Johannsen. Pharmcards

[Guest Ian Wong]

Pharmcards: Review Cards for Medical Students. Johannsen, E. C., Sabatine, M. S. 1995. Lippincott, Williams & Wilkins. Baltimore.

 

ISBN: 0-316-46549-6

Chapters/Indigo.ca price: $41.95

Pages: 199 (flashcards)

 

Here's an excellent study aid, and a useful supplement/substitute for Clinical Pharmacology Made Ridiculously Simple. Pharmcards are a medical student created resource, and were originally intended for a quick Pharmacology review for the USMLE Step 1 (United States Medical Licensing Exam). There are a total of 182 drug cards, along with 10 classification cards which describe a physiological function, and the types of drugs that can interfere/augment that function (eg. there is a Diuretics card with a diagram of a nephron, and sites of action for thiazide and loop diuretics.)

 

Each drug card contains the US generic and trade name for that medication, along with the following characteristics: Mechanism, Clinical Applications, Side Effects, Contraindications, Metabolism, and Additional Notes. The reverse side of the card tends to have the drug structure (not clinically useful), but often has names and possibly tables of other drugs in the same family which share similar mechanisms (more useful). These cards, like Ridiculously Simple, do not give you dosages.

 

I think Pharmacology is one of the disciplines of medicine that lends itself really well to studying via flashcards. You need to have both the generic name and trade names memorized, and you need to be able to recognise the mechanism and family of a drug when you are given its name. Some days you just need to recognise that clopidogrel is an anti-platelet medication, or that the H2-blockers, especially cimetidine really inhibit the cytochrome P-450 detoxification enzymes and can lead to higher drug levels of other medications. No amount of PBL groupwork, or postulating on the white board at the front of the room is going to help you. You just need to have it memorized at all times until it becomes part of your long-term memory. Also, inevitably you are going to forget these details unless they are regularly emphasized through repetition. Flashcards are therefore an ideal way to prepare, as they are portable, and much more convenient to access than typical large textbook.

 

I've found that a useful technique with these flashcards has been to take them out of the alphabetical order in which they are packaged, and sort them according to the organ system that they affect. You can then concentrate on studying the gastrointestinal drugs at the same time that you are studying your GI block in med school. Furthermore, because you are working with a much smaller and more manageable pool of drugs, after a while you'll find it's actually not very intimidating at all to encounter a new class of drugs. Also, because you are working with a very small pool of drugs, you will find that certain drugs start to stick in your mind as being related. For example, in the GI drug section, if your cimetidine card (H2 receptor blocker: decreases gastric acid secretion) consistently follows your omeprazole card (proton pump inhibitor: decreases gastric acid secretion), you will start to associate cimetidine with omeprazole, and this will help you to remember that both drugs can be useful in patients with gastric upset and reflux disease, although by different mechanisms.

 

The major downside to these cards are that they are not comprehensive, and the most important reason for that is that they have not been updated since 1995. As this project was a collaboration between medical students, who are all now long-graduated and most likely deep into their residency programs, it seems unlikely that there will be many future revisions unless new authors are recruited. Because of this, all of the new classes of drugs that have emerged in the past six years, and newer drugs from pre-existing families will not be covered in the Pharmcards. Examples would include the new COX-2 selective anti-inflammatories like celecoxib/Celebrex and rofecoxib/Vioxx, new and commonly used anti-psychotics like risperidone, or even the multi-kajillion dollar selling drug sildenafil, otherwise known as Viagra. Some drugs in the Pharmcards have since been withdrawn from the market, such as cisapride/Prepulsid (a GI motility agent), or terfenadine/Seldane (an anti-histamine).

 

Despite this, the cards do contain most of the medications that you are likely to encounter on the wards, so if you've studied them beforehand, you'll probably feel very comfortable. As far as I can tell, in Emerg, the cardiac drugs haven't really changed a great deal. We are still using the same antibiotics now that we were using six years ago (although the bugs are getting more resistant). Diuretics, ACE-inhibitors, and beta-blockers are still used to control high blood pressure. I think that Pharmcards will help give you a good base of medications that will be useful for your exams and also for your clinical work in the future. As future physicians, I think it extremely irresponsible to have anything less than an extremely strong grasp of Pharmacology. Whether you believe in prescribing drugs or not, it's a safe bet that many of your colleagues do, and because of that, you need to know the drugs as well to provide the best care for your patients.

 

With this said, I don't think it's necessary to buy both Ridiculously Simple, and the Pharmcards. I think the two cover similar enough material that it would be redundant to own both. Unless you really prefer flashcards for studying, and don't want to spend the time making your own, I would purchase Ridiculously Simple before Pharmcards. Both use a highly readable and concise (in other words, crammable!) format, but I like the idea that Ridiculously Simple is regularly updated, and I think that the content in Pharmcards will simply continue to become more obsolete over time. Don't get me wrong; Pharmcards is a good product, and worth buying if you have the money to spend. However, I think Ridiculously Simple is a better value for the cash.