Anti-Neoplastic Pharm

[12thMan]

First Aid seems to leave out a fair number of drugs that we covered in class, does Step 1 just cover the drugs that are listed in FA?

Also, I've heard that for the USMLE there isn't much use in learning the specific cancers for each drug (presumably due to a lot of overlapping drugs) and instead to just focus on mechanisms and toxicities...is that true?

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[Phloston]

First Aid seems to leave out a fair number of drugs that we covered in class, does Step 1 just cover the drugs that are listed in FA?

Also, I've heard that for the USMLE there isn't much use in learning the specific cancers for each drug (presumably due to a lot of overlapping drugs) and instead to just focus on mechanisms and toxicities...is that true?

I've been using this forum for this whole year so far, and I'd say that, with respect to pharm, 80% of posters have said that UWorld + FA were enough. Occasionally people have said they've encountered drugs on the real exam that they hadn't seen before.

I've also occasionally encountered practice questions that have asked for specific Txs. In general, MOA, side-effects and cell cycle stuff, etc., are higher-yield than knowing the specific uses of the drugs (i.e. what they're used to treat), but those questions are still fair game.

 

[ijn]

Learn the unique treatments. ALTRA for M3 AML, imantinib for CML, etc. Learning the modes of action and toxicities is much more important for the drugs that are used for multiple cancers.

Knowing ABVD for Hodgkin's lymphoma or CHOP for non-Hodgkin's lymphoma is a waste of time. You aren't taking a hematology-oncology fellowship exam. They don't even ask that kind of stuff on STEP 2 CK.

 

[12thMan]

thats reassuring to know cuz the pharm section of FA is very small although pharm itself was quite a bit more dense!

thanks for the info!

 

[Phloston]

Learn the unique treatments. ALTRA for M3 AML, imantinib for CML, etc. Learning the modes of action and toxicities is much more important for the drugs that are used for multiple cancers.

Knowing ABVD for Hodgkin's lymphoma or CHOP for non-Hodgkin's lymphoma is a waste of time. You aren't taking a hematology-oncology fellowship exam. They don't even ask that kind of stuff on STEP 2 CK.

I wouldn't think ABVD/CHOP are a waste of time at all. Even though my school didn't really teach pharm, they were obsessed with making sure we knew those combos for some reason.

I've encountered some vignettes where knowing those drug combos have been very helpful.

For instance, I had a question a while back about a guy with a Hx of Hodgkin's, and they mentioned that he now presented with wheezing and crackles.

At first I immediately thought bleomycin --> pulmonary toxicity. But then I remembered the drug combo, and adriamycin = doxorubicin --> dilated cardiomyopathy --> pulmonary oedema.

Then I realized I almost made a dumb mistake because obviously bleomycin-induced fibrosis doesn't present with wheezing and crackles, so knowing the combo has proven to be a safety net at times, and that's just an example.

A question might also say, "what other adverse side-effects of this patient's treatment are most likely?" So knowing the combos is helpful.

 

[ijn]

A STEP 1 question would say:

1. A patient is taking doxorubicin, what side effect may occur?
2. A patient has dilated cardoimyopathy, what drug was likely used to treat him?
3. What drug acts by inhibiting topoisomerase II?
4. etc...

That's STEP 1 material. They won't require you to know that a guy with stage IV Hodgkin's lymphoma is on ABVD because that is the current regimen and therefore the most likely thing causing dilated cardiomyopathy in him is doxorubicin. Even on STEP 2 CK they don't even want you to know that. On STEP 2 CK they would want you to know that you treat stage I/II with radiation and stage III/IV with chemo, not what chemo regimen is used for Hodgkin's. Maybe you'd have to know that most Hodgkin's is caught at stage I/II so it's mostly treated with radiation.

 

[12thMan]

A STEP 1 question would say:

1. A patient is taking doxorubicin, what side effect may occur?
2. A patient has dilated cardoimyopathy, what drug was likely used to treat him?
3. What drug acts by inhibiting topoisomerase II?
4. etc...

That's STEP 1 material. They won't require you to know that a guy with stage IV Hodgkin's lymphoma is on ABVD because that is the current regimen and therefore the most likely thing causing dilated cardiomyopathy in him is doxorubicin. Even on STEP 2 CK they don't even want you to know that. On STEP 2 CK they would want you to know that you treat stage I/II with radiation and stage III/IV with chemo, not what chemo regimen is used for Hodgkin's. Maybe you'd have to know that most Hodgkin's is caught at stage I/II so it's mostly treated with radiation.

Surely Step 1 has to be a little more complex than that?

 

[ijn]

Surely Step 1 has to be a little more complex than that?

Yes, it'll be buried behind a wall of text, but STEP 1 still tests very superficial knowledge. For example the one doxorubicin question that I've ever seen on an NBME you had to match two cancer drug MOAs from the question prompt to a pair of antineoplastics in the answer choices.