumoniae Borrelia burgdorferi (Lyme's) Rickettsia Tularemia
- Sulfonamides - furosemide - methicillin - rifampin - NSAIDS (ex. ASA)

16. Why is carbachol and pilocarpine useful in treatment of glaucoma?
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Binds ergosterol - Disrupts fungal membranes
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
CMV Retinitis in IC pts When Ganciclovir fails

17. Is toxicity rare or common whith Cromolyn used in Asthma prevention?
Bleeding.
AmOxicillin has greater Oral bioavailability
Hydralazine and Minoxidil
Rare.

18. How would hemicholinium treatment affect cholinergic neurons?
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
check PFTs - LFTs - and TFTs

19. Which Aminoglycoside is used for Bowel Surgery ?
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail
- Ethosuxamide - sulfonamides - lamotrigine
cortical collecting tubule
Neomycin

20. How would you reverse the effect of a neuromuscular blocking agent?
Diuresis in pateints with sulfa allergy
GI upset - Superinfections - Skin rashes - Headache - Dizziness
Inhibits CMV DNA polymerase
Give an antichloinesterase - neostigmine - edrophonium - etc

21. What is the formula for Clearance (CL)
Receptors = D1=D2>beta>alpha - thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
CL= (rate of elimination of drug/ Plasma drug conc.)
- Metronidazole - certain cephalosporins - procarbazine - sulfonylureas
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal

22. Which receptors does phenylephrine act upon?
alpha -1 > alpha -2; used as a pupil dilator - vasoconstrictor - and for nasal decongestion
Pregnant women - Children; because animal studies show Damage to Cartilage
Quinidine - Amiodarone - Procainamide - Disopyramide
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.

23. How do we stop angina?
Ceftriaxone
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
ARF - shock - drug overdose - decrease intracranial/intraocular pressure
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.

24. Digoxin v. Digitoxin: excretion?
Prophylaxis for Influenza A - Rubella; Parkinson's disease
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
Digoxin=urinary Digitoxin=biliary
- Hydralazine - Procainamide - INH - phenytoin

25. What are four H2 Blockers?
torsade de pointes
- Haloperidol - chlorpromazine - reserpine - MPTP
1. Cimetadine 2. Ranitidine 3. Famotidine 4. Nizatidine
Protease Inhibitors and Reverse Transcriptase Inhibitors

26. What is the loading dose formula?
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
Rheumatoid and osteoarthritis.
Hemolytic anemia
- Normalize K+ - Lidocaine - & Anti - dig Mab

27. What is the category - method of use - and adverse effects of Salmeterol in Asthma treatment?
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Abortifacient.
- B51Naloxone / naltrexone (Narcan)
Verapamil - Diltiazem - Bepridil

28. How are Interferons (INF) used clinically?

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29. Ca2+ channel blockers - site of action?
Cell membrane Ca2+ channels of cardiac sarcomere
Aminoglycosides - Tetracyclines
Minor hepatotoxicity - Drug interactions (activates P450)
1. Bleeding 2. Thrombocytopenia 3. Drug - drug interactions

30. Hydralazine - clinical use?
impotence - exacerbation of asthma - CV effects - CNS effects - may mask hypoclycemia
Reversible block of histamine H2 receptors
severe hypertension - CHF
- Nitrate - hydroxocobalamin thiosulfate

31. List the mechanism - clinical use - & toxicity of Paclitaxel.
Protamine sulfate
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA
Stimulates beta adrenergic receptors
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.

32. What are the products and their toxicities of the metabolism of ethanol by / alcohol dehydrogenase?
amphetamine and ephedrine
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
- Acetaldehyde - Nausea - vomiting - headache - & hypotension
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

33. Acetazolamide - site of action?
1. Bleeding 2. Teratogenicity 3. Drug - drug interactions
proximal convoluted tubule
HTN - CHF - calcium stone formation - nephrogenic DI.
GI discomfort

34. What drug is used to diagnose myasthenia gravis?
edrophonium (extremely short acting anticholinesterase)
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Beta Blockers
Quinolones

35. ________ ae not resistant to penicillinase - - but they are less susceptible than the other Beta lactams
- Nitrate - hydroxocobalamin thiosulfate
Cephalosporins
Beta lactams - inhibit cell wall synthesis - Bactericidal
- Flumazenil

36. Acetazolamide - clinical uses?
IV vitamin K and fresh frozen plasma
glaucoma - urinary alkalinization - metabolic alkalosis - altitude sickness
Alpha -1 antagonist
Inhalational general anesthetic.

37. Acetaldehyde is metabolized by Acetaldehyde dehydrogenase - Which drug inhibs this enzyme?
- Disulfram & also sulfonylureas - metronidazole
Bind cell membrane - disrupt osmotic properties - Are Cationc - Basic and act as detergents
- Penicillin
- Daunorubicin & Doxorubicin

38. What are toxicities associated with Chloramphenicol?
Cell membrane Ca2+ channels of cardiac sarcomere
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Severe Gram - rod infections.
Aplastic anemia (dose independent) - Gray Baby Syndrome

39. What is the effect of guanethidine on adrenergic NE release?
Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion of T4 to T3.
Lipoxygenase
No - hemicholinum block the uptake of Choline and thus Ach synthesis
It inhibits release of NE.

40. How does Ganciclovir's toxicity relate to that of Acyclovir?
Pentamidine
AluMINIMUM amount of feces.
Ganciclovir is more toxic to host enzymes
Inhibit RT of HIV and prevent the incorporation of viral genome into the host DNA

41. For Heparin What is the Structure
very short acting
Large anionic polymer - acidic
Interferes with microtubule function - disrupts mitosis - inhibits growth
With supplemental Folic Acid

42. Cocaine shares is mechanism of action with What antidepressant
TCA
DHPG (dihydroxy-2- propoxymethyl guanine)
Bacitracin - Vancomycin
blocking the beta adrenergic receptor leads to decreased cAMP - and decreased Ca2+ flux

43. What type of neurological blockade would hexamethonium create?
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.
Early myocardial infarction.
- ACE inhibitors (Losartan>no cough)
Phosphorylation by a Viral Kinase

44. What is the mechanism of Tacrolimus (FK506)?
Amphotericin B - Nystatin - Fluconazole/azoles
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
hyperaldosteronism - K+ depletion - CHF
Similar to cyclosporine; binds to FK- binding protein - inhibiting secretion of IL-2 and other cytokines.

45. What is the MOA for Methicillin - Nafcillin - and Dicloxacillin?
- Tetracycline - amiodarone - sulfonamides
Pralidoxime regenerates active cholinesterase.
Same as penicillin. Act as narrow spectrum antibiotics
AluMINIMUM amount of feces.

46. What is the MOA of Ganciclovir?
Verapamil - Diltiazem - Bepridil
- Tetracycline
- Isoniazid
Inhibits CMV DNA polymerase

47. Antimicrobial prophylaxis for Meningococcal infection
Reversible block of histamine H2 receptors
Methylation of rRNA near Erythromycin's ribosome binding site
Penicillin - Ampicillin - Ticarcillin - Pipercillin - Imipenem - Aztreonam - Cephalosporins
Rifampin (DOC) - minocycline

48. Which diuretics decrease urine Ca2+?
- Alkalate DNA - Brain tumors - CNS toxicity
thiazides - amiloride
These B-2 agonists cause respiratory smooth muscle to relax.
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

49. Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
pulmonary edema - dehydration
Decreased uptake or Increased transport out of cell
No - hemicholinum block the uptake of Choline and thus Ach synthesis
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

50. Does Warfarin have a long - medium - or short half life?
Long.
Early myocardial infarction.
Diuresis in pateints with sulfa allergy
Epinephrine

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USMLE Step 1 Pharmacology

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