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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. What are two toxicities of the Sulfonylureas?
distal convoluted tubule (early)
new arrhythmias - hypotension
1. Hypoglycemia (more common with 2nd - generation drugs: glyburide - glipizide) 2. Disulfiram - like effects (not seen with 2nd - generation drugs).
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.

2. Common side effects associated with Clindamycin include?
Pseudomembranous colitis (C. difficile) - fever - diarrhea
Treatment of hypertension - especially with renal disease (lowers bp centrally - so flow is maintained to kidney).
Rifampin (DOC) - minocycline
effective in torsade de pointes and digoxin toxicity

3. What are Fluoroquinolones indicated for? (3)
all except the K+ sparing diuretics Spironolactone - Triamterene - Amiloride
Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
hyperaldosteronism - K+ depletion - CHF

4. Which drug(s) cause this reaction: Tendonitis and rupture?
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic
RESPIre
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia
- Fluoroquinolones

5. What enzyme is responsible for the degredation of Ach
Chloramphenicol - Erythromycin/macrolides - Lincomycin - Clindamycin - Streptogramins (quinupristin - dalfopristin)
Acetylcholine esterase
Pentamidine
Succinylcholine

6. What drug is used during the pregnancy of an HIV+ mother? - Why?
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Inhibits bacterial Dihydrofolate Reductase - Bacteriostatic
Inhibits DNA dependent RNA polymerase
AZT - to reduce risk of Fetal Transmission

7. How can the t1/2 of INH be altered?
Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic tissue adducts in liver.
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.
TMP- SMZ
Fast vs. Slow Acetylators

8. What physiological effects was the Anes using Atropine to tx
Acts as a wide spectrum carbapenem
Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
SLUD (salivation - Lacrimation - urination - Defecation)as well as airway secretion - GI motility - acid secretions

9. What is a sign of toxicity with the use of thrombolytics?
Acute (hours)
Bleeding.
- Chloramphenicol - benzene - NSAIDS - PTU - phenytoin
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)

10. Name four HMG- CoA reductase inhibitors.
Lovastatin - Pravastatin - Simvastatin - Atorvastatin
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more
Rifampin
- Shifts the curve down - reduces Vmax

11. What parasitic condition is treated with Ivermectin?

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12. List the mechanism - clinical use - & toxicity of Tamoxifen.
- Estrogen receptor antagonist - Breast CA - increased endometrial CA risk
- Fluoroquinolones
diuretics - sympathoplegics - vasodilators - ACE inhibitors - Angiotensin II receptor inhibitors
effective in torsade de pointes and digoxin toxicity

13. List the mechanism - clinical use - & toxicity of Etoposide.
Prevents the release of Ca from SR of skeletal muscle
Cestode/tapeworm (e.g. - D. latum - Taenia species Except Cysticercosis
- Topo II inhibitor(GII specific) - Oat cell of Lung & prostate - & testicular - Myelosuppression & GI irritation.
- Shifts the curve down - reduces Vmax

14. Your patient wants an effective drug to treat his motion sickness - What would you prescribe
Scopolamine
Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
Erythromycin - Azithromycin - Clarithromycin

15. Which drug(s) cause this reaction: Gray baby syndrome?
Na/K ATPase
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
cortical collecting tubule
- Chloramphenicol

16. What are three clinical uses of the Leuprolide?
Beta -2 agonist.
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids
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
- Corticosteroids - heparin

17. What are toxic side effects for Metronidazole?
1. Antiandrogen 2. Nausea 3. Vomiting
Fast vs. Slow Acetylators
Local anesthetic.
Disulfiram - like reaction with EtOH - Headache

18. What is the enzyme inhibited - the effect of this inhibition - and the clinical use of the antiandrogren Finasteride?
Finasteride inhibits 5 Alpha - reductase - this decreases the conversion of testosterone to dihydrotestosterone - useful in BPH
Prefers beta's at low doses - but at higher doses alpha agonist effects are predominantly seen.
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol

19. MOA: Block peptidoglycan synthesis
Epinephrine
Bacitracin - Vancomycin
1) Hypersensitivity reactions 2) Increased nephrotoxicity of Aminoglycosides 3) Disulfiram - like reaction with ethanol (those with a methylthiotetrazole group - e.g. - cefamandole)
Terminal D- ala of cell wall replaced with D- lac; Decreased affinity

20. For Heparin What is the Route of administration
Paranteral (IV - SC)
Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease serum glucose levels
constipation - flushing - edema - CV effects (CHF - AV block - sinus node depression) - and torsade de pointes (Bepridil)
hyperaldosteronism - K+ depletion - CHF

21. Ca2+ channel blockers - site of action?
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
GI disturbances.
Cell membrane Ca2+ channels of cardiac sarcomere
Anaerobic infections (e.g. - B. fragilis - C. perfringens)

22. What antimicrobial class is Aztreonam syngergestic with?
Bleeding.
IV vitamin K and fresh frozen plasma
Aminoglycosides
amphetamine and ephedrine

23. Why is reserpine effective in treating HTN?
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.
Prevention of NSAID- induced peptic ulcers - maintains a PDA.
Blocks Peptide Bond formation at the 50S subunit - Bacteriostatic
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.

24. Hydrochlorothiazide - toxicity? (hyperGLUC - plus others)
Hypokalemic metabolic alkalosis - hyponatremia - hyperGlycemia - hyperLipidemia - hyperUricemia - hyperCalcemia - sulfa allergy.
Beta 2 agonist; used as a long - acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
- Hydralazine - Procainamide - INH - phenytoin

25. How is Griseofulvin used clinically?
check PFTs - LFTs - and TFTs
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.
Oral treatment of superficial infections
Atropine would also block the receptors in the ciliary muscle - causing an impairment in accommodation (cycloplegia).

26. Name three Antiarrhythmic drugs in class IB.
Staphlococcus aureus
- Physostigmine salicylate
Lidocaine - Mexiletine - Tocainide
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts

27. How does botulinum toxin result in respiratory arrest?
Botulinum
distal convoluted tubule (early)
Those patients who are taking nitrates.
Prevents the release of ACh - Which results in muscle paralysis.

28. Why is Cilastatin administered with Imipenem?
- Atropine & pralidoxime
To inhibit renal Dihydropeptidase I and decrease Imipenem inactivation in the renal tubules
VACUUM your Bed Room'
Epinephirine(Alpha1 -2 and Beta 1 -2)

29. What is the major side effect for Carbenicillin - Piperacillin - and Ticarcillin?
Hypersensitivity reactions
Amphetamine and Ephedrine
prevention of nodal arrhythmias (SVT)
Phosphorylation by a Viral Kinase

30. Decrease Digoxin dose in renal failure?
ACE inhibitor.
Fluconazole - Ketoconazole - Clotrimazole - Miconazole - Itraconazole
YES
TMP- SMZ (DOC) - aerosolized pentamidine

31. What is the formula for Clearance (CL)
Bactericidal for: Gram + rod and cocci - Gram - cocci - and Spirochetes
Inhibits formation of Initiation Complex - causes misreading of mRNA - Bactericidal
Binds to the Pyrophosphate Binding Site of the enzyme
CL= (rate of elimination of drug/ Plasma drug conc.)

32. For Warfarin What is the Ability to inhibit coagulation in vitro
- Tetracycline - amiodarone - sulfonamides
No
Beta - lactam antibiotics
Flecainide - Encainide - Propafenone

33. What are the four conditions in Which Omeprazole - Lansoprazole is used?
1. Peptic ulcer 2. Gastritis 3. Esophageal reflux 4. Zollinger - Ellison syndrome
Same as penicillin. Extended spectrum antibiotics
Prevents the release of ACh - Which results in muscle paralysis.
Dopamine; causes its release from intact nerve terminals

34. Antiarrhythmic Class III- effects?
Centrally acting alpha agonist - thus causing a decrease in central adrenergic outflow - spairing renal blood flow
Succinylcholine
It affects beta receptors equally and is used in AV heart block (rare).
increase AP duration - increase ERP - increase QT interval - for use When other arrhythmics fail

35. MOA for Penicillin (3 answers)?
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
Md= (CpxCL)/F Cp= plas. Conc. CL=clear. F=bioaval.
Megaloblastic anemia - Leukopenia - Granulocytopenia
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes

36. What is the MOA for the Cephalosporins?
Beta lactams - inhibit cell wall synthesis - Bactericidal
- aminoglycosides - loop diuretics - cisplatin
Used in combination therapy with SMZ to sequentially block folate synthesis
effective in torsade de pointes and digoxin toxicity

37. Does Warfarin have a long - medium - or short half life?
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs
Inhibits cell wall synthesis ( binds to PBP3). A monobactam
Long.
Hexamethonium is a nicotinic antagonist - and thus is a ganglionic blocker.

38. Which drug(s) cause this reaction: Gynecomastia (6)?
Reversibly inhibits cyclooxygenase - mostly in CNS. Inactivated peripherally.
- Cimetidine - ketoconazole - spironolactone - digitalis - EtOH - estrogens
With supplemental Folic Acid
Protease inhibitor.

39. What is the MOA for Amphotericin B?
GI discomfort
Penicillin.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis
cholestyramine - colestipol

40. Are not penicillinase resistant
Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic stroke.
Inhibits Viral DNA polymerase
Carbenicillin - Piperacillin - and Ticarcillin
Inhibits reabsorption of uric acid.

41. Name the common Nucleoside Reverse Transcriptase Inhibitors
Zidovudine (AZT) - Didanosine (ddI) - Zalcitabine (ddC) - Stavudine (d4T) - Lamivudine (3TC)
- Glucocorticoid withdrawal
first dose orthostatic hypotension - dizziness - headache
Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor - used in prostate carcinoma.

42. Common toxicities associated with Griseofulvin?
Short.
Scopolamine
Teratogenic - Carcinogenic - Confusion - Headaches
Hemolysis (if G6PD deficient) - Neurotoxicity - Hepatotoxicity - SLE- like syndrome

43. What are four clinical uses of glucocorticoids?

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44. What are the clinical indications for neostigmine?
Prevents the release of ACh - Which results in muscle paralysis.
Neostigmine - pyridostigmine edrophonium - physostigmine echothiophate
Post - op and neurogenic ileus and urinary retention - myasthenia gravis - and reversal of neuromuscular junction blockade (post - op) through anticholinesterase activity.
Selectively inhibit cyclooxygenase (COX) isoform 2 - Which is found in inflammatory cells nad mediates inflammation and pain; spares COX-1 Which helps maintain the gastric mucosa.

45. What is the category - desired effect - and period of use of albuterol in the treatment of Asthma?
CMV - esp in Immunocompromised patients
Sulfonamide Loop Diuretic. Inhibits ion co - transport system of thick ascending loop. Abolishes hypertonicity of the medulla - thereby preventing concentration of the urine.
DHPG (dihydroxy-2- propoxymethyl guanine)
Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute exacerbation.

46. Ca2+ channel blockers - mechanism?
Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic environment to polymerize.
not a sulfonamide - but action is the same as furosemide
Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of fibrinogen.
block voltage dependent L- type Ca2+ channels of cardiac and smooth muscle - decreasing contractility

47. What is the MOA of Griseofulvin?
Interferes with microtubule function - disrupts mitosis - inhibits growth
Blocks viral penetration/uncoating; may act to buffer the pH of the endosome
ACE inhibitor.
edematous states (CHF - cirrhosis - nephrotic syndrome - pulm edema) - HTN - hypercalcemia

48. What is the clinical use for Nystatin?
1. Acarbose 2. Miglitol
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.
Atropine pts are suffering from Cholinestrase inhibitor poisining (Nerve gas/Organophosphate poisining)
Topical and Oral - for Oral Candidiasis (Thrush)

49. ACE inhibitors - clinical use?
- ED 50 is less than the Km (less than 50% of receptors)
Choline acetyltransferase
Initially vasoconstriction would increase bp - but then it acts on central alpha -2 receptors to decrease adrenergic outflow resulting in decreased bp.
hypertension - CHF - diabetic renal disease

50. What is the category of drug names ending in - azepam (e.g. Diazepam)
- Triggers apoptosis - CLL - Hodgkin's in MOPP - Cushing - like syndrome
- MT polymerization stabilizer - Ovarian & breast CA - Myelosupperession & hypersensitivity.
Glycoproteins from leukocytes that block various stages of viral RNA and DNA synthesis
Benzodiazepine.