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From USMLE Step 1 226 to Step 2CK 260


How to Master Pharmacology for the USMLE Step 1 Over a Glass of Wine



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USMLE Step 1 Pharmacology

Along with biochemistry, pharmacology has the power to induce terror in the majority of medical students preparing for their USMLE Step 1 exam.  This is a shame, since so much of pharmacology is simply learning a large volume of basic information – once you know enough basic information, you can get the majority of questions correct.  In other words, pharmacology = free points on your USMLE Step 1!  Here, I outline 6 simple steps to set up highly efficient cards, to learn the basic information necessary for each drug.  Note: this specifically deals with learning the drugs for Step 1, Step 2, and Step 3; the basic principles of pharmacology (e.g. competitive inhibitors, kinetics curves, etc.) can be learned using the basic principles of Anki card-making detailed here.

USMLE Step 1 Pharmacology

“Affiliate Disclosure: Some of the links below are affiliate links, which means we will earn a commission if you purchase one of these products. This commission comes at no additional cost to you, and doesn’t impact whether an item is included on this list or not.” 

1. Use electronic resources to facilitate “copy + paste” of basic information

First, get a copy of First Aid for the USMLE Step 1 (note: I HIGHLY recommend getting an electronic copy like the Kindle copy linked to here, as the “copy + paste” functionality will save you LOTS of time).  For the vast majority of drugs, knowing the information in First Aid is sufficient for getting the questions correct.

Second, decide which drugs you will cover.  This may sound simple, but given that it can be such an overwhelming topic, simply having a jumping off point is a huge step.

If you are still in the classroom-portion of medical school (i.e. not yet in serious Step 1 mode):  the drugs you choose should be part of the organ system/block you are currently in, and identify the “pharmacology” section for the block in First Aid, typically the last section per organ block.  For example, if I was studying cardiology, I would turn to the back of the cardiology section:

First Aid Cardiovascular Pharmacology

2. Use simple cards to save time and improve retention

Next, and this is critical, make separate forward AND reverse cards for “mechanism,” “clinical use,” and “toxicity.”  This means that you will likely have at least 6 cards per drug.

For question/answer design, I prefer simple cards.  For example, “(Drug) – mechanism,” “(Drug) – use,” and “(Drug) – toxicity,” with appropriate reverse cards.  Then, on the reverse side, I will use my electronic copy of FA to copy/paste the information into my card.



In Anki, this would look like:

Anki for USMLE Step 1 Pharm

What the $β↑α% happened to my symbols?

When copying symbols from electronic copies of books, it often will not recognize it, and so instead of having nice symbols like ↑ or →, I end up with things like atomic death.  By using  the super-useful text expander aText program, I can replace all of the symbols quickly to their original form.

USMLE Step 1 Pharmacology Add Reverse

3. Check the “add reverse” box to save time on making cards

Note that I put a “y” in the “Add Reverse” text box, signifying that I want to make a reverse card.  A “Forward” card means that the front box (i.e. “Hydralazine – mechanism”) is the question, and the back box (“↑ cGMP → smooth muscle relaxation…”) is the answer.  A “Reverse” card is the opposite, where the back box is now the question, and I have to identify that the drug is from the mechanism itself.

This is important, because most USMLE Step 1 pharmacology questions will deal with your basic knowledge regarding these drugs.  Some will ask you the name of the drug after identifying the mechanism, while others will ask the toxicity while giving you the name.  In other words, they may ask you the equivalent of either a “forward” or a “reverse” Anki question.  Make your Anki cards accordingly, to deal with any such scenario.

So far, we’ve made 2 cards (a mechanism card, in both “forward” and “reverse” directions).  We repeat the process until we have “forward” and “reverse” cards for “clinical use” and “toxicity,” for a total of at least 6 cards per drug.

Applying the same “Copy and Paste” to this, the two “drug uses” cards would look something like this:

USMLE Step 1 Pharmacology Pre-Edit

Note that despite bolding what I felt was the important information to recall, that this is still a fair amount of information (this breaks the rule that basic cards should have no more than 2-3 unrelated facts).  Additionally, the forward question (e.g. where the “front” is the question, and the “back” is the answer; i.e. the question is “Hydralazine – use?”) is significantly more difficult than the reverse question (e.g. uses of hydralazine).  In other words, to answer the forward question, I would have to recall that hydralazine is used for hypertension, CHF, hypertension in pregnancy, and that it can be co-administered with β blockers to prevent reflex tachycardia (4 facts).  However, in the reverse direction, I would just have to recall one of those facts to recall that the drug is hydralazine (1 fact).

How can I make these cards easier to recall, while simultaneously improving my retention?

4. Balance the difficulty of the “forward” and “reverse” directions by rating the difficulty from 1-10

The simplest thing I can do is recognize that it is often much more difficult in the forward than in the reverse direction, and to try and balance those difficulties.  I like to rate cards from a 1-10 (1 being so simple I could remember it even without Anki; 10 being so difficult it’d be like memorizing the opening to Canterbury Tales).  In this case, I would rate the “forward” question “Hydralazine – uses” as roughly a 7, since I would find it hard to remember all of these uses together, while I would rate the “reverse” question of “(uses) – drug?” as a 2.  I prefer to have forward and reverse cards that are approximately equal difficulty, which will reduce the overall number of times I will have to repeat that information for it to stick.  In this case, I would re-write the card to the following:

USMLE Step 1 Pharmacology

5. + 6. Additionally, for lists, give reminders for number of facts to recall, and explain “why” when possible

Notice that now, the forward question is easier, as there are only 3 things to remember.  Additionally, I made it easier by reminding myself that there will be 3 things (3) to recall in the future, as often I can recall most of the things easily, but will forget how many things I am supposed to recall.  Finally, I added a brief explanation for why it would make sense to coadminister with β blockers, since in the months/years I will review this card, I am likely to forget why this is, and remembering “why” will significantly increase recollection.

Applying the same principles to drug toxicities

Now, let’s try the same thing with drug toxicities.  The basic “Copy + Paste” approach yields us this:

USMLE Step 1 Pharmacology Toxicities

Here, we have the same problems as before.  After first trying to make sense of as many symptoms as possible, I then try and balance out the difficulties of the cards in either direction.  This would lead to a card like the following:

USMLE Step 1 Pharmacology Toxicities Edit

Here, I have grouped together the adverse effects I can make sense of.  An afterload reducer will lead to reflex sympathetic effects (I am not blocking sympathetic receptors like I am w/ β blockers), so when my baroreceptors sense decreased BP, I will feel the full sympathetic reflex effects, which include tachycardia (leading to increased cardiac demand/potentially angina) and RAAS activity → fluid retention.  Making sense of these toxicities will improve retention.  This cannot be emphasized enough:

Investing the time to make sense of as many things as possible will vastly improve recall, save time, and supercharge your USMLE Step 1 score

I was relatively confident that I could identify tachycardia and fluid retention, but I was less sure I could recall that it might cause angina.  For that reason, I asked specifically for what it was contraindicated in (angina/CAD), to help me remember this fact.  Finally, you can see that I moved the “Lupus-like syndrome” to the opposite side, since I couldn’t relate it to any of the CV facts.

Additionally, note that I intentionally didn’t bold “nausea” since I felt that it was a nonspecific, and signaled to myself that it was less important to recall.  Why?  Because so many drugs are associated with nausea that it is unlikely that it would be the defining feature of this particular drug.

HIGH YIELD STEP 1 TIP: Remember that on any USMLE exam, the question-writers MUST give you enough information that a group of experts could agree on the specific answer  without knowing the answer choices.

In other words, ask yourself, “if they gave me a patient with this side-effect, could I unambiguously identify the drug without needing to look at the answer choices?”  For “nausea”, there is no way.  Imagine the question stem, “47 year old man comes in with hypertension diagnosed 3 months ago.  He complains of nausea for the past several weeks.  What drug was he given?”  No dice.  If instead, they gave you the same clinical scenario, but told you he had been having a photosensitive rash in the malar distribution, you could definitely identify the particular drug.

Study accordingly.

If there is other information that appears relevant that does not fit neatly in one of the three aforementioned categories, consider making separate cards for these (in addition to the 6).  A major category would be drug names in a given category (e.g. “Azithromycin, clarithromycin, erythromycin” instead of their class – macrolides).  Remember that you will be tested much more frequently on your ability to recognize/recall specific drugs names, both for Step 1, as well as for clerkships, and so it is a worthwhile investment in time to learn the specific drug names now, along with the specific pronunciation.

Too much information in cards = retention ↓, needless repetitions ↑

Most people ask, “why don’t you put more information on your pharm cards?  Aren’t you making lots of extra cards?  What if you made fewer cards with more information on each?”  This approach isn’t wrong, per se, but I would argue that you will review lots of material unnecessarily, which will add unnecessary hours to your studying.  Let me give you an example to illustrate.

Let’s say I wanted to learn antibiotics, and I started with the macrolides class.  If I were to write a question that included the mechanism, use, and toxicity, it would look something like this.

Anki for USMLE Step 1 Pharm

This is clearly way too much information, and it illustrates  why having cards with too much information can quickly make your cards worthless, and can consume inordinate amounts of time.  Let’s say I were to review this card, and remembered everything except the mechanism of resistance.  I would have to review the entire card again, despite not knowing one of the 4 facts associated with the card.  But I would be reviewing 90% of the information that I already knew well!  And what if the next time I remembered everything but the mechanism?  The more unrelated information you have in a card, the more likely it is you will forget any one piece of it.

Additionally, when I try and recall the information on the card, I likely try to run through the card in a specific order (i.e. I will recite the mechanism first, then the use, then the toxicity, etc.).  In other words, when I’m taking my Step 1 exam, if I get a question on the toxicity of macrolides, I will have to run through the mechanism and use first, which will extend the amount of time it takes to answer the question unnecessarily.

The most common mistake for both me and the students I work with is to make cards that are too long, which makes reviewing cards much longer than it needs to be, and much less effective.

Finally, you’ve probably noticed that making these cards, unlike many other cards that require you to be doggedly on the lookout for  explanations, these are largely “mindless” activities.  When I was studying pharm for my USMLE Step 1, I liked to save making cards for the evening when I needed a break.  Once I got the hang of the general layout of how I wanted my cards to look, I would sit on the couch, watching TV with my family, while having a glass of wine, copying and pasting the information from First Aid into my flashcards.  It was a nice way to relax while also still feeling like I was moving forward.

Want to save hours of time and get a huge jumpstart to learning pharmacology – for FREE??

As a thank you for your amazing support, I’ve sorted through my deck to pull out the ANS Pharm cards I used to rock the USMLE Step 1, as well as my cardiology and anesthesiology clerkships.

 Congrats!  Here are the ANS Pharm Cards!


What should you do next?

  1. If you haven’t already, get an electronic copy of First Aid.
  2. Consider using a text expander program like aText to make your cards visually easier to follow.
  3. Remember the 6 simple steps for making pharm cards:
    1. Use electronic resources to facilitate “copy + paste” of basic information
    2. Use simple cards to save time and improve retention (~6 cards / drug)
    3. Check the “add reverse” box to save time on making cards
    4. Balance the difficulty of the “forward” and “reverse” directions by rating the difficulty from 1-10
    5. For lists, give reminders for number of facts to recall
    6. Explain “why” when possible
  4. Grab your favorite beverage and get started!

What do you think?  Please share your experiences with the rest of the YOUSMLE community by leaving a comment below.

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Photo by Bernaldo Leal

  • Forup Loading

    Man… This stuff is gold. This entire site looks too good to be true (almost). I have my Step 1 in 3 weeks… 3 weeks and 2 days actually. Any advice? I had never known about your site until today…. I wish I heard about this months ago. :(

    • Yousmle

      Hi! Thank you so much for your feedback and kind words. I write a lot of this stuff because I got sick of having to rely on forums for information when I was studying for Step 1, and never really knew who to trust or what was the best way to study, etc. I’m glad to see I’m not alone!

      As to your question, it really depends on what you are weak on, but the best advice I can give is to slow down and learn how to interpret questions fully, and to focus on your weakest areas and learn them well. You’d be surprised at how many students get questions wrong because they don’t actually understand what the question is asking. EVERY question on the test will depend in part on your ability to understand what the question is asking, so practicing that skill is critical.

      I actually wrote an article recently on what to do if you have only a few weeks before your test. If you’d like to read it, the link is below:

      I would love to hear your feedback on it or any other article you read on the site.

      Best of luck!

      • Forup Loading

        Although I would reply on that page, even that information is amazing! I just feel disappointed I did not find all this earlier. I feel like I would have been so much further along in my understanding had I used your method. I feel concerned that I cannot formulating cards to use them effectively with a little over 3 weeks left to the exam… I hope I do okay… Thanks for this awesome resource, though. Not sure how more people aren’t aware of it.

        • Yousmle

          Thank you so much for your reply. I agree with your instinct that more time would help to implement this strategy more effectively. The biggest mistake people make is that they get SO excited about this strategy that they try and put everything into Anki cards…and then get overwhelmed with everything they have to do and don’t actually get to finish their cards.

          As such, my best advice would be to have more modest goals with it. 3 weeks isn’t a ton of time, so I’d just focus on making good, basic cards, and try to avoid making the same mistake twice on QBank questions. Use the USMLE Step 1 Cheat Sheets on this site for topics you feel particularly weak, and copy and paste the questions you don’t know into your Anki cards, especially the questions at the end.

          Here’s the link to the basic card making guide:

          Again, I really appreciate your feedback, and want to help as much as I can to simplify what it takes to do well on Step 1!

          • Forup Loading

            I sent you an email. Did you happen to receive it?

          • Yousmle


          • Arfan

            is it possible for you to upload the rest of your anki pharm cards?

          • Yousmle

            Hi Arfan – thank you for your message. Unfortunately, I was not the most organized when I made my pharm cards, so I don’t have a reliable way of uploading only my pharm cards. Additionally, even if I did, there would be LOTS of “lower-yield” cards mixed in, since I made these cards throughout my first and second years. I will continue to upload more and more cards as I organize them, so I encourage you to check out the many articles where I DO share Anki cards, as well as to check back in the future! Thanks for your question!

  • tabatch89 .

    Hi Alec! Your method and your individualized approach to us are heavensent, thank you so much for that!

    I have been using Anki for the past week now and always at the back of mind I’m asking, “is this high yeild?”. You mentioned in one post that you took note of the educational objectives in UWorld- what about those that are the wrong answers? Did you taken them into consideration too?

    Nevertheless, again, I want to thank you for all your insights!

    • Yousmle

      Thank you for your message! My hope with this is to cut through the clutter and provide practical, actionable information that you can use to improve your USMLE/Shelf scores.

      I completely understand the desire to put information into Anki that comes from things outside the educational objectives. We’ve ALL done it, for sure.

      I typically do NOT put information that isn’t in the educational objectives, unless it helps explain something that I didn’t know previously (e.g. maybe I had just memorized that ACTH was high in congenital adrenal hyperplasia, but didn’t realize that it was because they all have to do with low cortisol → feedback inhibition ↓ → ACTH ↑).

      If I learned something new, I would either add that explanation to an existing card, or make a new card. Remember, the key to learning things well for Step 1 is to understand the MECHANISMS of disease. The less you memorize, the more you will be able to apply your knowledge.

      If you start putting random information in your cards, you run the risk of making too many cards, which will cause you to have to review lots of cards, which will take more time away from doing QBank questions. Like many things in life, using Anki is a balance, and if you make too many cards, you will spend too much time reviewing less valuable information, while simultaneously be taking away time from other valuable activities.

      You might be the exception, but virtually every student I’ve tutored who has made cards on information outside of what was in the educational objective ended up making too many cards, got really behind, and regretted it. Instead, focus on the highest yield information, which they’ve already outlined for you conveniently in the educational objectives!

  • disqus_JVKHY0rUnk

    Hey hi! I have no idea how I stumbled upon this but this site just makes things easier. I don’t take my steps in quite a while but m pretty sure these strategies are bound to help in Medical School as well, as I was already facing lots of problems with covering Pharmacology and this helps a lot
    So I was wondering how did you manage your time making cards in Medical School and even during that time did you end up revising everything everyday? it just seems like a very difficult fate. But Thank you so much for all the valuable advice :)

    • Yousmle

      Hi!  Thanks for the fantastic feedback.  That is a fantastic question, one that I hope to address soon in an article.  My basic goal was to make all cards for subjects I’d learned ON THE SAME DAY.  This was hard to do, but ultimately worth it, since it takes so much time to make cards on subjects you have to re-learn.  I usually would try and wake up early, too, and make full use of time to make sure I finished my cards before the end of the day.  Hope this helps, and I look forward to hearing more feedback of other articles!

  • Mohammad Sha’ar

    Hi there, I would like to thank you for the inspiring tips and advice that you are providing us with. I am actually inspired by not only the awesome technique that you are using, but also with the discipline and the consistancy that you are adhering with. I am a man of discipline and I really admire that characteristic in a person.
    As for my request, I am a new graduate from Palestine, and I am preparing to sit USMLE step 1 in 2 months. For us (graduates) it’s different to review all that basic medical knowledge since it has been a while. But for now I am doing fine and after reading a couple of your articles I wish I used this method from the beginning. Anyways, I would like to ask you for your Pharmacology deck of cards, since I am having trouble finding the time to create mine, since I need that time to understand some Bio concepts and I only need to revise pharmacology because I think I understood it well back then.
    I did try to start making them a week ago, but I am struggling with time and I would like to ask you for help. I know that it will be much better if I made mine, but sadly I have no choice.

    • Yousmle

      Thank you so much for your kind words! I am currently working on a step one deck, but unfortunately do not have a pharmacology deck yet available. I hope to have one in the future, so definitely check back on the website!
      Best of luck with your studies!



  • Kimberly Ann

    I just wanted to say that after discovering your website and techniques,
    in the last week alone I have become more efficient in studying for the
    Boards than my efforts altogether in the past 2 months! Thank you so
    much for all the time and effort you’ve invested into creating the
    resources on this site (especially the Heme “cheat sheet” regarding
    Warfarin/ the coagulation cascade – which was absolutely brilliant!); it
    is one thing to be an exceptional physician, and another to be that
    exceptional person who passes on knowledge/self-formulated study
    techniques to the benefit of everyone save yourself. I have forwarded
    your URL to numerous other students, (some of whom are international
    grads, and therefore lack ready access to seniors, or even fellow
    batchmates for tips and guidance) and so far the response has been
    overwhelmingly positive. The majority of them expressed similar
    gratitude after reading your advice, and are now considering tutoring
    sessions with you as they near the end of their prep time. So as
    collective voice from everyone who has benefited from your work, “Thank
    You”. Your efforts are appreciated far more than you may realise. I look
    forward to conquering Step 1 with all the guidance you have provided
    here, and definitely plan on getting in touch as I near that fateful
    date! :)

    • Yousmle

      Dear Kimberly,

      Thank you so much for your kind words and fantastic feedback! It is comments like these that inspire me to continue to work on better and better ways of helping other students. One of the things I found most frustrating as a student was not having proper guidance on the best ways to learn subjects, as well as how to study for one of the most important tests of my life. I have worked with tons of students in similar situations, and if my experiences can be helpful at all, this has been worth it. Thank you again for your support and for sharing the website with others! I greatly appreciate it ^^


  • Matthew So

    hey alec,
    thanks for the website!
    wanted to get your thoughts about the following:

    anki has a feature that lets you make both a forward/reverse card on one click right? your protocol says to make two seperate cards. am i talking about two seperate things?

    • Yousmle

      Thank you for your message. Yes, I would use forward and reverse cards to make 2 separate cards.

  • JR

    Sorry if this posts twice. I am having trouble pasting from FA and I am hopeful you (or someone reading this) can help. aText is available for Mac only. Is there an equivalent program for PC?

  • LY

    Great post. So I downloaded aText but have no idea how to go about changing the symbols back to normal, if someone could point me in the right direction or share an article on how to do it I’d really appreciate it!

  • JDM

    Great information. Do you have an all-inclusive (or “mostly-inclusive”) pharm deck yet? What about micro? I’d be more than happy to pay for a good Anki deck for those two subjects. Thanks!

    • Yousmle

      Thank you so much for your kind words. I am in the process of an all inclusive pharmacology deck, and will be sure to let you know when it is released. I may also work on a microbiology deck if there is enough interest. Thanks again for your feedback, and I look forward to hearing again from you soon!


      • johnshop

        Same interest (pharmacology&microbiology) here. And, what about the other subjects like Pathology, Biochemistry…?

        • Yousmle

          You can find those subjects in the Step 1 deck. I will continue to work on a charm-specific deck, however, and will be sure to let you know when it’s done!!


  • Bryan

    Hi, Alex. I bought the app aText, but I couldn’t change the strange symbols when I copy the lines from PDF to anki. Could you help me out with this? Thank you so much!

    • Yousmle

      You have to create replacement symbols, like creating a command like “,bet” to replace it with a symbol like “β.” Unfortunately, there is no way to automatically replace all symbols – you will have to do it manually.

  • John

    Hi Alex, I love your website and your approach. Using the example of azithromycin, clarithromycin, erythromycin all being macrocodes, would you just make a “Macrolide-names (3)” flashcard or do the sequence of 6 cards for each one of the three macrolides? thank you!

    • Yousmle

      I’d probably make a card on simply the names of the macrolides, as you suggested first.

  • Enole Onche

    Please do not send me emails on “How You Might Fail the USMLE?” I am already frightened at the prospect of taking the exam. I don’t need these demoralizing articles to add to that!! I had tried using your “Anki” software and was not able to do so…So I would really appreciate it if you do not send any articles with negative headlines!!

  • Nelson

    Hey Alec,

    “Quick” question, how do you go about making cards for drugs that have the same info (as seen on the FA)? For instance, if I’m making cards for alteplase, reteplase, streptokinase and tenecteplase, which are all thrombolytics, how would you go about making the cards for them? I’m following the guide on your website and making the forward + reverse cards for mechanism, uses and toxicity. If I make cards for all these things for drugs with the same info I would perhaps think of one drug for the card but it’s actually another (e.g. think of alteplase for a card a run into but the actual card is reteplase), though they all do the same. This seems like it’d be a waste of time/frustrating thing to deal with when studying. Would I just make the cards for the drug class (in this case thrombolytics)? Or is there another way of going about making cards for the drugs?

    This is especially important/relevant for drug classes with lots of drugs, e.g. macrolides and nucleotide analogs. I’m making a pharma deck for Step 1 so I’d appreciate any help you could provide.

    Thanks a lot in advance!

  • Zaid Tornado

    Hi Alex
    I’m Zaid , I’m a medical student and the pharmacology is one of my biggest problems, in our college we don’t study pharm correctly ( focusing mainly on reading classifications and dosing).
    I’ve read what you wrote about reading pharm and it is a very effective way , but the question is “” is your method for any student or for student who have a strong base (knowledge) in pharmacology???””
    And please what resource(s) that i can recommend for mastering the pharm for usmle step1 exam???
    thank you already

    • Yousmle

      This is true for all students learning pharm, regardless of background. I have a pharm deck that I continue to work on, if it interests you in saving time on creating cards in this manner without having to put in all of the time to try and re-create a pharm deck:


      • Zaid Tornado

        Thanks Alec, I’ll try it.
        Another question please about the biochemistry and the behavioral science , what are the books that I should use for the usmle exam??

        • Yousmle

          I used the Rapid Review Biochem book, which I found to be pretty good/concise. For behavioral science/stats some of my students have found the UW stats package useful.



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