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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 19 10 Drugs of Choice Antipsychotics 1 Below
What 3 conditions are the antipsychotic drugs used to treat (start with the obvious)?
- Psychosis, schizophrenia, hallucinations.
And what is the other name for the class of drugs termed “antipsychotics”?
Except for a few important ones we’ll learn about in a minute, almost all neuroleptics block what central receptor?
- Central dopamine D2 receptors.
Now, because all antipsychotics work about equally well in treating psychosis, but can have serious side effects, board questions tend to focus on receptors and side effects, and on only a few drug of choice distinctions. We’ll hit several specific drugs of choice here, and then we’ll work on side effects- wanted and unwanted.
What is the drug of choice for treating schizophrenia that has failed to respond to other neuroleptics?
And the trade name for Clozapine?
What class of drug is Clozapine/Clozaril?
- It is a dibenzodiazepine, an atypical agent.
Why is Clozapine/Clozaril called an atypical agent?
- Because Clozapine/Clozaril doesn’t have the side effects of most antipsychotics.
But it does have the possible side effect of what?
We’ll come back to the side effect profile later.
What type of receptor is Clozapine/Clozaril thought to work on?
- Either serotonin receptors or D1 receptors.
Now, Clozapine/Clozaril is also the only neuroleptic which is effective for a particular group of schizophrenic symptoms, not always present.
When they are present, what is this group of schizophrenic symptoms?
- These are the negative symptoms.
Please give 3?
- Flat affect, avolition, poverty of speech.
What 2 long-acting neuroleptics are drugs of choice for treating the non-compliant patient?
- Haloperidol and Fluphenazine.
And the trade name for Haloperidol?
And the trade name for Fluphenazine?
In addition to their long action, what else makes them useful for non-compliance?
- They are both available IM- injectable into muscle.
One of the extrapyramidal side effects that the high-potency neuroleptics can cause is acute dystonia. What is that?
- Sustained muscle contractions in the head and neck region.
What are 5 muscle spasms that commonly occur with dystonia in the head and neck region?
- Eye, tongue, jaw, neck, laryngeal. Laryngeal dystonia can cause airway obstruction.
What are the 2 drugs of choice for the emergency treatment of laryngeal dystonia due to high-potency antipsychotics (also give the route of administration)?
- Diphenhydramine or Benztropine IV or IM.
The trade name for Diphenhydramine injectable?
- Benadryl injection.
And the trade name for Benztropine injectable?
- Cogentin injection.
What class of drug is Diphenhydramine/Benadryl and Benztropine/Cogentin?
- They’re both anticholinergics.
Ok, I’ll warn you- this next section is long and tough, but it will pay off. In general, in terms of potency, neuroleptics fall into what 2 categories?
- Low potency and high potency.
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