Opioids: interactions: 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: interactions

Sample item

A 45-year-old man on phenelzine for depression becomes agitated, hyperthermic and rigid with clonus after receiving an analgesic postoperatively. Which analgesic was most likely given?

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

The answer and the reasoning

C. Pethidine

Pethidine (meperidine) has serotonin reuptake inhibiting activity, and with monoamine oxidase inhibitors it can precipitate serotonin syndrome or severe excitatory reactions. Tramadol and fentanyl-related drugs are also implicated with serotonergic agents. Non-opioid analgesics do not interact in this way.

Option by option

  • A. Diclofenac

    Diclofenac is an NSAID without serotonergic activity.

  • B. Paracetamol

    Paracetamol has no serotonergic interaction with MAO inhibitors.

  • C. Pethidine (correct)

    Pethidine combined with an MAO inhibitor can cause serotonin syndrome.

  • D. Ketorolac

    Ketorolac is an NSAID and does not cause serotonin toxicity.

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 C, Pethidine. Pethidine (meperidine) has serotonin reuptake inhibiting activity, and with monoamine oxidase inhibitors it can precipitate serotonin syndrome or severe excitatory reactions.

Why is "Diclofenac" not the answer?

Diclofenac is an NSAID without serotonergic activity.

Why is "Paracetamol" not the answer?

Paracetamol has no serotonergic interaction with MAO inhibitors.

Why is "Ketorolac" not the answer?

Ketorolac is an NSAID and does not cause serotonin toxicity.

What concept does this question test?

It tests Opioids: interactions in Pharmacology. Tramadol and fentanyl-related drugs are also implicated with serotonergic agents. Non-opioid analgesics do not interact in this way.

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: interactions?

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.