You have Friday night, Saturday, Sunday and one hour on Monday. That is enough to be solid on everything that can be examined, if every hour goes into pulling facts out of your head instead of looking at them again.
Lectures 4 to 8 (eye, ear, nose and throat, blood pressure, lipids, myocardial ischemia) with Dr. Wood. Pictures first, words second, tests all the way through.
On screen, scroll. To print or save a PDF, choose landscape: every map prints on its own page. Or download the PDF (68 pages, landscape).
The whole plan in one picture, then five rules. If you read nothing else, read this page.
Each colored block is a block of time with a job: DRAW a map, TEST yourself, RECALL from a blank page, FIX your misses, take a MOCK exam. Gray is rest. Times are adjustable in section 4.
Study a map for 10 minutes, then redraw it on a blank template and fix it in red. Rereading feels easy and fails exactly when the exam asks you to produce an answer.
Know the family (the ending, where it acts, what it costs you, when never) before you learn names. Wood: "your job is to be able to identify these agents into which class they fit into."
Blue M mechanism, green I use, orange S side effect, purple C never when, red ! black box or killer, light blue E what you tell the patient. Same colors on every page.
Practice with classes shuffled together, because the exam asks "which class?" Sunday you take whole-exam mock forms, not topic quizzes.
No new facts after dinner Sunday. Sleep 7.5 to 8 hours. Monday is one hour of looking, not learning.
Five lectures: eye drops, ear, nose and throat drugs, blood pressure drugs, lipid-lowering drugs, angina and heart attack drugs. Lecture 8 is the last testable one; the diuretic and heart failure deck that follows it in the same recording belongs to Exam 3. No doses. Dr. McInnis, the course director, told the class that past students spent too long on mechanisms: study the drug more broadly, meaning indications as lectured, patient education, side effects and contraindications.
Short, specific and built for someone who thinks in pictures. The evidence is simple: pulling information out of memory beats looking at it again, and spreading it over days beats cramming it.
A page you have read three times feels familiar, and familiarity is not the same as being able to produce the answer. The exam hands you a stem and asks you to produce the class, the side effect, the never-when. In a well-known review of study techniques (Dunlosky and colleagues, 2013), rereading and highlighting rated low in usefulness; practice testing and spacing rated high.
So: the maps are for the first 10 minutes only. After that, the page gets closed.
The blank-page brain dump and the draw-from-memory template are the same move: struggle to recall, then check. Struggling is the point. Tests of this kind beat extra reading even when the reading group feels more confident (Roediger and Karpicke, 2006).
Same material on different days forces you to rebuild it from memory, which is what makes it last. Lectures 6, 7 and 8 get a first pass on one day and a warm-up recall the next morning.
Practicing one class at a time feels productive. Mixing them trains the skill the exam tests: telling classes apart (ACE (angiotensin-converting enzyme) inhibitor or ARB (angiotensin receptor blocker)? beta blocker or calcium channel blocker?). In one study people learned categories better when examples were mixed, though they believed blocking worked better (Kornell and Bjork, 2008). That is why Saturday afternoon and all of Sunday are mixed.
You say you are a visual learner. Use it, with one honest caveat: studies of "learning styles" do not show that teaching to a preferred style raises scores (Pashler and colleagues, 2008). What does work for everyone is drawing, because turning words into a picture and back is retrieval and dual coding in one move. So draw, and then say it in words, because the exam is in words.
One fixed color per meaning, in every drawing you make:
Carry three pens: blue, green, red. Red is for your misses and for black box items. The letters (M, I, S, C, !, E) matter as much as the colors, so the code survives a black-and-white printer.
For each class, learn four things before any names: where it acts, what it is for, the signature side effect, and when never to give it. Then attach two or three agent names from the ending. A question about a drug is usually a question about its class.
| Ending | Class | Examples in this exam |
|---|---|---|
| -pril | ACE (angiotensin-converting enzyme) inhibitors | captopril, lisinopril, enalapril, ramipril |
| -sartan | ARBs (angiotensin receptor blockers) | losartan, valsartan, candesartan |
| -olol | beta blockers (carvedilol, labetalol end in -lol) | propranolol, metoprolol, atenolol |
| -dipine | dihydropyridine calcium channel blockers (diltiazem, verapamil are the other kind) | amlodipine, nifedipine, nicardipine |
| -zosin | alpha-1 blockers (tamsulosin is the odd one) | prazosin, terazosin, doxazosin |
| -statin | statins. Trap: nystatin is an antifungal | atorvastatin, rosuvastatin, simvastatin |
| -mab | monoclonal antibodies: here, PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors | alirocumab, evolocumab |
| -caine | local anesthetic eye drops (Wood) | tetracaine, proparacaine |
| -prost | prostaglandin analog glaucoma drops | latanoprost, travoprost, bimatoprost, tafluprost |
| -floxacin | fluoroquinolones (eye drops for corneal ulcer) | ciprofloxacin, ofloxacin, levofloxacin |
| -zoline | alpha-agonist vasoconstrictors, eye and nose: rebound! | tetrahydrozoline, naphazoline, oxymetazoline |
| -plase | fibrinolytics (clot busters) | alteplase, reteplase, tenecteplase |
| -afil | phosphodiesterase type 5 inhibitors: never with a nitrate | sildenafil, tadalafil, vardenafil |
Wood on beta blockers: names from N to Z are usually non-selective, A to M beta-1 selective, "not the best rule because there's exceptions": carvedilol and labetalol. Endings are shortcuts, not proof.
A story ties the mechanism to the use, the side effects and the never-when, so one memory carries all four. Same recipe as the lipid "garbage system" in map E. Three examples from this exam (every claim is in the course data):
ACE has two jobs: it makes angiotensin II and it clears bradykinin. Block it and pressure falls and diabetic kidneys are protected (use). But bradykinin piles up: dry cough, angioedema. Less aldosterone: potassium rises. Angiotensin II also holds up kidney filtration: kidney function can dip. And the baby: pregnancy, boxed warning.
An ARB leaves bradykinin alone: no cough.
Turns down the heart's volume knob (rate and force) so it is the first-line angina drug (use). The same knob lives in the lungs and in sugar control: bronchospasm, hides low blood sugar. After long blockade the receptors multiply, so stopping suddenly floods them: rebound angina, heart attack. Avoid it with verapamil or diltiazem: heart block.
Oxymetazoline in the nose, tetrahydrozoline and naphazoline in the eye: all squeeze vessels (clears congestion, redness). Constant use tires the receptors, so stopping brings rebound congestion or redness, and the patient reaches for the bottle again. Hence 3 to 5 days for the nose, under 2 weeks for the eye. Swallowed by a child: slow pulse, low pressure.
For each class, give a 30-second patient script: what it is for, how to take it, the one thing to watch for, the one thing never to do. Dr. McInnis named patient education explicitly, so this is also exam practice.
Every miss goes into a mistake log (a printable one is in section 5). Four columns: what was asked, what I said, the fact, one line, why I missed it. The last column is the one that fixes you: mixed up two classes? forgot the never-when? never knew it?
Then redraw that map's red parts from memory and re-ask it tomorrow. Misses are the most valuable thing the weekend produces.
| 10 min | Read map A and the Monday cheat page. That is Wood's list of what he stressed. |
| 25 min | Redraw maps D (blood pressure) and E (lipids) from the blank templates, 12 minutes each. They are the two biggest lectures. |
| 20 min | Read posters G and H (black box and killers, contraindications), cover them, then list from memory. |
| 40 min | Open the Master Drill (213 questions) and do 40 questions, then Master Exam Form A questions you have time for. Mark every guess. |
| 25 min | Fix every miss: write the fact, redraw the weakest map. Then stop and sleep. |
Sources for the study methods above: Dunlosky et al. (2013), Psychological Science in the Public Interest; Roediger and Karpicke (2006), Psychological Science; Kornell and Bjork (2008), Psychological Science; Pashler et al. (2008), Psychological Science in the Public Interest.
Eight maps (nine pages), then five drug-by-use charts that list every drug for every use. Each map is built the same way: the class first, then its agents, each fact tagged with the same color code. Look for 10 minutes, then close it and redraw the matching blank template in section 5. Every drug fact on these pages comes from the course data (slides, recordings, and the study chart behind the site).
Every drug for every use: 1 Eye · 2 Ear, nose and throat · 3 Blood pressure · 4 Lipids · 5 Angina and acute coronary syndrome. Example: “every drug for cytomegalovirus retinitis” is one row in chart 1.
Five lectures as five colored regions: what Wood stressed in each, and the question shapes he said he would use.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; CYP3A4 = cytochrome P450 3A4.
Grouped by what you are trying to do. Glaucoma is a sink: turn down the tap or open the drain. Every drug for every use: Lecture 4 Indication chart.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: NSAID = nonsteroidal anti-inflammatory drug.
Choose the infection drug, then pain and fever, allergy and steroids, congestion and cough. Rebound, Reye and polymyxin B are the headline items. Every drug for every use: Lecture 5 Indication chart.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: ACE = angiotensin-converting enzyme; NSAID = nonsteroidal anti-inflammatory drug; CYP3A4 = cytochrome P450 3A4; QT = QT interval on the electrocardiogram; PE = phenylephrine.
Where each class acts, the one side effect and one never-when to own, and the start-with order. Every drug for every use: Lecture 6 Indication chart.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; CYP3A4 = cytochrome P450 3A4; AT1 = angiotensin II type 1 receptor.
The "garbage system" from the Exam 2 study guide: a memory aid that places every drug in one city. When a question asks for a fact, answer from the facts, not the story. Where it breaks: trucks are concentrations, not vehicles with intent. Every drug for every use: Lecture 7 Indication chart.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: LDL = low-density lipoprotein; HDL = high-density lipoprotein; VLDL = very-low-density lipoprotein; CYP3A4 = cytochrome P450 3A4; PCSK9 = proprotein convertase subtilisin/kexin type 9; HMG-CoA = 3-hydroxy-3-methylglutaryl coenzyme A; ApoB-100 = apolipoprotein B-100.
Every antianginal either lowers oxygen demand, raises supply, or both. Prevention and quick relief are different drugs. Every drug for every use: Lecture 8 Indication chart.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: ACE = angiotensin-converting enzyme; AV = atrioventricular. Course answers: the study guide marks where current practice differs.
Sort by the electrocardiogram, then walk the drugs in order. The one drug class missing from the non-ST-elevation branch is the fibrinolytics. Every drug for every use: Lecture 8 Indication chart.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; P2Y12 = platelet adenosine diphosphate receptor type; ST = ST segment on the electrocardiogram. Course sequence: intravenous then oral beta blocker is what the course taught; current guidelines favor oral therapy in the first day.
Four rules prevent most of the harm: know the boxed warnings, stop-and-evaluate signs, never stop suddenly, never combine.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; NSAID = nonsteroidal anti-inflammatory drug; CYP3A4 = cytochrome P450 3A4; CYP2C19 = cytochrome P450 2C19; QT = QT interval on the electrocardiogram; FDA = Food and Drug Administration.
Drug class to when never to give it. Dark purple means never (or contraindicated); light purple means avoid or take care. The last box lists items taught one way where current practice differs.
Swipe sideways to see the whole map, or pinch to zoom.
Short forms on this page: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; AV = atrioventricular.
One row per use. Every agent the Lecture 4 slides name for that use, with its class. Read a row, cover the right side, say the drugs.
| INFECTION: BACTERIA | |
|---|---|
| Bacterial conjunctivitis | Macrolideserythromycin ointment, azithromycin•erythromycin: most common, cheap, soothingFluoroquinolonesciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, gatifloxacinSciprofloxacin: white precipitateAminoglycosidesgentamicin, tobramycinScorneal ulceration with several days of useFolate blockerssulfacetamide, trimethoprim with polymyxin BCsulfacetamide: sulfonamide allergyCell wall blockerbacitracin ointmentPolymyxin B combinationspolymyxin B with other agents (various solutions and ointments) |
| Conjunctivitis in a contact lens wearer | Fluoroquinolonesciprofloxacin, ofloxacin, levofloxacin, moxifloxacin, gatifloxacinpreferred once keratitis is ruled out |
| Corneal ulcer, or Pseudomonas aeruginosa | Fluoroquinolonesciprofloxacin, levofloxacin, ofloxacin, moxifloxacin, gatifloxacinclass preferred•the drug table names the first three; the class slide names corneal ulcers for the classAlso on the tablegentamicin, bacitracin |
| Keratitis, blepharitis | Named for bothbacitracin, ciprofloxacin, gentamicin, polymyxin B combinations |
| Keratoconjunctivitis, blepharoconjunctivitis, meibomianitis | Named for all threebacitracin, ciprofloxacin, gentamicin |
| Dacryocystitis (tear sac) | Namedciprofloxacin, gentamicin |
| Other external or superficial eye infection | Superficial infection (erythromycin: conjunctiva or cornea)erythromycin, sulfacetamideExternal eye and adnexatobramycin |
| Prevention of newborn eye infection (ophthalmia neonatorum) | Macrolideerythromycin ointment |
| INFECTION: VIRUSES AND FUNGI | |
| Herpes simplex keratitis or keratoconjunctivitis | Antiviralstrifluridine, valacyclovir, famciclovir, ganciclovir (Zirgan)Strifluridine: punctate keratopathy |
| Herpes simplex iridocyclitis | Antiviralacyclovir |
| Herpes zoster ophthalmicus | Antiviralsacyclovir, valacyclovir, famciclovir |
| Cytomegalovirus retinitis | Antiviralsganciclovir (intravenous, oral, intravitreal implant), valganciclovir (oral), foscarnet (intravenous), cidofovir (intravenous) |
| Adenoviral conjunctivitis (viral) | •No antiviral exists: it resolves alone; relieve symptoms only |
| Fungal keratitis | Polyenenatamycin, amphotericin B•natamycin: the only commercially available eye antifungalAzolesmiconazole, itraconazole, fluconazole, ketoconazole•fluconazole and ketoconazole: yeast keratitis |
| Fungal blepharitis or conjunctivitis | Polyenenatamycin |
| Fungal endophthalmitis (inside the eye) | Polyeneamphotericin BAzolesfluconazole, itraconazole, ketoconazole, miconazole |
| ALLERGY AND RED EYE | |
| Allergic conjunctivitis: acute symptoms | Antihistamine dropsalcaftadine, azelastine, bepotastine, emedastine, epinastine, ketotifen, olopatadineusually preferred; works in minutesNSAID dropsbromfenac, diclofenac, flurbiprofen, ketorolac, nepafenac•also listed for allergic conjunctivitis |
| Allergic conjunctivitis: seasonal prevention (predictable season) | Mast cell stabilizerscromolyn, lodoxamide, nedocromil•not for acute symptoms; 5 to 14 days to work |
| Severe ocular allergy | Glucocorticoid dropsdexamethasone, prednisolone, difluprednate, fluorometholone, loteprednol, rimexolone, triamcinolone•topically or intraocularly; see the inflammation block |
| Red eye (short-term relief) | Vasoconstrictorstetrahydrozoline, naphazoline, pheniramine with naphazolineSrebound redness; under 2 weeks!swallowed by a child: slow heart rate, low blood pressure |
| INFLAMMATION AND DRY EYE | |
| Postoperative inflammation and pain | NSAID dropsbromfenac, diclofenac, flurbiprofen, ketorolac, nepafenacSraised eye pressure, keratitisGlucocorticoidsdexamethasone, prednisolone, difluprednate, fluorometholone, loteprednol, rimexolone, triamcinolone (intravitreal)•inflammation after ocular surgery |
| Anterior uveitis and external eye inflammatory disease | Glucocorticoidsdexamethasone, prednisolone, difluprednate, fluorometholone, loteprednol, rimexolone, triamcinolone (intravitreal)Scataract, raised pressure, infection, slow healing•soft steroids (lower pressure risk): fluorometholone, loteprednol, rimexoloneCycloplegics for uveitisatropine, cyclopentolate, tropicamide•prevent synechiae, relieve ciliary spasm |
| Dry eye | Tear substitutesbalanced salt solution, carboxymethylcellulose, hydroxypropyl cellulose, polyvinyl alcoholImmunomodulatorcyclosporine•chronic dry eye with inflammation (keratoconjunctivitis sicca) |
| GLAUCOMA (OPEN-ANGLE) AND DIAGNOSTICS | |
| Glaucoma: raise outflow (open the drain) | Prostaglandin analogslatanoprost, travoprost, bimatoprost, tafluprost1st line; once a daySeyelash and iris color changeAlpha-2 agonistsapraclonidine, brimonidineCchildren under 2: apneaCholinergic agonistspilocarpine, carbachol, acetylcholine (surgical use)•last line; small fixed pupils |
| Glaucoma: lower production (turn down the tap) | Beta blockerstimolol, carteolol, levobunolol, betaxolol (beta-1 selective)2nd lineCheart failure, slow pulse, heart block, asthma; betaxolol if asthma historyCarbonic anhydrase inhibitorsdorzolamide, brinzolamideSbitter taste, burningAlpha-2 agonistsapraclonidine, brimonidine•both production and outflow |
| Glaucoma: combination products (fewer drops) | Fixed combinationsbrimonidine with timolol, brinzolamide with brimonidine, dorzolamide with timolol |
| Numbing the eye (tonometry, foreign body removal, superficial corneal surgery) | Anestheticstetracaine, proparacaine!no blink reflex for 10 to 20 minutes; clinic use only |
| Dilating the pupil (fundoscopic examination) | Antimuscarinicsatropine, cyclopentolate, tropicamideSympathomimeticphenylephrine•more reactive to light |
| Showing corneal damage (staining) | Dyefluorescein |
One row per problem. Every agent the Lecture 5 slides name for it, class first. Penicillin-allergy options are in their own rows.
| INFECTION | |
|---|---|
| Acute otitis media (ear infection) | Penicillinamoxicillin (high dose)mainstay of therapyPenicillin plus clavulanateamoxicillin-clavulanate•severe or resistant disease, or antibiotics in the last monthPenicillin allergycefdinir, azithromycinFailed therapy (no better in 3 days)amoxicillin-clavulanate, cefdinir (third-generation cephalosporin), ceftriaxone (intramuscular or intravenous) |
| Acute bacterial rhinosinusitis (sinus infection) | Standard therapyamoxicillin-clavulanatestandardPenicillin allergyclindamycin plus cefixime, or levofloxacin |
| Sore throat: group A strep (pharyngitis) | Treatmentamoxicillin, benzathine penicillin G (intramuscular, once)•rapid strep test firstPenicillin allergycephalexin, clindamycin, azithromycin |
| Ear infections: antibiotic ear drops | Fluoroquinolone dropsciprofloxacin, ofloxacinAntibiotic plus steroidciprofloxacin with dexamethasone, neomycin with polymyxin B and hydrocortisoneSneomycin: contact allergyCpolymyxin B: ruptured eardrum or ear tubes (cochlear damage, hearing loss)Cheaper alternativeofloxacin with dexamethasone (eye drops)•ciprofloxacin with dexamethasone is expensive |
| Oral candidiasis (thrush): inhaled steroids, human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), chemotherapy | Nonabsorbable antifungalnystatin oral suspensionErinse the mouth after inhaled steroids |
| Systemic fungal infections | Azole antifungalketoconazole!QT prolongation, liver injury; blocks CYP3A4 |
| PAIN, FEVER AND INFLAMMATION | |
| Fever (above 100 degrees Fahrenheit) | Analgesic and antipyreticacetaminophen!no more than 4 grams in 24 hoursSalicylateaspirin!never for a child with a viral fever: Reye syndromeNSAID (classified antipyretic)ibuprofen |
| Pain | Nonsteroidal anti-inflammatory drugsibuprofen (mild to moderate pain), naproxen (longer half-life)Sstomach ulcer or bleeding; kidney injurySalicylateaspirinSbleeding; ringing in the ears at high dosesAnalgesic and antipyreticacetaminophen•no anti-inflammatory action |
| Inflammation | Salicylate (higher doses)aspirinNSAIDibuprofenCasthma, children under 6 months, past ulcer, kidney disease |
| Platelet blocking (lowest dose range) | Salicylateaspirin•irreversible platelet inhibitor |
| Hypertensive disorders of pregnancy (pre-eclampsia) | Salicylate (very low dose)aspirin•pregnancy is otherwise a contraindication |
| ALLERGY AND STEROIDS | |
| Allergic reactions: rhinitis, urticaria, insect bites, drug hypersensitivity | First-generation antihistamines (sedating)chlorpheniramine, dimenhydrinate, diphenhydramine, hydroxyzine, meclizine, promethazineSsedation, dry mouth, urinary retentionSecond-generation antihistaminescetirizine, fexofenadine, loratadine•least sedating: the truck driver |
| Allergic rhinitis and vasomotor rhinitis (nose) | Nasal antihistamineazelastineSbitter taste, nosebleedNasal corticosteroidsbeclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinoloneSnosebleed, septal perforation, unpleasant taste•not the inhaled asthma versionsSystemic steroidsdexamethasone, prednisone, prednisoloneEnever stop abruptly after a week |
| Drug hypersensitivity reactions | Systemic steroidsdexamethasone, prednisone, prednisoloneAntihistaminesfirst- and second-generation histamine-1 blockers (the list above) |
| Allergic conjunctivitis (systemic therapy) | Glucocorticoidprednisone, prednisolone |
| Motion sickness, nausea, vestibular disturbances | First-generation antihistaminespromethazine (strongest antimuscarinic), hydroxyzine, meclizine, dimenhydrinate, diphenhydramine•antiemetic effect high: promethazine, hydroxyzine, meclizine |
| Sleep aid (over the counter) | First-generation antihistaminedoxylamine |
| Adjunct in anaphylaxis | Antihistamineshistamine-1 blockers (adjuvant role only) |
| CONGESTION, COUGH AND MUCUS | |
| Nasal congestion | Topical decongestantoxymetazolineSrebound rhinitis after 3 to 5 daysCmonoamine oxidase inhibitorsOral decongestantpseudoephedrineSfast pulse, high blood pressure, headacheOral phenylephrinephenylephrine•lecture: oral form does not work |
| Common cold, hay fever, sinus congestion, eustachian tube dysfunction after a viral infection | Oral decongestantpseudoephedrine•weakens blood pressure drugs |
| Dry (non-productive) cough | Antitussivesbenzonatate, dextromethorphanEbenzonatate: swallow wholeCdextromethorphan: monoamine oxidase inhibitor within 2 weeks |
| Thick mucus: loosening it | ExpectorantguaifenesinEdrink plenty of fluidMucolyticN-acetylcysteine (inhaled)Srotten-egg smell, bronchospasmInhaled salinehypertonic saline (inhaled) |
| Cystic fibrosis sputum | Enzyme that cuts deoxyribonucleic acid (DNA)dornase alfa•mild to moderate lung disease |
| Acetaminophen poisoning (the classic use) | AntidoteN-acetylcysteine |
One row per use. Every agent the Lecture 6 slides name, grouped by class. Diuretics, heart failure drugs and the rest of Exam 3 are not here.
| HYPERTENSION: THE CLASSES AND EVERY AGENT | |
|---|---|
| Hypertension: first-step choices | ACE inhibitorscaptopril, lisinopril, enalapril (enalaprilat intravenous), benazepril, fosinopril, trandolapril, quinapril, ramipril, perindopril, moexiprilpreferred in diabeticsSdry cough, angioedema, high potassium!pregnancy: never in the second and third trimestersARBs (angiotensin receptor blockers)candesartan, olmesartan, losartan, azilsartan, eprosartan, irbesartan, telmisartan, valsartanSno cough; high potassium!pregnancy: never in the second and third trimestersDihydropyridine calcium channel blockersamlodipine, nifedipine, nicardipine (also intravenous), felodipine, isradipine, nisoldipineSankle swelling, flushing, reflex fast pulseCshort-acting nifedipine; severe aortic stenosis |
| Hypertension: other classes (not in the slide algorithm) | Non-dihydropyridine calcium channel blockersdiltiazem, verapamilCadvanced heart block, low pressure, heart failureBeta blockersacebutolol, atenolol, bisoprolol, esmolol, metoprolol, carteolol, carvedilol, labetalol, betaxolol, nadolol, penbutolol, pindolol, propranolol, sotalol, timolol•not first line; works best in the young!never stop suddenlyAlpha-1 blockersprazosin, terazosin, doxazosinSdizzy on standingCentral sympatholyticsclonidine, guanfacine!clonidine: never stop suddenly (rebound hypertension) |
| Chronic hypertension (hydralazine) and severe or refractory hypertension (minoxidil) | Direct vasodilatorshydralazine (chronic, with a diuretic and a beta blocker), minoxidil (triple therapy for severe or refractory)Sreflex fast pulse, fluid retention!minoxidil: boxed warning (not on the slide) |
| Hypertensive crisis | Intravenous vasodilatornitroprusside (infusion)!cyanide toxicity; thiosulfate is the antidote |
| Slide algorithm: how to start | Pressure well above goalACE inhibitor or ARB plus a dihydropyridine•over 20 systolic or 10 diastolic above goalAlbumin in the urineACE inhibitor or ARB•albumin-to-creatinine ratio at or above 300Everyone elseACE inhibitor or ARB, or a dihydropyridine |
| USES BEYOND BLOOD PRESSURE: BY CONDITION | |
| Heart failure and left ventricular dysfunction | ACE inhibitorscaptopril, lisinopril, enalapril (enalaprilat intravenous), benazepril, fosinopril, trandolapril, quinapril, ramipril, perindopril, moexipril•everyone with left ventricular dysfunction unless contraindicatedARBscandesartan, olmesartan, losartan, azilsartan, eprosartan, irbesartan, telmisartan, valsartan•when an ACE inhibitor is not toleratedBeta blockerscarvedilol, metoprolol succinate, bisoprololSstart very low; may worsen symptoms at first |
| After a myocardial infarction | ACE inhibitorscaptopril, lisinopril, enalapril (enalaprilat intravenous), benazepril, fosinopril, trandolapril, quinapril, ramipril, perindopril, moexipril•lower overall mortalityBeta blockersbeta blockers (avoid those with intrinsic sympathomimetic activity) |
| Diabetic nephropathy (kidney protection) | ACE inhibitorscaptopril, lisinopril, enalapril (enalaprilat intravenous), benazepril, fosinopril, trandolapril, quinapril, ramipril, perindopril, moexipril•prevent or delay kidney disease progressionARBscandesartan, olmesartan, losartan, azilsartan, eprosartan, irbesartan, telmisartan, valsartan |
| Angina | Beta blockersbeta blockers (class)Calcium channel blockersdiltiazem, verapamil, amlodipine, nifedipine, nicardipine |
| Supraventricular arrhythmias, atrial fibrillation or flutter | Non-dihydropyridine calcium channel blockersdiltiazem, verapamilBeta blockersbeta blockers (class) |
| Subarachnoid hemorrhage | Dihydropyridinenimodipine |
| Diastolic heart failure, cerebral ischemia, migraine prevention | Calcium channel blockerscalcium channel blockers (class) |
| Migraine prevention | Beta blockerspropranolol, timolol |
| Glaucoma | Beta blockerstimolol, betaxolol, carteolol |
| Hyperthyroidism, panic attacks, essential tremor | Beta blockersbeta blockers (class)•slow pulse, tremor, anxiety; lower thyroid hormone conversion |
| Benign prostatic hyperplasia | Alpha-1 blockersterazosin, doxazosin, tamsulosin (alpha-1A) |
| Opiate withdrawal reactions | Central sympatholyticclonidine•blunts withdrawal |
One row per lipid problem. Every class and agent the Lecture 7 slides name for it. Read direction, not percentages: resins can raise triglycerides.
| HIGH LOW-DENSITY LIPOPROTEIN (LDL) CHOLESTEROL | |
|---|---|
| High LDL: first line | Statins (-statin)atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatinfirst line; most efficaciousSmuscle pain, liver enzymesCpregnancy, active liver disease |
| High LDL: other LDL-lowering classes | Cholesterol absorption inhibitorezetimibe•extra 15 to 20 percent LDL loweringBile acid resinscholestyramine, colestipol, colesevelam•or for modest LDL loweringPCSK9 inhibitors (-mab)alirocumab, evolocumabSinjected, costly; hypersensitivity |
| Four statin benefit groups: start a moderate- or high-intensity statin | High intensity (LDL down 50 percent or more)atorvastatin, rosuvastatinModerate intensity (LDL down 30 to 49 percent)atorvastatin, rosuvastatin, simvastatin, pravastatin, lovastatin, fluvastatin extended release, fluvastatin, pitavastatin•the slide lists the same drug in more than one tierLow intensity (LDL down under 30 percent)simvastatin, pravastatin, lovastatin, fluvastatinWho qualifies (the four groups)clinical atherosclerotic disease; LDL above 190; diabetes aged 40 to 75 with LDL 70 to 189; no disease or diabetes with 10-year risk above 7.5 percent |
| LDL 190 or above, no cardiovascular disease (slide algorithm) | High-intensity statinsatorvastatin, rosuvastatin•evaluate for familial hypercholesterolemia first |
| 10-year risk above 10 percent, LDL under 190 (slide algorithm) | Moderate-dose statinstatins (class)•high intensity if risk is 20 percent or more and LDL above 100; at 5 to 10 percent, discuss a statin |
| LDL lowering in children, adolescents or pregnancy | Bile acid resinscholestyramine, colestipol, colesevelam•approved for these groups; the safest drug (no systemic effects) |
| TRIGLYCERIDES AND HIGH-DENSITY LIPOPROTEIN (HDL) | |
| High triglycerides (above 1000 is the fibrate target) | Fibratesgemfibrozil, fenofibrate, bezafibrateprimary indicationSgallstones, muscle injuryCpregnancy; severe liver or kidney disease; gallbladder diseaseNiacinniacin (nicotinic acid), Niacor (immediate release), Niaspan (extended release), inositol hexaniacinateSflushing•from the effects table, not a stated indication |
| Low HDL | Fibratesgemfibrozil, fenofibrate, bezafibrateNiacinniacin (nicotinic acid), Niacor, Niaspan, inositol hexaniacinate•raises HDL most, with fibratesEaspirin first to reduce flushing |
| Atherogenic dyslipidemia (alone, or with high LDL) | Niacinniacin (nicotinic acid), Niacor, Niaspan, inositol hexaniacinate•not niacinamide: it does not lower lipidsStatin with niacinlovastatin with extended release niacinSliver injury, muscle injury, flushing |
| Never when triglycerides are high | Bile acid resinscholestyramine, colestipol, colesevelamCtriglycerides above 400 (relative above 200)Scan raise triglycerides |
One row per use. Every agent the Lecture 8 slides name, by class. Rows marked course answer follow the slide; the study guide says where current practice differs.
| ANGINA: WHAT TO GIVE | |
|---|---|
| Stable angina: preventing attacks | Beta blockers: beta-1 selectivemetoprolol, atenololfirst line if no contraindication!never stop suddenlyBeta blockers: non-selectivepropranolol, nadololBeta blockers: third generationcarvedilol, labetalolNon-dihydropyridine calcium channel blockersdiltiazem, verapamil•first if a beta blocker is not toleratedDihydropyridinesamlodipine, nifedipine, nicardipine (Lecture 6 slide)•added to a beta blocker; felodipine only on the hemodynamic tableCavoid short-acting nifedipineLong-acting nitratesisosorbide mononitrate, isosorbide dinitrate, nitroglycerin ointment or patch•usually the third add-onE12-hour nitrate-free gap |
| Angina attack: quick relief, or before effort | Short-acting nitratenitroglycerin (sublingual tablet or spray)Csildenafil, tadalafil, vardenafilEno relief 5 minutes after the first dose: call emergency |
| Angina with severe peripheral vascular disease or uncontrolled diabetes | Calcium channel blockerscalcium channel blockers (class)•slide population list; dihydropyridines for a weak left ventricle |
| Vasospastic (variant, Prinzmetal) angina | Calcium channel blockerscalcium channel blockers (class)Nitratesnitrates (class)Avoidbeta blockersCmay worsen symptoms |
| Angina with high blood pressure | Slide comorbidity tablefirst line beta blocker; alternative non-dihydropyridine |
| Angina after a myocardial infarction | Slide comorbidity tablefirst line beta blocker; avoid calcium channel blockerscourse answer; current practice differs |
| Angina with a weak left ventricle | Slide comorbidity tablefirst line beta blocker; alternative amlodipine; avoid the other calcium channel blockers |
| Angina with a slow pulse or atrioventricular block | Slide comorbidity tablefirst line a dihydropyridine; alternative long-acting nitrate; avoid non-dihydropyridines and beta blockers |
| Angina with diabetes | Slide comorbidity tablefirst line a non-dihydropyridine; alternatives long-acting nitrate or cardioselective beta blocker; avoid non-cardioselective beta blockerscourse answer; current practice differs |
| Angina with asthma | Slide comorbidity tablefirst line non-dihydropyridine and cardioselective beta blocker; avoid non-cardioselective beta blockers |
| PROTECTING THE ARTERIES (ALL CORONARY DISEASE) | |
| Preventing a clot or acute coronary syndrome | Antiplateletsaspirin, clopidogrel (if allergic to aspirin)aspirin for all without contraindication |
| Give to all coronary disease unless contraindicated | ACE inhibitorsACE inhibitor (class)•diabetes, weak left ventricle, after a myocardial infarctionLipid loweringstatins (plaque stabilization)Beta blockersbeta blockers (if a prior myocardial infarction) |
| ACUTE CORONARY SYNDROME | |
| Chest pain in the first minutes (both kinds) | Salicylateaspirin (chew first)Callergy, recent gastrointestinal bleed or intracranial hemorrhageNitratesnitroglycerin (sublingual, then intravenous)•relief only: no mortality benefitClow pressure; sildenafil, tadalafil, vardenafilBeta blockersbeta blockers (intravenous, then oral)older teachingCslow pulse, heart block, severe reactive airway diseaseOpioidmorphine•pain not relieved by nitrates; used in ST-elevation; may raise mortality in the other kind |
| ST-elevation myocardial infarction: reopening the artery | Fibrinolyticsalteplase, reteplase, tenecteplase, streptokinase, urokinase!bleeding, including intracranial•within 12 hours; run the contraindication checklist |
| Unstable angina or non-ST-elevation myocardial infarction | Early drugssame as for ST-elevation, but no fibrinolyticsCbleeding risk is greater than benefitAnticoagulantenoxaparinpreferred over heparinAntiplateletglycoprotein IIb/IIIa inhibitors•used more commonly |
| Stent procedure (percutaneous coronary intervention) | P2Y12 receptor antagonistsP2Y12 receptor antagonists (class; clopidogrel is the one the slides name)•before the procedure and with stentsAntiplateletglycoprotein IIb/IIIa inhibitors•not routine before itAnticoagulantheparins•with fibrinolysis or antiplatelets |
Friday evening about 2 h 45, Saturday and Sunday about 5 to 5.5 hours of work each, Monday one hour. Focus in 50-minute blocks with 10-minute breaks. Every block says exactly what to do and which page to open. Change a start time and the clock times recalculate; tick blocks as you finish them.
| 5 min5 min | SET UP | Set up Open this guide to the maps. Have maps B and C and their blank templates on screen or printed. Three pens: blue, green, red. Phone away. | |
| 50 min50 min | DRAW | Eye (Lecture 4) 10 min study map B, then drug-by-use chart 1 (read a row, cover the drugs, say them). 10 min redraw the blank template B from memory, then check and fix in red. 10 min fill the blank drug-by-use chart 1: every drug for each use, cytomegalovirus and herpes first. 10 min Glaucoma and Diagnostics Drill (do about 15 of 25). 10 min mistake log: one line per miss. | |
| 10 min10 min | REST | Break Stand up, water, no phone. | |
| 50 min50 min | DRAW | Ear, nose, throat (Lecture 5) 10 min study map C, then drug-by-use chart 2. 10 min redraw: the infection table and the pain-drug column first. 10 min fill the blank drug-by-use chart 2 (infections, then congestion and cough). 10 min ENT Anti-infectives quiz, then Analgesics quiz (do what fits). 10 min mistake log. | |
| 10 min10 min | REST | Break Walk, snack. | |
| 30 min30 min | RECALL | Peek at tomorrow, then say it aloud 5 min look at map D once, only to see the picture (do not memorize). 25 min Rapid-fire Friday (30 prompts, plus the 8 every-drug prompts for Lectures 4 and 5): say each answer out loud before you open the answer page. | |
| 10 min10 min | RECALL | Brain dump 1 Blank page, no notes, 10 minutes: everything you can about the eye and the ear, nose and throat. Then compare with maps B and C and drug-by-use charts 1 and 2, and mark every miss in red. |
| 15 min15 min | RECALL | Warm-up brain dump (Friday) Blank page, no notes: eye and ear, nose, throat. Compare with maps B and C and drug-by-use charts 1 and 2. Red pen for misses. This is spaced retrieval, the part that makes it stick. | |
| 50 min50 min | DRAW | Lecture 6, part 1: the renin-angiotensin chain 10 min study the top half of map D. 15 min redraw the chain with ACE (angiotensin-converting enzyme) inhibitor and ARB (angiotensin receptor blocker) blocks, then their two cards. 20 min Renin-Angiotensin Inhibitors quiz. 5 min log. | |
| 10 min10 min | REST | Break | |
| 50 min50 min | DRAW | Lecture 6, part 2: beta blockers and calcium channel blockers 10 min study. 15 min redraw the beta blocker and calcium channel blocker cards (signature side effect, never-when). 25 min Beta Blockers quiz, then Calcium Channel Blockers quiz. Log the misses. | |
| 10 min10 min | REST | Break | |
| 50 min50 min | TEST | Lecture 6, part 3: the rest, and the algorithm 10 min study, including drug-by-use chart 3 (every agent in every class). 15 min draw the 4-step algorithm and the alpha-1, clonidine and vasodilator cards from memory. 10 min fill the blank drug-by-use chart 3 (ACE inhibitors, ARBs and dihydropyridines first). 10 min Alpha-1, Central Agents and Vasodilators quiz. 5 min Antihypertensives Drill (do about 8 of 29). | |
| 45 min45 min | REST | Lunch and a walk A real break. Do not study. | |
| 50 min50 min | DRAW | Lecture 7: lipids 10 min read map E and tell the garbage-system story out loud, then read drug-by-use chart 4. 15 min redraw the city with the six numbered drugs. 10 min fill the blank drug-by-use chart 4 (each lipid problem and its drugs). 10 min Statins quiz. 5 min log. | |
| 10 min10 min | REST | Break | |
| 50 min50 min | TEST | Lecture 7, part 2: the other lipid drugs 15 min Resins, Ezetimibe and PCSK9 quiz. 15 min Fibrates, Niacin and Lipid Profiles quiz. 15 min Lipid-Lowering Drugs Drill (24 questions). 5 min log. | |
| 10 min10 min | REST | Break | |
| 30 min30 min | TEST | Mixed practice (interleaving) 25 min Rapid-fire Saturday (30 prompts, plus the 8 every-drug prompts for Lectures 6 and 7): they alternate classes on purpose. 5 min redraw the two things you missed most. | |
| 10 min10 min | RECALL | Brain dump 2 Blank page: Lectures 6 and 7. Classes first, then the signature side effect and the never-when for each. |
| 15 min15 min | RECALL | Warm-up brain dump (Lectures 6 and 7) Blank page: every class, one side effect, one never-when. Compare with maps D and E and drug-by-use charts 3 and 4; red pen. | |
| 50 min50 min | DRAW | Lecture 8, part 1: angina 10 min study map F1, then drug-by-use chart 5 (angina rows). 15 min redraw the seesaw table and the "start with the condition" box. 10 min fill the blank drug-by-use chart 5, angina rows first. 10 min Antianginal Drugs quiz. 5 min log. | |
| 10 min10 min | REST | Break | |
| 50 min50 min | DRAW | Lecture 8, part 2: acute coronary syndrome 10 min study map F2 and the acute coronary syndrome rows of drug-by-use chart 5. 15 min redraw the ST-elevation fork and the six cards. 15 min Acute Coronary Syndrome and Fibrinolytics quiz. 10 min Myocardial Ischemia Drill (do about 15 of 32). | |
| 10 min10 min | REST | Break | |
| 50 min50 min | RECALL | The killers and the never-lists 10 min read posters G and H. 10 min cover them and list every black box drug and every never-combine pair. 20 min the Killers, Commons and Zebras page: cover the right column and say it. 10 min blank page: class, then when never to give it. | |
| 45 min45 min | REST | Lunch and a walk Get outside if you can. | |
| 60 min60 min | MOCK | Mock exam: Master Exam Form A 60 questions, no notes, no pausing. Mark every one you guessed. Cumulative: all five lectures mixed, exactly the skill the exam tests. | |
| 45 min45 min | FIX | Fix every miss For each miss and each guess: write the class, the fact, and why you missed it (mixed up classes? forgot the never-when?). Then redraw the map of your weakest lecture from memory. | |
| 10 min10 min | REST | Break | |
| 30 min30 min | RECALL | Rapid-fire Sunday, then patch 25 min Rapid-fire Sunday (30 prompts: Lecture 8 and the whole exam mixed, plus the 8 every-drug prompts). 5 min redraw your weakest map or chart once more. | |
| 15 min15 min | RECALL | Brain dump 3: all five lectures One page per lecture, 3 minutes each. Compare with the maps and the drug-by-use charts. Circle what is still missing and read only those spots. |
| 10 min10 min | REST | Eat, water Breakfast first. Nothing new yet. | |
| 10 min10 min | RECALL | Cheat page, cold read Read the Monday cheat page once, then say the colored items out loud. | |
| 15 min15 min | RECALL | Draw the three heavy hitters From memory: (1) the antihypertensive algorithm, (2) the lipid city, (3) the four rules of the killers poster. | |
| 15 min15 min | TEST | Rapid-fire your own misses Pick the 10 prompts from your mistake log that you still miss. Say each answer aloud. | |
| 5 min5 min | RECALL | Wood's question shapes Read the bottom strip of map A once: add-on, backup, contraindicated vs preferred, patient-first, prevention vs relief. | |
| 5 min5 min | REST | Close everything Stop 30 minutes before you leave. Breathe, pack, go. |
Everything you need is by the door. Alarm set. Phone charging across the room. Nothing new after dinner.
Breakfast, then: cheat page, draw the three heavy hitters, rapid-fire your own misses. If a fact feels shaky, do not chase it: write it on the cheat page margin and move on.
Stop studying 30 minutes before you leave. Say the five rules once. When a stem confuses you, ask: which class is this, what does it do to the heart, vessel or kidney, what is the never-when?
Tap a cell to cycle: ✗ shaky, ~ getting there, ✓ solid. Be honest: rate what you could do from a blank page, not what you recognize. Your ratings stay on this device (and it prints blank for pen). Anything still ✗ on Sunday afternoon goes first on Sunday's patch block and into Monday's rapid-fire.
| Topic | Fri | Sat | Sun | Mon | |
|---|---|---|---|---|---|
| L4 | Eye: infection | ||||
| L4 | Eye: allergy and red eye | ||||
| L4 | Eye: inflammation and dry eye | ||||
| L4 | Eye: glaucoma and diagnostics | ||||
| L5 | Ear, nose, throat: infection and antifungals | ||||
| L5 | Ear, nose, throat: aspirin, ibuprofen, acetaminophen | ||||
| L5 | Ear, nose, throat: antihistamines and steroids | ||||
| L5 | Ear, nose, throat: decongestants and cough | ||||
| L6 | Blood pressure: ACE inhibitors and ARBs | ||||
| L6 | Blood pressure: beta blockers | ||||
| L6 | Blood pressure: calcium channel blockers | ||||
| L6 | Blood pressure: alpha-1, clonidine, vasodilators, algorithm | ||||
| L7 | Lipids: statins and the four groups | ||||
| L7 | Lipids: ezetimibe, resins, PCSK9 | ||||
| L7 | Lipids: fibrates, niacin, which lipid moves | ||||
| L8 | Angina: nitrates, beta blockers, calcium channel blockers | ||||
| L8 | Acute coronary syndrome and fibrinolytics | ||||
| All | Black box and killers poster | ||||
| All | Contraindication match-up poster | ||||
| All | Drug-by-use charts: every drug for each use | ||||
Four checkpoints, each a blank page and no notes: Friday 10 min (Lectures 4 and 5), Saturday 10 min (6 and 7), Sunday 15 min (all five), Monday 15 min (three heavy hitters). After each, compare with the maps and mark every hole in red. A hole you can see is a hole you can fix.
Short forms used in this section: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; NSAID = nonsteroidal anti-inflammatory drug; LDL / HDL / VLDL = low-density / high-density / very-low-density lipoprotein; CYP3A4 = cytochrome P450 3A4; PCSK9 = proprotein convertase subtilisin/kexin type 9; P2Y12 = platelet adenosine diphosphate receptor; AV = atrioventricular; QT = a heart-rhythm interval; PPAR-alpha = peroxisome proliferator-activated receptor alpha; HMG-CoA = 3-hydroxy-3-methylglutaryl coenzyme A.
Print these. The map templates keep each map's frame and card titles and erase the facts; the five drug-by-use templates keep the list of uses and erase every drug, with the same colored letters showing what goes where. Redraw from memory, check against the map, and fix in red. Hard mode: cover the card titles with sticky notes. Hardest: use the blank drug frame on the last template page.
Redraw map B from memory: fill each card with the agent names (M, I, S, C, ! as the letters show).
Swipe sideways to see the whole template.
The infection table first, then pain and fever, allergy and steroids, congestion and cough.
Swipe sideways to see the whole template.
Draw the renin-angiotensin chain and the blocks first, then the class cards, then the four-step algorithm.
Swipe sideways to see the whole template.
Sketch the city and place the six numbered drugs, then fill the cards and the benefit groups.
Swipe sideways to see the whole template.
Seesaw, effect table, four class cards, then the three boxes below.
Swipe sideways to see the whole template.
The fork, then the six drug cards.
Swipe sideways to see the whole template.
Cover the chart. For each use, write every class and every drug you can, in the color code (I for the use, then S, C, ! where you know them). Check against chart 1 and fix in red.
| INFECTION: BACTERIA | |
|---|---|
| Bacterial conjunctivitis | |
| Conjunctivitis in a contact lens wearer | |
| Corneal ulcer, or Pseudomonas aeruginosa | |
| Keratitis, blepharitis | |
| Keratoconjunctivitis, blepharoconjunctivitis, meibomianitis | |
| Dacryocystitis (tear sac) | |
| Other external or superficial eye infection | |
| Prevention of newborn eye infection (ophthalmia neonatorum) | |
| INFECTION: VIRUSES AND FUNGI | |
| Herpes simplex keratitis or keratoconjunctivitis | |
| Herpes simplex iridocyclitis | |
| Herpes zoster ophthalmicus | |
| Cytomegalovirus retinitis | |
| Adenoviral conjunctivitis (viral) | |
| Fungal keratitis | |
| Fungal blepharitis or conjunctivitis | |
| Fungal endophthalmitis (inside the eye) | |
| ALLERGY AND RED EYE | |
| Allergic conjunctivitis: acute symptoms | |
| Allergic conjunctivitis: seasonal prevention (predictable season) | |
| Severe ocular allergy | |
| Red eye (short-term relief) | |
| INFLAMMATION AND DRY EYE | |
| Postoperative inflammation and pain | |
| Anterior uveitis and external eye inflammatory disease | |
| Dry eye | |
| GLAUCOMA (OPEN-ANGLE) AND DIAGNOSTICS | |
| Glaucoma: raise outflow (open the drain) | |
| Glaucoma: lower production (turn down the tap) | |
| Glaucoma: combination products (fewer drops) | |
| Numbing the eye (tonometry, foreign body removal, superficial corneal surgery) | |
| Dilating the pupil (fundoscopic examination) | |
| Showing corneal damage (staining) | |
Cover the chart. For each use, write every class and every drug you can, in the color code (I for the use, then S, C, ! where you know them). Check against chart 2 and fix in red.
| INFECTION | |
|---|---|
| Acute otitis media (ear infection) | |
| Acute bacterial rhinosinusitis (sinus infection) | |
| Sore throat: group A strep (pharyngitis) | |
| Ear infections: antibiotic ear drops | |
| Oral candidiasis (thrush): inhaled steroids, human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), chemotherapy | |
| Systemic fungal infections | |
| PAIN, FEVER AND INFLAMMATION | |
| Fever (above 100 degrees Fahrenheit) | |
| Pain | |
| Inflammation | |
| Platelet blocking (lowest dose range) | |
| Hypertensive disorders of pregnancy (pre-eclampsia) | |
| ALLERGY AND STEROIDS | |
| Allergic reactions: rhinitis, urticaria, insect bites, drug hypersensitivity | |
| Allergic rhinitis and vasomotor rhinitis (nose) | |
| Drug hypersensitivity reactions | |
| Allergic conjunctivitis (systemic therapy) | |
| Motion sickness, nausea, vestibular disturbances | |
| Sleep aid (over the counter) | |
| Adjunct in anaphylaxis | |
| CONGESTION, COUGH AND MUCUS | |
| Nasal congestion | |
| Common cold, hay fever, sinus congestion, eustachian tube dysfunction after a viral infection | |
| Dry (non-productive) cough | |
| Thick mucus: loosening it | |
| Cystic fibrosis sputum | |
| Acetaminophen poisoning (the classic use) | |
Cover the chart. For each use, write every class and every drug you can, in the color code (I for the use, then S, C, ! where you know them). Check against chart 3 and fix in red.
| HYPERTENSION: THE CLASSES AND EVERY AGENT | |
|---|---|
| Hypertension: first-step choices | |
| Hypertension: other classes (not in the slide algorithm) | |
| Chronic hypertension (hydralazine) and severe or refractory hypertension (minoxidil) | |
| Hypertensive crisis | |
| Slide algorithm: how to start | |
| USES BEYOND BLOOD PRESSURE: BY CONDITION | |
| Heart failure and left ventricular dysfunction | |
| After a myocardial infarction | |
| Diabetic nephropathy (kidney protection) | |
| Angina | |
| Supraventricular arrhythmias, atrial fibrillation or flutter | |
| Subarachnoid hemorrhage | |
| Diastolic heart failure, cerebral ischemia, migraine prevention | |
| Migraine prevention | |
| Glaucoma | |
| Hyperthyroidism, panic attacks, essential tremor | |
| Benign prostatic hyperplasia | |
| Opiate withdrawal reactions | |
Cover the chart. For each use, write every class and every drug you can, in the color code (I for the use, then S, C, ! where you know them). Check against chart 4 and fix in red.
| HIGH LOW-DENSITY LIPOPROTEIN (LDL) CHOLESTEROL | |
|---|---|
| High LDL: first line | |
| High LDL: other LDL-lowering classes | |
| Four statin benefit groups: start a moderate- or high-intensity statin | |
| LDL 190 or above, no cardiovascular disease (slide algorithm) | |
| 10-year risk above 10 percent, LDL under 190 (slide algorithm) | |
| LDL lowering in children, adolescents or pregnancy | |
| TRIGLYCERIDES AND HIGH-DENSITY LIPOPROTEIN (HDL) | |
| High triglycerides (above 1000 is the fibrate target) | |
| Low HDL | |
| Atherogenic dyslipidemia (alone, or with high LDL) | |
| Never when triglycerides are high | |
Cover the chart. For each use, write every class and every drug you can, in the color code (I for the use, then S, C, ! where you know them). Check against chart 5 and fix in red.
| ANGINA: WHAT TO GIVE | |
|---|---|
| Stable angina: preventing attacks | |
| Angina attack: quick relief, or before effort | |
| Angina with severe peripheral vascular disease or uncontrolled diabetes | |
| Vasospastic (variant, Prinzmetal) angina | |
| Angina with high blood pressure | |
| Angina after a myocardial infarction | |
| Angina with a weak left ventricle | |
| Angina with a slow pulse or atrioventricular block | |
| Angina with diabetes | |
| Angina with asthma | |
| PROTECTING THE ARTERIES (ALL CORONARY DISEASE) | |
| Preventing a clot or acute coronary syndrome | |
| Give to all coronary disease unless contraindicated | |
| ACUTE CORONARY SYNDROME | |
| Chest pain in the first minutes (both kinds) | |
| ST-elevation myocardial infarction: reopening the artery | |
| Unstable angina or non-ST-elevation myocardial infarction | |
| Stent procedure (percutaneous coronary intervention) | |
One class per row: how it works, what it is for, the signature side effect, never give when, black box or killer. This is the six-point drug frame.
Patient education is a named exam category. Cover the page and say each line aloud, then check. All lines come from the lectures.
One line per miss, written the moment you miss it. The last column is the one that changes what you do next.
| What was asked | What I said | The fact, in one line | Why I missed it | Redrawn? Re-asked? |
|---|---|---|---|---|
Why I missed it: mixed up two classes · forgot the never-when · never knew it · misread the stem · knew it but rushed.
Question and answer, not multiple choice. Say the answer aloud first, then open the answers (closed by default; they print on the page after the questions). About 40 seconds each: it is retrieval, not a quiz to score. Anything you miss goes in the mistake log.
Say every drug you can, in classes, before opening the answers. The same lists are rows in the drug-by-use charts (section 3).
Wood's own words, with the lecture and the minute you can hear them. If he said he will not quiz it, it does not earn your Saturday.
Don’t worry so much about indications for use… And then formulation-wise, I don’t care that you memorize that necessarily, with some exceptions… [On dosing:] not for memorization sake necessarily, because you can always look up the dosing for a medication if you know which drug you actually want to use in the first place.
For my purposes, in terms of like test questions, I’m probably not going to be asking a lot of duration questions either, just like the dosing. You can always look that stuff up, but if you don’t even know what drug to use in the first place, you kind of lost. So I’d rather you know what drug to use.
So looking at kind of the dosing ranges here, and the specific numbers, I don’t care that you memorize, right? What I’m talking about are the relative safety sort of features between salicylates and some of your other nonsteroidal anti-inflammatory drug (NSAID) type of products.
Now, you don’t have to memorize a lot of dosages, but this is one you have to know. Tylenol, no more than four grams in a day… So make sure no more than four grams in 24 hours. Know that number. Star it, highlight it, whatever you got to do.
Don’t worry so much about indications for use… And then formulation-wise, I don’t care that you memorize that necessarily, with some exceptions… [On dosing:] not for memorization sake necessarily, because you can always look up the dosing for a medication if you know which drug you actually want to use in the first place.
Carry instead: The antibiotic table lists strengths, forms and indications, and he said not to worry about them; he covers the specific use of each agent as he goes. The ones he built up: erythromycin ointment is the most common ophthalmic antibiotic, dirt cheap, and soothing on the inflamed eye even before a…
Adverse effects, this is gonna be the same with just about any ophthalmic antibiotic. So don’t memorize which ones cause eye irritation or hypersensitivity. Any of these can do that, right?
Carry instead: Eye irritation and hypersensitivity belong to every ophthalmic antibiotic on the deck, and he called interactions a non-issue for the topical forms because so little reaches the bloodstream. The exceptions he did name: sulfacetamide (sulfonamide allergy) and the aminoglycosides gentamicin and…
Strains this works against, I’m not going to be quizzing on necessarily. I’ll just give you an idea. It’s a fairly broad spectrum antifungal.
Carry instead: Know that natamycin is the <b>only commercially available ophthalmic antifungal</b>: it binds sterol in the fungal membrane and makes it leak, and mostly causes eye irritation. Serious fungal eye infection usually needs a systemic antifungal such as fluconazole instead.
Unless you’re working specifically in ophthalmology, you’re probably never going to prescribe these. You might see patients using these and so it’s good to be familiar with what they’re being used for and what some of the downsides are.
Carry instead: What to carry: they are reserved for refractory or severe inflammation and limited to short courses (under two weeks), and the downsides are cataract formation, raised eye pressure that can become glaucoma, infection from lowered immunity, slow wound healing and corneal ulcers.
We’re mainly gonna focus on the open angle glaucoma because drugs are mainly gonna be focused there… It’s more of a surgical issue if you’re having a closed angle glaucoma sort of issue.
Carry instead: Open-angle glaucoma is the chronic, painless form (too much aqueous humor made or too little drained) and is where the drugs work: they either cut aqueous production or raise outflow through the trabecular meshwork. Angle-closure is an acute, very painful blockage that is treated surgically.
Again, it gets really complicated when you’re looking at the flow of ions… Don’t get lost in the weeds. It’s really easy to drive yourself crazy and try to make heads and tails of all these arrows going back and forth in your ions and all that good stuff.
Carry instead: What to know instead: <b>dorzolamide and brinzolamide</b> block carbonic anhydrase (which converts carbon dioxide and water to bicarbonate), so less bicarbonate and fluid move, less aqueous humor forms and eye pressure falls. They are add-on drugs because of burning, stinging and a bitter taste;…
For my purposes, in terms of like test questions, I’m probably not going to be asking a lot of duration questions either, just like the dosing. You can always look that stuff up, but if you don’t even know what drug to use in the first place, you kind of lost. So I’d rather you know what drug to use.
Carry instead: The durations on the deck are context: ear infection five to seven days (five may be too short when severe), sinus infection ten to fourteen days in children versus five to seven in adults, strep throat ten days of amoxicillin.
So looking at kind of the dosing ranges here, and the specific numbers, I don’t care that you memorize, right? What I’m talking about are the relative safety sort of features between salicylates and some of your other nonsteroidal anti-inflammatory drug (NSAID) type of products.
Carry instead: The table shows the pattern by dose: low doses give the antiplatelet effect and bleeding; mid doses give pain and fever relief with stomach upset; higher doses cause ringing in the ears (tinnitus); the toxic range causes rapid breathing, then metabolic acidosis, shock and death. His point was that…
There’s a few exceptions, like captopril and lisinopril — I don’t care necessarily that you know that. But just to give you an example, if we needed an intravenous (IV) ACE [angiotensin-converting enzyme] inhibitor you couldn’t give the prodrug form… if you ever see the drug called enalaprilat, that’s the activated form of a drug called enalapril.
Carry instead: Most angiotensin-converting enzyme (ACE) inhibitors are prodrugs activated in the liver (captopril and lisinopril are not); enalaprilat is the injectable, already-active form of enalapril. The suffix <b>-pril</b> identifies the class.
Angiotensin-converting enzyme (ACE) inhibitors are mostly renally eliminated, angiotensin receptor blockers (ARBs) are going to be a little bit more equal between renal and biliary excretion. It’s not really going to be a really key feature for their purposes here, so I’m not going to worry too much about that.
Carry instead: For the record, the deck says angiotensin-converting enzyme (ACE) inhibitors are cleared by the kidney (fosinopril is the balanced exception) and angiotensin receptor blockers (ARBs) by both kidney and bile, but this is not a distinguishing fact he will test.
Am I going to have you memorize which one has three pluses versus five pluses? No, I don’t care if you know that, but I do want to get the general flavor of the differences between your non-dihydropyridines (non-DHPs), which will have both vasodilatory action but also suppressing cardiac function, versus the DHPs are mainly focusing on vasodilatory actions.
Carry instead: The grid rates vasodilation, contraction, sinoatrial node and atrioventricular node effects: the dihydropyridines are strongly vasodilating with little effect on the heart, and verapamil hits the heart harder than diltiazem. Know the direction, not the number of pluses.
Other things that could differentiate beta blockers, which I’m not going to highlight too much for our purposes here… I’m not going to get in the weeds on that… Do I care that you know if something’s renally eliminated versus how it’s metabolized, or if it has a membrane stabilizing effect or intrinsic sympathomimetic activity? No, I’m not going to worry about that so much. I want you to distinguish between your different groups of beta blockers and what kind of side effects and clinical actions that entails.
Carry instead: Learn the three groups (non-selective, beta-1 selective, third generation with extra vasodilating actions) and what each causes. The one property he singled out: <b>propranolol</b> is very lipid soluble, so it reaches the brain and is tied to nightmares and worse depression.
Now on the test question, am I going to get so granular to give you a patient situation to say, hey, what do they need, moderate versus high versus low intensity statin? Probably not, right? But more so is, can you identify what falls into the category of high versus moderate… only two drugs based off their dose get into the high intensity statins, atorvastatin and rosuvastatin, only those two are considered high intensity.
Carry instead: Only two statins reach high intensity, and only at higher doses: <b>atorvastatin and rosuvastatin</b>. The others are less potent; at the right dose they reach moderate intensity, and lower doses are low intensity.
The end of the testable material for the exam for Monday ends with this PowerPoint, and then we’ll get started on the first PowerPoint for the third exam right after.
Carry instead: Myocardial ischemia is the <b>last</b> lecture on Exam 2. The diuretics and heart failure deck he starts straight afterwards, in the same recording, belongs to the next exam.
Streptokinase, kind of an older one we’ve used in the past, I don’t want you to worry so much about that, but I do want to focus on this picture here… plasminogen coming in with streptokinase to form a complex… a tissue plasminogen activator, which is what we naturally produce, could do this as well.
Carry instead: Streptokinase the drug is low priority; the <b>mechanism picture</b> (plasminogen converted to plasmin, by a streptokinase complex or by tissue plasminogen activator) is what he wants known.
I don’t care that you know the difference between which one’s made with E. coli versus hamster cells.
Carry instead: Skip the cell-line details on slide 64 (hamster ovary cells against <i>Escherichia coli</i>).
The 20 highest-yield items, colored by the same code. Last look only. If you have not met one of these before this morning, it will not be on you.
Short forms: ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; LDL = low-density lipoprotein; HDL = high-density lipoprotein; CYP3A4 = cytochrome P450 3A4.