Make it Rain with Pharm Flashcards

  • /Reviewed by: Amy Rontal, MD
  • Flashcards. They are dull. They’re usually low-tech. They can be a huge pain. But we need them.

    Flashcards are a necessary weapon in your arsenal for solid Step 1 and Step 2 CK performance. We’ve talked in previous posts about how to set up some basic flashcards, as well as different software available for flashcard construction—some featuring algorithmic spaced repetition to help you focus more on topics you are struggling with.

    In this post, we will talk about how to quickly and effectively construct a brilliant flashcard for each of the 723* drugs in First Aid.

    Warning: Showing you how quickly and simply a pharmacology flashcard can be created will lead to destruction of the “I don’t have enough time!” excuse.

    *Don’t worry. There’s not this many (we think).

    There are 5 basic tenets of a pharmacology flashcard. Every single drug, including all of the information you need to know about it, fits into the simple framework below. It covers everything that you might see on a USMLE exam without getting too verbose.

    On front of card:

    Drug Name

    On back of card:

    1. Class
    2. Indication
    3. Mechanism of Action (MoA)
    4. Toxicities & Side Effects
    5. Miscellaneous (e.g., antidote to overdose, cytochrome inhibition/induction, etc.)

    Let’s use an old favorite and see what it would look like:


    Class:  selective beta-1-antagonist
    Indication:  tachycardia, heart failure, post-MI, angina, hypertension
    MoA:  inhibition of sympathetic nervous system by beta-adrenergic blockade (dec. HR, SV, contractility)
    Tox:  hypotension, heart block, sedation, shortness of breath, impotence
    Misc:  antidote = glucagon; contraindicated in asthma

    Done. When you prepare a flashcard with your reference in front of you, this should only take about a minute. As we so often remind students, it is not only the usage of flashcards that imparts great value to memorizing these rote facts, it is the creation of them as well.

    Let’s try another less common medication:


    Class:  anti-gout medication
    Indication:  acute gout flare, pericarditis
    MoA:  inhibits neutrophil chemotaxis and microtubule formation
    Tox:  GI upset, neutropenia
    Misc:  second-line after NSAIDs for acute flare

    That’s all. Now, I know what you are thinking. Each individual drug doesn’t have too much information to remember, but multiplied by a few hundred, it is near impossible!

    Let’s take a deep breath and put this into perspective.

    Q: Are there many drugs to memorize?
    A: Yes, of course. That is undeniable.

    Q: Is the process complex?
    A: Not at all; it’s just a matter of getting information from point A (reference book) to point B (flashcard deck), with the mediator of your mind to absorb some of the information along the way.

    Q: Isn’t making pharm cards a waste of time? I’ve already got the information in black and white in my books!
    A: Reading and re-reading without internalization and progress is a waste of time. Systematically approaching this large task with a tried-and-true plan is NOT a waste of time, but rather a valuable investment in your own success.

    Q: Won’t it be hard? You said there are loads of drugs.
    A: Yes. It will require time and effort. But remember, nothing great in life was ever achieved without great efforts. No terrific board score was either. By having a tangible approach (create a flashcard utilizing the above framework for each drug), you will be light-years ahead of those who skipped it because it was hard/too much work.

    Q: What about multiple drugs in the same class? Do I need a separate card for haloperidol, fluphenazine, chlorpromazine, and thioridazine?
    A: If drugs contain different side effects/toxicities, indications, or have any other dissimilar information from one another, this warrants an extra card. For instance, thioridazine classically has a side effect of retinopathy, while haloperidol is most likely to cause neuroleptic malignant syndrome. We encourage you to make separate cards for each drug. Also, creating them in succession can help you group drugs from the same class together in your mind.

    Low-Hanging USMLE Fruit

    Pharmacology is a difficult subject for many, but it is one where challenges can be surmounted with nothing more than strong efforts and a healthy deck of flashcards.

    You would be surprised at how many USMLE questions go after a one-off fact about a random drug. A long and seemingly complex question stem can often be distilled down into: “Which drug has a side effect of nasal polyps?” or, “Which antihypertensive should I start a diabetic patient on?” These questions are low-hanging fruit that flashcards will help you to pick.

    To make matters even sweeter, these cards don’t need to be cathartically burned up after your Step 1 test day. They are reusable and will serve you well when studying during clerkships, shelf exams, and even for Step 2. Pharmacology is the subject with the greatest redundancy between Step 1 and Step 2; the indications, mechanisms, and toxicities don’t change. Well made flashcards will pay you great dividends.

    Every pharmacology card you make is one less that needs to be created; it is one more drug that you know more about. Running through your cards in free-time, as well as during devoted flashcard sessions will slowly transform your testing attitude from “Oh crap, another pharmacology question…” to “All right! I’ve prepared well for a question like this.” And when you combine a confident attitude with structured knowledge, there is nothing that can stop you.


    Class:  study aid
    Indication:  impending USMLE exam
    MoA:  through creation and repetition, you will develop mastery
    Tox:  none; well tolerated at very high doses
    Misc:  there is no substitute for hard work and a solid systematic approach

    What questions do you have about making flashcards? Have you had successes/failures with them in the past?