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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 13 Drugs of Choice Antipsychotics 4 Below
What 3 high potency antipsychotics probably have the highest risk for extrapyramidal side effects, tardive dyskinesia, and neuroleptic malignant syndrome (please give them in the order from highest risk to slightly lower risk)?
- Haloperidol, Fluphenazine, Thiothixene.
And the trade name for Haloperidol?
And the trade name for Fluphenazine?
And the trade name for Thiothixene?
All of the antipsychotics, except 1, block what dopamine receptor?
- The D2 receptors.
Which one blocks the D1 receptor instead?
What is the relationship between potency of antipsychotic drugs and their concurrent risk for extrapyramidal side effects and tardive dyskinesia, and neuroleptic malignant syndrome AND the D2 receptors?
- The greater the binding affinity for the D2 receptor, the higher the potency of the antipsychotic.
In terms of some other side effects, blockade of the dopamine D2 receptors by antipsychotics may cause elevation of what hormone?
And abnormal elevation of prolactin (hyperprolactinemia) may result in what 3 abnormalities in women?
- Gynecomastia, galactorrhea, and menstrual dysfunction.
In addition, in men, what 3 problems with sexual function may occur? Erectile dysfunction, retrograde ejaculation, and inhibition of orgasm.
Speaking of orgasms, patients sometimes have severe headaches with orgasms, especially men. These are usually benign. If there is no subarachnoid hemorrhage, and that has to be checked for first, what is the drug of choice?
And how given?
- 50mg oral prior to intercourse.
What is the treatment for Wilson’s disease?
- Because in Wilson’s disease, there is abnormal deposition of copper in tissues, with damage to the brain, liver, kidney, and cornea.
Let’s look at the 4 generations of Cephalosporins.
The differences between the 4 generations, especially the first 3 generations can be summed up in very general terms by what 2 opposite progressions?
- The lower the generation of cephalosporin, the better it works against gram positives. The higher the generation of cephalosporin, the better it works against gram negatives. The 2nd and 3rd generation Cephalosporins are quite similar in coverage, except for a small difference and a key difference.
What is the small difference for the 3rd generation Cephalosporins?
- They’re slightly better than the 2nd generation at gram negatives.
And what is the key difference between the 3rd generation and the 2nd generation Cephalosporins?
- The 3rd generation is also anti-pseudomonal.
Now, the 3rd and 4th generation Cephalosporins are also quite similar. Again, the 4th generation being a little better than the 3rd generation at gram negative, and in particular which gram negative?
- The gram negative Enterobacteria.
And coming full circle, the 4th generation is also a little better than the 3rd against something that we usually think of in terms of the 1st generation. What is this?
- Gram positive cocci.
Keep in mind, however, which generation is still the best, by far, for gram positive?
- The 1st generation.
And finally, the 4th generation is a little better than the 3rd at the key difference for the 3rd, what is this?
By the way, what class of antibiotic are the Cephalosporins?
- They’re beta-lactams.
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