USMLE Step 2 Review 18 04 Drugs of Choice Activated Charcoal

USMLE Step 2 Review 18 04 Drugs of Choice Activated Charcoal


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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.

Play USMLE Audio MP3 18 04 Drugs of Choice Activated Charcoal Below


Begin 18 04 Drugs of Choice Activated Charcoal Transcription

What is indicated both for reducing gas in the bowel, and for absorbing poison in the digestive tract?

  • Activated charcoal.

In the immunocompetent host, of mucocutaneous herpes simplex fever blisters, treatment is not normally indicated. When there are severe herpes simplex fever blisters however, in addition to other infections such as pneumococcal sepsis, what is the drug of choice?

  • Acyclovir.

And the trade name for Acyclovir?

  • Zovorax.

In osteomyelitis after a fracture, after a puncture such as a nail through a sneaker, or after orthopedic surgery, what four bugs are of most concern?

  • Staph aureus, Enterobacter, Pseudomonas, and anaerobes such as Clostridium species.

Again, 4 bugs of most concern after a nail though a sneaker?

  • Staph aureus, Enterobacter, Pseudomonas, and anaerobes such as Clostridium species.

What drug of choice is specific for pseudomonas and also covers Enterobacter and anaerobes?

  • Ticarcillin.

Trade name for Ticarcillin?

  • Ticar.

What type of antibiotic is Ticarcillin/Ticar?

  • It’s an antipseudomonal Penicillin.

How is it administered?

  • IM or IV.

What type of agent would need to be added to Ticarcillin to also cover the Staph aureus?

  • A beta-lactamase inhibitor.

And what is the beta-lactamase inhibitor that is added to Ticar for covering Staph aureus?

  • Clavulanate.

Now, if Staph aureus is suspected, what are the 2 drugs in combination then, which form the drug of choice for osteomyelitis post-op, post-puncture, or post-fracture?

  • Ticarcillin and Clavulanate.

And what’s the trade name for Ticarcillin with Clavulanate?

  • Timentin.

In addition to drug therapy with Timentin, what is also often indicated in osteomyelitis?

  • Surgical debridement of infected bone.

When the patient is allergic to the Penicillins, what 2 are usually used instead for osteomyelitis?

  • Ciprofloxacin and Rifampin.

Trade names?

  • Cipro and Rifadin.


  • PO or IV, usually begins IV.

Now, which of these 2 is the quinolone that covers the Staph aureus, the Enterobacter, and the pseudomonas?

  • Ciprofloxacin/Cipro.

What organisms does Rifampin/Rifadin cover in osteomyelitis?

  • The anaerobes, such as Clostridium species.

What is the drug of choice for preventing stage fright?

  • Propranolol.

And what’s the trade name for propranolol?

  • Inderal.

What type of drug is propranolol/Inderal?

  • It’s a non-cardioselective beta blocker.

What is the organism found in acne vulgaris?

  • Propionibacterium acnes.

What immune cell reacts to Propionibacterium acnes to cause an inflammatory condition in the skin?

  • Neutrophils.

Acne vulgaris generally comes in 4 forms- mild or moderate, a moderate form with extensive whiteheads and sun wrinkling, inflammatory, and severe cystic. The severe cystic may also be called comedonal.

What systemic antibiotic is indicated for mild or moderate acne vulgaris?

  • None. There is no systemic antibiotic indicated.

What compound is the mainstay of topical treatment for mild or moderate acne vulgaris?

  • Topical benzoyl peroxide.

What systemic antibiotic is most often used for inflammatory acne vulgaris?

  • Doxycycline.

And what are 4 trade names for Doxycycline when used for acne?

  • Vibramycin, Vibra-Tabs, Doryx, Monodox.

For acne with extensive whiteheads or with fine wrinkling due to sun exposure, there is a drug of choice for these special situations. This is a retinoic acid derivative. What is it?

  • Tretinoin.

And how is tretinioin administered?

  • Only topical.

And what’s the trade name for Tretinoin?

  • Retin-A.

What systemic drug or retinoic acid derivative is often used PO for severe cystic or comedonal acne vulgaris?

  • Isotretinoin.

And what’s the trade name for isotretinoin?

  • Accutane.

When prescribing isotretinoin (trade name Accutane), there are a number of side effects to worry about.

What is the biggest fear with Accutane, and what do you have to make sure of?

  • The biggest fear is birth defects. Isotretinoin is a teratogen. You must prevent pregnancy.

What is the first line drug of choice for hiccups? (Hint- it’s not something prescription).

  • Carbon dioxide (CO2 inhibits hiccups).

And what are 2 easy methods to apply extra CO2?

  • Breath holding or re-breathing into a paper bag. Now, there is a long list of drugs and maneuvers that may be tried as a second resort. None, however, are consistently successful.

As almost a last resort, what may be injected in the vicinity of the phrenic nerve to inhibit the diaphragm?

  • Procaine.

What is the drug of choice, and route of administration for lessening the severity of measles in adults?

  • Ribavirin IV.

Trade name for Ribavirin?

  • Virazole.



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