...updated June 2009

I think every M1 (and M2) needs a “decent” basic pharmacology text to supplement lectures and to serve as some sort of reference in the remaining years of med school. I say you need one fully recognizing that many medical students do OK on exams with just handouts and no text at all; and that it's a rare faculty member (around here, at least) who says “read pages 628 to 645 of Text A -- you'll be tested on it.”

But coursepack information, other lecture stuff, and no textbook, probably won't be adequate for learning about and understanding what I think you need to know about the diverse drugs, and their many actions, for Step 1 and the early clinical years. Yes, you can find “rat facts” about certain drugs on the web, in review books, or in your notes, but I think (hope) you want (and know you NEED) to UNDERSTAND more. Your medicine text, or your surgery text, may refer to drugs, but they're not going to address the important basic pharmacology you must know.

When I directed our former M1 pharmacology course I had the authority to decide what the “required” pharmacology text would be. Now that that course is gone, and I no longer have any course to direct in the M1 year, there were two options about picking a book. It's hard getting a consensus on “which book is best” (or anything else) from my department, so I'm offerning my personal opinions (and many of you who read this know how opinionated I am).

Below you'll find a list of and my personal comments about several texts, each of which has strengths and weaknesses as I see them. I've read them carefully.

One piece of advice: Lots of students purchase a pharmacology review book, including those allegedly designed for Step 1. Review books are great for just that: review. They're not designed to help you learn material the first time around, simply because they lack adequate explanatory text to help you get the “big picture”of a particular topic -- information you need to understand and apply the rat facts to the care of your patients.

You may also pick a one-book-covers-all review book, like First Aid for USMLE Step 1. Compared with a pharmacology-only review book, these panacea reviews have to cover the gamut of basic science topics and so don't contain nearly enough discipline-based material, and really pander to the patently incorrect notion that I've heard often and hate: "It's the memorization, stupid."

So, here's my text list -- again, it's just my opinions.

Basic & Clinical Pharmacology. B. G. Katzung, ed. 11th Edition, McGraw-Hill, 2009. Paperback, approx. 1,200 pages. Amazon price (new) about $60.

Pros:

• Largely an excellent balance between details on drug mechanisms and clinical applications.
• The author has a long history of publishing medical pharmacology books (texts and USMLE study/self-exam), and medical student teaching, and so the text is quite “fine tuned” to the undergraduate medical student.
• Contains great coverage on such special topics, largely given little or no attention, in other texts: perinatal/pediatric pharmacology; geriatrics; therapeutic and toxicity issues concerning OTC drugs, toxicology, and herbals.
• Lots of full color diagrams or other illustrations make it lots easier on the eyes

Cons:

• I'd probably do some things differently.... different emphasis on certain drugs, different sequencing of some things in some chapters. However, that's being very picky. I can't come up with anything substantive that would weigh against recommending this book.

Shlafer’s rating of this text for M1s and M2s:

... and it'll continue to serve you well in the M3 and M4 years.

Goodman & Gilman’s The Pharmacological Basis of Therapeutics. L. Brunton, J. Lazo, and K. Parker, eds., 11th Edition, McGraw-Hill, 2005. Hardcover, approx. 2,100 pages ($140 approx); digital edition (book plus life-of-edition online subscritption that includes a drug database; $195); or on-line only ($125).

Pros:

• “G&G” is generally regarded as the definitive reference textbook of pharmacology and therapeutics; it’s often been called the “bible of pharmacology,” in fact.
• Excels in terms of extensive and highly-referenced information on drug structure (and structure-activity relationships) and mechanism of action (accompanied by detailed tables and illustrations)
• Does a fine job of putting the basic pharmacologic information in a contemporary clinical context
• The basic pharmacology is presented with much supporting research-based background information, plus good sections on background/history of the topics being addressed
• Good (but not great) integration with clinical use of the drugs, and prospectuses that give the reader insight into what's coming down the pike
• New on-line access (digital edition) gets you to quick links for follow-up; drug interaction tables; and robust searching, indexing, and cross-referencing.

Cons:

• Information overload for the M1 and M2 years, and quite expensive too (unless you calculate cost per pound).
• Many of the graphics and tables are too detailed to identify the crux of an issue (e.g., mechanisms of drug action) as the first-time learner may want or need.
• Too much material in "small type" -- this is supposed to set apart material of lesser importance, but in some cases material traditionally taught (and expected to be learned) in preclinical pharmacology is set that way. After a while of reading, the "big type" and "small type" seem to blur into the same.
• The style and content between chapters isn't consistent. In some chapters individual drugs, in separate subclasses, are described separately and rather well. In other chapters, different classes of drugs mainly used for the same general purposes are lumped together in a general discussion, and it's therefore difficult (often without looking at some relatively detailed tables) to see how the subclasses differ in a meaningful way.
• Lots of detailed info on structure-activity relationships, much of which you will never need to worry about.
• Serves more as a reference (it excels in that) than as a text for initial student learning.
• Weighs a hefty 8 pounds or so, so you're not going to tote it around. (If you have the bucks, then spring for the digital edition, which gets you not only the book itself but also access to the full content - and other nice stuff - on-line.)
• 
  Shlafer’s rating of this text for M1s and M2s:

...but this is, in my opinion, a must have once you graduate and are wallowing in money from your salary as a house officer. For now, if you have limited funds, you might want consider buying a used copy of the 10th edition. In some ways, it's better than the 11th. The 12th edition probably won't be out until late 2009.

Pharmacology. G.M. Brenner and C. W. Stevens, 3rd Edition, Sunders-Elsevier, 2010 (available now). Paperback, approx. 540 pages. Amazon price (new) about $55

Pros:

• The newest of the books I've reviewed lately
• Succinct and no extra verbiage
• Nice balance between pharmacologic principles (in general, and for specific drugs groups), pathophysiology, and clinical uses of drugs
• Excellent tables that compare important properties of what I call prototype drugs (important) and other agents in the same class or family (not that important, but good information to have available for quick look-up)
• Excellent diagrams (eg, sites/mechanisms of action) and in color for easy comprehension
• Summary of "important points," and several self-study questions (with explanations) for each chapter.
• Full text searchable on-line.

Cons:

• In some areas of the book, and in parts of individual chapters, the discussions may be a bit too concise, and a bit more explanatory information to provide better understanding of the whats and whys might be in order.

Shlafer’s rating of this text for M1s and M2s:

Principles of Pharmacology. The Pathophysiologic Basis of Drug Therapy. D. E. Golan et al., eds. 2nd Edition, Lippincott Williams & Wilkins, 2007. Paperback, approx. 980 pages. Amazon price (new) about $95

Pros:

• A well-written and illustrated collaborative effort between faculty and medical students, and a vast improvement over the first edition.
• Largely systems-oriented, and describing drug actions and uses from a physiologic - pathophysiologic - biochemical perspective in a way that one just doesn’t see in other texts.
• Each chapter sets the stage for the discussions that follow by starting with a clinical vignette and several key questions posed about it. Excellent graphics, and a departure from most other texts, all of which seem to depict “the same old stuff” in marginally different ways.
• A reasonable blend of molecular pharmacology content with human therapeutics.
• A workbook to accompany the text is available. Each chapter, corresponding to chapters in the text, include two case scenarios (one the same as in the text) with several multiple choice questions, followed by explanations of each correct and incorrect answer.

Cons:

• While the basic pharmacology is usually explained well, and integrated with pathophysiology, the applications of the drugs to clinical medicine (how the drugs are likely to be used, side effects, interactions, and other pertinent problems that may arise) are not presented clearly or consistently, despite the presence of clinical vignettes at the start of the chapters.
• Some explanations of mechanisms (drug action, etc.) are so detailed or otherwise off-base for medical students (especially in the preclinical years) that it's easy to miss the big, “must-know and understand” points: the proverbial “can't see the forest for the trees” problem.
• Thus, the book might be more suited for a curriculum that's more heavily dependent on small group discussion sections where the essential points and clinical relevance can be fleshed-out by the students and discussion leaders (faculty).
• Nearly all the contributors are from or in some way associated with Harvard Medical School (…or is that supposed to be a plus?).
• The workbook (see above) asks questions that I think are too mechanistic or otherwise too picky, and they (in my opinion) cause the student to focus on somewhat irrelevant information such that the "basics" and the "big picture" are obscured.

Shlafer’s rating of this text for M1s and M2s:

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e-mail me: mshlafer@umich.edu