Endocrine drugs: antiandrogens: 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 · Endocrine drugs: antiandrogens

Sample item

A man with metastatic castration-resistant prostate cancer is started on abiraterone with prednisolone. What is the reason for the steroid?

AIt enhances abiraterone's antiandrogen effect directlyBIt treats bone pain onlyCAbiraterone inhibits CYP17, lowering cortisol and increasing mineralocorticoid excess, so steroid replacement is neededDIt prevents abiraterone from being metabolised

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

The answer and the reasoning

C. Abiraterone inhibits CYP17, lowering cortisol and increasing mineralocorticoid excess, so steroid replacement is needed

Abiraterone inhibits CYP17A1 in adrenal and tumour tissue, blocking androgen synthesis, and the resulting ACTH rise causes mineralocorticoid excess with hypertension and hypokalaemia unless glucocorticoid is replaced. Flutamide and bicalutamide are androgen receptor antagonists.

Option by option

A. It enhances abiraterone's antiandrogen effect directly
The steroid is not an antiandrogen booster.
B. It treats bone pain only
Pain control is not the main reason.
C. Abiraterone inhibits CYP17, lowering cortisol and increasing mineralocorticoid excess, so steroid replacement is needed (correct)
Correct. Prednisolone replaces cortisol and suppresses ACTH drive.
D. It prevents abiraterone from being metabolised
Prednisolone does not alter abiraterone metabolism.

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.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Abiraterone inhibits CYP17, lowering cortisol and increasing mineralocorticoid excess, so steroid replacement is needed. Abiraterone inhibits CYP17A1 in adrenal and tumour tissue, blocking androgen synthesis, and the resulting ACTH rise causes mineralocorticoid excess with hypertension and hypokalaemia unless glucocorticoid is replaced.

Why is "It enhances abiraterone's antiandrogen effect directly" not the answer?

The steroid is not an antiandrogen booster.

Why is "It treats bone pain only" not the answer?

Pain control is not the main reason.

Why is "It prevents abiraterone from being metabolised" not the answer?

Prednisolone does not alter abiraterone metabolism.

What concept does this question test?

It tests Endocrine drugs: antiandrogens in Pharmacology. Flutamide and bicalutamide are androgen receptor antagonists.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Endocrine drugs: antiandrogens?

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.