Preparing for the United States Medical Licensing Examination (USMLE) Step 1 is a daunting task. Pharmacology is a critical component of USMLE testing and represents 10-20% of USMLE Step 1 

Improve your study efficiency by focusing on the topics that the USMLE tells you are going to be on the exam.  The USMLE website has resources available including sample test questions and a PDF file with the topics subject to examination on the Step 1 exam. 

This article will review the content outline, sample question style, and specifications related to pharmacology for the Step 1 exam.

Continue reading this series to learn details about the pharmacology content of the STEP 1 exam broken down by system.

As always, Catapult Pharmacology offers a comprehensive review of pharmacology including video lectures, worksheets, quizzes, written summaries, and a memory tool to aid in memorizing drug names and facts.

What type of pharmacology questions will be on the USMLE Step 1 Exam?

Question Style

From the USMLE website (January 2025):

“The Step 1 examination continues to assess content related to the discipline of pharmacology. However, the primary focus of this content will be on the mechanisms of actions of drugs rather than on specific pharmacotherapy, drug-drug interactions, adverse effects, or contraindications of medications.”

Let’s break this down. What is specific pharmacotherapy?

Specific pharmacotherapy relates to knowledge of the drugs used to treat a specific condition with medications. So, this statement by USMLE indicates that the STEP 1 exam will not be asking you know the preferred antibiotic used to treat community acquired pneumonia in a penicillin allergic patient; however, the examiners will want you to know that ceftriaxone (which is a commonly used intravenous antibiotic used to treat community acquired pneumonia) works by inhibiting enzymes including transpeptidases that bacteria use to synthesize cell walls, which leads to weakening of the cell wall and eventual lysis of the bacteria. 

In addition, USMLE notes that drug-drug interactions, adverse effects, and contraindications of medications will not be a focus of the exam. 

Example Question

Here is an example of a sample question from the USMLE Website:

“A 27-year-old woman comes to the office for counseling prior to conception. She states that a friend recently delivered a newborn with a neural tube defect and she wants to decrease her risk for having a child with this condition. She has no history of major medical illness and takes no medications. Physical examination shows no abnormalities. It is most appropriate to recommend that this patient begin supplementation with a vitamin that is a cofactor in which of the following processes?

(A) Biosynthesis of nucleotides

(B) Protein gamma glutamate carboxylation

(C) Scavenging of free radicals

(D) Transketolation

(E) Triglyceride lipolysis”

The answer to this question is A. Folate is an important nutrient to the normal development of the neural tube and is a cofactor in the production of nucleotides. 

While the USMLE states that specific treatments, adverse effects, drug-drug interactions, and contraindications will not be a focus, that does not mean that these topics won’t come up.  The next section will review the USMLE Step 1 content outline provided by USMLE.

As always, Catapult Pharmacology offers a comprehensive review of pharmacology including video lectures, worksheets, quizzes, written summaries, and a memory tool to aid in memorizing drug names and facts. Enroll today to enhance your pharmacology knowledge.

USMLE Pharmacology Content Sections

Human Development
Immune System
Blood & Lymphoreticular System
Behavioral Health
Nervous System & Special Senses
Skin & Subcutaneous Tissue
Musculoskeletal System
Cardiovascular System
Respiratory System
Gastrointestinal System
Renal & Urinary System
Pregnancy, Childbirth, & the Puerperium
Female and Transgender Reproductive System & Breast
Male and Transgender Reproductive System
Endocrine System
Multisystem Processes & Disorders