Opioids: remifentanil: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Opioids: remifentanil

Sample item

An anaesthetist wants an opioid with a very short context-sensitive half-life that is independent of liver and kidney function. Which agent is chosen?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Remifentanil, metabolised by plasma and tissue esterases

Remifentanil is broken down by non-specific plasma and tissue esterases, giving a rapid offset of about 3 to 10 minutes even after prolonged infusion. Fentanyl accumulates with prolonged use because of redistribution.

Option by option

  • A. Remifentanil, metabolised by plasma and tissue esterases (correct)

    Correct. Esterase metabolism gives predictable rapid offset.

  • B. Fentanyl, metabolised by hepatic CYP3A4

    Fentanyl depends on hepatic metabolism and has a longer tail.

  • C. Morphine, conjugated in the liver

    Morphine is conjugated and its metabolites accumulate in renal failure.

  • D. Methadone

    Methadone has a long half-life.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Pharmacology questions

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Remifentanil, metabolised by plasma and tissue esterases. Remifentanil is broken down by non-specific plasma and tissue esterases, giving a rapid offset of about 3 to 10 minutes even after prolonged infusion.

Why is "Fentanyl, metabolised by hepatic CYP3A4" not the answer?

Fentanyl depends on hepatic metabolism and has a longer tail.

Why is "Morphine, conjugated in the liver" not the answer?

Morphine is conjugated and its metabolites accumulate in renal failure.

Why is "Methadone" not the answer?

Methadone has a long half-life.

What concept does this question test?

It tests Opioids: remifentanil in Pharmacology. Fentanyl accumulates with prolonged use because of redistribution.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Opioids: remifentanil?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.