Substance use: practice question

A Psychiatry 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.

Try it

Psychiatry · Substance use

Sample item

A man with opioid dependence is stabilised on buprenorphine-naloxone sublingual tablets. Which statement about buprenorphine explains why it is safer than methadone in overdose?

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

The answer and the reasoning

B. It is a partial mu-agonist with a ceiling effect on respiratory depression

Buprenorphine is a high-affinity partial agonist at the mu receptor and an antagonist at the kappa receptor. Its partial agonism produces a ceiling on respiratory depression, which lowers overdose risk. Its high affinity and slow dissociation also allow once-daily or less frequent dosing, but it can precipitate withdrawal if given to a patient with full agonists on board.

Option by option

  • A. It is a full mu-agonist with a very short half-life

    Buprenorphine is a partial agonist with a long duration of action, so this is incorrect.

  • B. It is a partial mu-agonist with a ceiling effect on respiratory depression (correct)

    Correct. Partial agonism leads to a ceiling effect on respiratory depression.

  • C. It is a pure mu-antagonist that blocks all opioid effects

    A pure antagonist describes naltrexone, which is not an agonist maintenance drug.

  • D. It is a kappa agonist that does not affect respiration

    Buprenorphine acts as a kappa antagonist, and its safety does not come from kappa agonism.

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 Psychiatry questions

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, It is a partial mu-agonist with a ceiling effect on respiratory depression. Buprenorphine is a high-affinity partial agonist at the mu receptor and an antagonist at the kappa receptor.

Why is "It is a full mu-agonist with a very short half-life" not the answer?

Buprenorphine is a partial agonist with a long duration of action, so this is incorrect.

Why is "It is a pure mu-antagonist that blocks all opioid effects" not the answer?

A pure antagonist describes naltrexone, which is not an agonist maintenance drug.

Why is "It is a kappa agonist that does not affect respiration" not the answer?

Buprenorphine acts as a kappa antagonist, and its safety does not come from kappa agonism.

What concept does this question test?

It tests Substance use in Psychiatry. Its partial agonism produces a ceiling on respiratory depression, which lowers overdose risk. Its high affinity and slow dissociation also allow once-daily or less frequent dosing, but it can precipitate withdrawal if given to a patient with full agonists on board.

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 Substance use?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry 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.