Purpose Traditional pharmacology instruction often teaches drugs and diseases in isolation, limiting students' ability to integrate physiology, pathophysiology, pharmacology, and patient context when selecting therapies. To address this, we developed Speed Pharm, a rapid, mechanism-based instructional model to cultivate integrated pharmacotherapeutic reasoning through repeated comparison of therapies across common cardiovascular diseases. Methods During a two-hour session, 65 first-year medical students rotated in small groups (10–11) through six 20-minute faculty-led stations on hypertension, pulmonary hypertension, atrial fibrillation, acute coronary syndrome, acute and chronic heart failure, and hypertrophic cardiomyopathy. Students compared therapies, justified medication selection using pharmacologic mechanisms, pathophysiology, and patient-specific factors. Following the session, an anonymous survey with six Likert-scale items and one open-ended question was administered; 30 students responded. Results All respondents agreed or strongly agreed that Speed Pharm enhanced integration of pharmacology with physiology and pathophysiology, improved understanding of therapeutic rationale, reinforced key concepts, and provided an effective learning experience. All recommended expanding the model to other courses. Qualitative feedback highlighted the value of faculty-guided discussion, repeated comparison of therapies across disease states, and application of mechanistic principles to pharmacotherapeutic reasoning. Suggestions focused on logistics and broader curricular implementation. Conclusions Speed Pharm offers a scalable instructional model for cultivating integrated pharmacotherapeutic reasoning by linking foundational science with clinical application through rapid, comparative clinical cases. Student feedback supports its value as a learner-centered reinforcement strategy that promotes pharmacotherapeutic reasoning and is readily adaptable across organ systems.