We have 4 semesters of med chem at UF. The 2 in year one are more introductory in nature. Regular med chem is during year two. It's not as bad as regular organic, though you still need to understand mechanisms.
In year 2, our classes are pretty well integrated. In pharmacotherapy, we learn drugs, dosing, and applications of drug therapy. This section has dealty with hypertension, angina, myocardial infarctions, etc. The drugs we needed to use were studied in pharmacology. There we learn how the drugs work in your body. Then in med chem, we study the structure of the drug, how it binds to receptors, the mechanism of action, etc.
A typical med chem exam will have you draw drug structures. You'll have to draw a mechanism to get from an active form to an inactive form and vice versa. They'll give you structures (could be real, could be made up) and you have to say what the pKA values would be on each group, which hydrogen will leave at physiological pH, etc.
I wouldn't really call anything an organic synthesis problem, though you do need to go to one form of the drug to another and know the enzyme in the body that performs that task and the functional groups on that enzyme that cause the reaction so you can draw the mechanism. You will still you concepts from organic. When a drug enters your body, you need know what happens to it. That's part of pharmacy school.