General anaesthetics: etomidate: 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 · General anaesthetics: etomidate

Sample item

A patient in septic shock is intubated with etomidate and then has refractory hypotension that improves with hydrocortisone. What is the underlying mechanism?

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

The answer and the reasoning

A. Inhibition of adrenal 11-beta-hydroxylase causing adrenocortical suppression

Etomidate has excellent haemodynamic stability but reversibly inhibits 11-beta-hydroxylase, reducing cortisol synthesis even after a single dose. This is of concern in septic shock, when adrenal reserve is already stressed. Other adverse effects include myoclonus, pain on injection and postoperative nausea.

Option by option

  • A. Inhibition of adrenal 11-beta-hydroxylase causing adrenocortical suppression (correct)

    Adrenal enzyme inhibition lowers cortisol, which explains the response to hydrocortisone.

  • B. Histamine release causing vasodilation

    Histamine release is typical of thiopentone and atracurium, not etomidate.

  • C. Direct negative inotropy from calcium channel blockade

    Etomidate has minimal direct myocardial depression.

  • D. Depletion of presynaptic catecholamines

    Catecholamine depletion is a feature of reserpine and not of etomidate.

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 A, Inhibition of adrenal 11-beta-hydroxylase causing adrenocortical suppression. Etomidate has excellent haemodynamic stability but reversibly inhibits 11-beta-hydroxylase, reducing cortisol synthesis even after a single dose.

Why is "Histamine release causing vasodilation" not the answer?

Histamine release is typical of thiopentone and atracurium, not etomidate.

Why is "Direct negative inotropy from calcium channel blockade" not the answer?

Etomidate has minimal direct myocardial depression.

Why is "Depletion of presynaptic catecholamines" not the answer?

Catecholamine depletion is a feature of reserpine and not of etomidate.

What concept does this question test?

It tests General anaesthetics: etomidate in Pharmacology. This is of concern in septic shock, when adrenal reserve is already stressed. Other adverse effects include myoclonus, pain on injection and postoperative nausea.

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 General anaesthetics: etomidate?

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.