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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 beta 2 agonist will help your 21yo Astma pt?
- NaHCO3
Albuterol - tertbutaline
Increases mean - systolic - and diastolic bp - while there is little change in pulse pressure.
G6PD deficient individuals

2. What conditions are treated with Metronidazole?
orthostatic and exercise hypotension - sexual dysfunction - diarrhea
fetal renal toxicity - hyperkalemia - Cough - Angioedema - Proteinuria - Taste changes - hypOtension - Pregnancy problems - Rash - Increased renin - Lower Angiotensin II (CAPTOPRIL)
Giardiasis - Amoebic dysentery (E. histolytica) - Bacterial vaginitis (Gardnerella vaginalis) - Trichomonas
- Constant AMOUNT eliminated per unit time. - Etoh & ASA

3. For Heparin What is the Duration of action
Pralidoxime regenerates active cholinesterase.
Clavulanic acid
Small lipid - soluble molecule
Acute (hours)

4. What is the lab value used to monitor the effectiveness of Warfarin therapy?
Gram + cocci - Proteus mirabilis - E. coli - Klebsiella pneumoniae (PEcK)
- Sulfonamides - INH - ASA - Ibuprofen - primaquine - nitrofurantoin /- pyrimethamine - chloramphenicol
Close K+ channels in Beta - cell membrane leading to cell depolarization causing insulin release triggered by increase in Calcium ion influx.
The PT.

5. List the mechanism - clinical use - & toxicity of Prednisone.

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6. Which cancer drugs effect nuclear DNA (4)?
cinchonism: HA - tinnitus - thrombocytopenia - torsade de pointes due to increased QT interval
- Alkalating agents+cisplatin - Doxorubicin+Dactinomycin - Bleomycin - Etoposide
HSV - VZV - EBV - Mucocutaneous and Genital Herpes Lesions - Prophylaxis in Immunocompromised pts
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes

7. In What population does Gray Baby Syndrome occur? Why?
Premature infants - because they lack UDP- glucuronyl transferase
1)Binds penicillin - binding proteins 2) Blocks transpeptidase cross - linking of cell wall 3) Activates autolytic enzymes
Butyrophenone (neuroleptic).
Rapid (seconds)

8. K+- clinical use?
Carbenicillin - Piperacillin - and Ticarcillin
depresses ectopic pacemakers - especially in digoxin toxicity
Blocks Influenza A and RubellA; causes problems with the cerebellA
BM suppression (neutropenia - anemia) - Peripheral neuropathy

9. What is the major side effect for Ampicillin and Amoxicillin?
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
1.Gram - rods of the Urinary and GI tracts (including Pseudomonas) 2.Neisseria 3. Some Gram + organisms
Carbenicillin - Piperacillin - and Ticarcillin
Hypersensitivity reactions

10. Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
These B-2 agonists cause respiratory smooth muscle to relax.
Phase 1 = prolonged depolarization - no antidote - effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked - an anticholinesterase is the antidote for this phase.
1. Taken daily 2. No protection against STDs 3. Raises triglycerides 4. Depression - weight gain - nausea - HTN 5. Hypercoagulable state
It affects beta receptors equally and is used in AV heart block (rare).

11. What are three toxicities of Propylthiouracil?
Bacitracin - Vancomycin
1. Antipyretic 2. Analgesic 3. Anti - inflammatory
1. Skin rash 2. Agranulocytosis (rare) 3. Aplastic anemia
toxic

12. Are penicillinase resistant
Methicillin - Nafcillin - and Dicloxacillin
distal convoluted tubule (early)
all of them
1) Aminoglycosides = bactericidal 2) Tetracyclines = bacteriostatic

13. What is the mechanism of action of the Alpha - glucosidase inhibitors?
TMP- SMZ (DOC) - aerosolized pentamidine
Inhibit intestinal bursh border Alpha - glucosidases; delayed hydrolysis of sugars and absorption of sugars leading to decresed postprandial hyperglycemia.
viral kinase
cardiac muscle: Verapamil>Diltiazem>Nifedipine

14. What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
Reserpine inhibits dopamine transport into vesicles - attenuating its conversion to NE by dopamine beta - hydroxylase.
1. Gastric ulceration 2. Bleeding 3. Hyperventilation 4. Reye's syndrome 5. Tinnitus (CN VIII)
NE increases bp - Which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
Botulinum

15. How can Isoniazid (INH)- induced neurotoxicity be prevented?
Pseudomonas species and Gram - rods
Benzodiazepine.
- N- acetylcystine
Pyridoxine (B6) administration

16. What is the MOA for the Fluoroquinolones?
Nonspecific beta - agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse effect is tachycardia (Beta 1).
- Glucocorticoid withdrawal
Beta - lactam antibiotics
Inhibit DNA Gyrase (topoisomerase II) - Bactericidal

17. What are the clinical uses for Aztreonam?
Gentamicin - Neomycin - Amikacin - Tobramycin - Streptomycin
Gram - rods: Klebsiella species - Pseudomonas species - Serratia species
GI upset - Superinfections - Skin rashes - Headache - Dizziness
TMP- SMZ

18. How is Chloramphenical used clinically?
Beta1 more than B2
Mg = Must go to the bathroom.
sedation - sleep alterations
Meningitis (H. influenza - N. meningitidis - S. pneumoniae) - Conserative treatment due to toxicities

19. Name two classes of drugs for HIV therapy
- Alkalating agent - NHL - Breast - ovary - & lung. - Myelosuppression - & hemorrhagic cystitis.
Flecainide - Encainide - Propafenone
Protease Inhibitors and Reverse Transcriptase Inhibitors
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.

20. What is a mnemonic to remember Amantadine's function?
Blocks Influenza A and RubellA; causes problems with the cerebellA
proximal convoluted tubule - thin descending limb - and collecting duct
Gemfibrozil - Clofibrate
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.

21. List the mechanism - clinical use - & toxicity of Busulfan.
- Alkalates DNA - CML - Pulmonary fibrosis hyperpigmentation
prevention of nodal arrhythmias (SVT)
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Muscarinic antagonist; competatively blocks muscarinic receptors - preventing bronchoconstriction.

22. What is clinical use for Carbenicillin - Piperacillin - and Ticarcillin?
Pseudomonas species and Gram - rods
Nephrotoxicity (esp. with Cephalosporins) - Ototoxicity (esp. with Loop Diuretics)
Hypersensitivity reactions
carbonic anhydrase inhibitors - K+ sparing diuretics

23. Which drug(s) cause this reaction: Gray baby syndrome?
Chronic Hepatitis A and B - Kaposi's Sarcoma
Beta lactams - inhibit cell wall synthesis - Bactericidal
GI discomfort - Acute cholestatic hepatitis - Eosinophilia - Skin rashes
- Chloramphenicol

24. Explain pH dependent urinary drug elimination?
Minor hepatotoxicity - Drug interactions (activates P450)
Binds ergosterol - Disrupts fungal membranes
Benzodiazepine.
- Weak Acids>Alkinalize urine(CO3) to remove more - Weak bases>acidify urine to remove more

25. What is Nifurtimox administered for?

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26. What is are two clinical uses of Cyclosporine?
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.
1. Antipyretic 2. Analgesic 3. Anti - inflammatory 4. Antiplatelet drug.
1. Suppresses organ rejection after transplantation 2. Selected autoimmune disorders.
Triple Therapy' 2 Nucleoside RT Inhibitors with a Protease Inhibitor

27. What is the category of drug names ending in - barbital (e.g. Phenobarbital)
Babiturate.
Inhibt Assembly of new virus by Blocking Protease Enzyme
Cryptococcal meningitis in AIDS patients and Candidal infections of all types
distal convoluted tubule (early)

28. What is the memory aid for subunit distribution of ribosomal inhibitors?

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29. What is the effect of epinephrine infusion on bp and pulse pressure?
Gram + cocci - Gram - rods - and Anerobes
Indirect agonist - uptake inhibitor
Increased systolic and pulse pressure - decreased diastolic pressure - and little change in mean pressure.
not a sulfonamide - but action is the same as furosemide

30. What is the MOA of Aztreonam?
- Phenytoin
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
hypertension - angina - arrhythmias
Inhibits cell wall synthesis ( binds to PBP3). A monobactam

31. What is the category of drug names ending in - azol (e.g. Ketoconazole)
Aminoglycosides
Aminoglycosides - Tetracyclines
hypertension - CHF - diabetic renal disease
Antifungal.

32. Which drug(s) cause this reaction: Hepatitis?
Inhibit steroid synthesis - used in the treatment of polycystic ovarian syndrome to prevent hirsutism.
- Isoniazid
CL= (rate of elimination of drug/ Plasma drug conc.)
ACE inhibitor.

33. Adverse effects of Loop Diuretics?
K+ wasting - metabolic alkalosis - hypotension - ototoxicity
1) Serious Gram - infections resistant to other Beta lactams 2) Meningitis (most penetrate the BBB)
Giant Roundworm (Ascaris) - Hookworm (Necator/Ancylostoma) - Pinworm (Enterobius)
The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal lining.

34. What is the mechanism of action of Warfarin (Coumadin)?
is resistant
depresses ectopic pacemakers - especially in digoxin toxicity
1. Addison's disease 2. Inflammation 3. Immune suppression 4. Asthma
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.

35. Toxicities associated with Acyclovir?
Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.
- Halothane - Valproic acid - acetaminophen - Amantia phalloides
depresses ectopic pacemakers - especially in digoxin toxicity
Delirium - Tremor - Nephrotoxicity

36. What are four advantages of newer low - molecular - weight heparins (Enoxaparin)?
Digitoxin>95% Digoxin 75%
- polymyxins
Chronic gout.
1. Better bioavailability 2. 2 to 4 times longer half life 3. Can be administered subcutaneously 4. Does not require laboratory monitoring

37. How do we stop angina?
Mg = Must go to the bathroom.
decrease myocardial O2 consumption by: 1- decreasing end diastolic volume 2- decreasing BP 3- decreasing HR 4- decreasing contractility 5- decreasing ejection time
-100% oxygen - hyperbaric
- Tetracycline

38. Acetazolamide - mechanism?
Chronic (weeks or months)
Protease inhibitor.
acts at the proximal convoluted tubule to inhibit carbonic anhydrase. Causes self - limited sodium bicarb diuresis and reduction of total body bicarb stores.
AmOxicillin has greater Oral bioavailability

39. What is the mechanism of action of Colchicine used to treat acute gout?
Interferes with microtubule function - disrupts mitosis - inhibits growth
YES
They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
Depolymerizes microtubules - impairing leukocyte chemotaxis and degranulation.

40. Which drug(s) cause this reaction: SLE- like syndrome?
- Hydralazine - Procainamide - INH - phenytoin
Keratin containing tissues - e.g. - nails
AluMINIMUM amount of feces.
Binds Ergosterol - forms Membrane Pores that Disrupt Homeostatis

41. Ca2+ channel blockers - toxicity?
cardiac depression - peripheral edema - flushing - dizziness - constipation
hypertrichosis - pericardial effusion - reflex tachycardia - angina - salt retention
CMV - esp in Immunocompromised patients
Sulfonylureas are oral hypoglycemic agents - they are used to stimulate release of endogenous insulin in NIDDM (type -2).

42. How does botulinum toxin result in respiratory arrest?
- ACE inhibitors (Losartan>no cough)
Can affect absorption - bioavailability - or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying.
Prevents the release of ACh - Which results in muscle paralysis.
Methylzanthine; desired effect is bronchodilation - may cause bronchodilation by inhibiting phosphodiesterase - enzyme involved in degrading cAMP (controversial).

43. Name some common Sulfonamides (4)
Epinephirine(Alpha1 -2 and Beta 1 -2)
Sulfamethoxazole (SMZ) - Sulfisoxazole - Triple sulfas - Sulfadiazine
Ld= (CpxVd)/F Cp=plasma conc. F= Bioaval.
sedation - depression - nasal stuffiness - diarrhea

44. What are three clinical uses of the Leuprolide?
- EDTA - dimercaprol - succimer - & penicillamine
Used in combination therapy with SMZ to sequentially block folate synthesis
BM suppression (neutropenia - anemia) - Peripheral neuropathy
1. Infertility (pulsatile) 2. Prostate cancer (continuous: use with flutamide) 3. Uterine fibroids

45. Antiarrhythmic class IA effects?
increased AP duration - increased ERP increased QT interval. Atrial and ventricular.
- Alkalating agent - testicular - bladder - ovary -& lung - Nephrotoxicity & CN VIII damage.
Ceftriaxone
- Physostigmine salicylate

46. What are major side effects of Methicillin - Nafcillin - and Dicloxacillin?
Rapid (seconds)
- Glucocorticoid withdrawal
thiazides - amiloride
Hypersensitivity reactions

47. Which RT inhibitors cause a Rash?
Non - Nucleosides
reduce levels of Angiotensin II - thereby preventing the inactivation of bradykinin (a potent vasodilator); renin level is increased
Activates antithrombin III
1. Mycobacterium tuberculosis 2. Delays resistance to Dapsone When used of Leprosy 3. Used in combination with other drugs

48. What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
Hemicholinium inhibits the transport of choline into the nerve - thus inhibiting formation of ACh.
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
Imipenem
- MT polymerization inhibitor(M phase) - MOPP - lymphoma - Willm's & choriocarcinoma - neurotoxicity and myelosuppression

49. What is the only depolarizing neuromuscular blocking agent?
Succinylcholine
AluMINIMUM amount of feces.
- Cimetidine - ketoconazole - grapefruit juice - erythromycin - INH - sulfonamides
Leukopenia - Neutropenia - Thrombocytopenia - Renal toxicity

50. How is Ribavirin used clinically?
Chronic Hepatitis A and B - Kaposi's Sarcoma
Impairs the synthesis of vitamin K- dependent clotting factors
for RSV
- Act on same receptor - Full has greater efficacy

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USMLE Step 1 Pharmacology

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