Chemotherapy: aromatase inhibitors: 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 · Chemotherapy: aromatase inhibitors

Sample item

A 38-year-old premenopausal woman with ER-positive breast cancer is proposed anastrozole alone. Why is this unsuitable, and what adverse effect limits long-term use in postmenopausal women?

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

The answer and the reasoning

C. Ovarian oestrogen production rebounds through raised gonadotrophins; bone loss limits long-term use

Aromatase inhibitors block conversion of androgens to oestrogen in peripheral tissue, which is the main source after menopause. In premenopausal women the ovary is the source, and falling oestrogen removes feedback so that gonadotrophins rise and stimulate the ovary, which overcomes the block. Long-term use in postmenopausal women causes bone loss and arthralgia, so bone density is monitored.

Option by option

  • A. It needs hepatic activation absent before menopause; thromboembolism limits use

    Anastrozole is not a prodrug; thromboembolism is more typical of tamoxifen.

  • B. The drug is not absorbed before menopause; hot flushes only

    Absorption does not depend on menopause, and the key problem is ovarian oestrogen.

  • C. Ovarian oestrogen production rebounds through raised gonadotrophins; bone loss limits long-term use (correct)

    Correct. The intact ovarian axis overrides peripheral aromatase inhibition, and bone loss follows prolonged oestrogen depletion.

  • D. It acts only on the oestrogen receptor; endometrial cancer limits use

    Anastrozole inhibits the enzyme and not the receptor; endometrial cancer is a tamoxifen issue.

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.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Ovarian oestrogen production rebounds through raised gonadotrophins; bone loss limits long-term use. Aromatase inhibitors block conversion of androgens to oestrogen in peripheral tissue, which is the main source after menopause.

Why is "It needs hepatic activation absent before menopause; thromboembolism…" not the answer?

Anastrozole is not a prodrug; thromboembolism is more typical of tamoxifen.

Why is "The drug is not absorbed before menopause; hot flushes only" not the answer?

Absorption does not depend on menopause, and the key problem is ovarian oestrogen.

Why is "It acts only on the oestrogen receptor; endometrial cancer limits use" not the answer?

Anastrozole inhibits the enzyme and not the receptor; endometrial cancer is a tamoxifen issue.

What concept does this question test?

It tests Chemotherapy: aromatase inhibitors in Pharmacology. In premenopausal women the ovary is the source, and falling oestrogen removes feedback so that gonadotrophins rise and stimulate the ovary, which overcomes the block. Long-term use in postmenopausal women causes bone loss and arthralgia, so bone density is monitored.

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 Chemotherapy: aromatase inhibitors?

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.