Anticancer drugs: tumour lysis and G6PD: 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 · Anticancer drugs: tumour lysis and G6PD

Sample item

A 12-year-old boy with Burkitt lymphoma is about to start chemotherapy and has hyperuricaemia. He is known to have G6PD deficiency. Which urate-lowering measure should be avoided?

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

The answer and the reasoning

D. Rasburicase

Rasburicase is a recombinant urate oxidase that converts uric acid to the more soluble allantoin and generates hydrogen peroxide. In G6PD deficiency, red cells cannot handle this oxidant load, so haemolysis and methaemoglobinaemia result and the drug is contraindicated. Allopurinol and intravenous hydration can be used instead.

Option by option

  • A. Allopurinol

    Allopurinol inhibits xanthine oxidase and does not cause oxidative haemolysis.

  • B. Intravenous saline hydration

    Hydration is the cornerstone of tumour lysis prevention.

  • C. Febuxostat

    Febuxostat inhibits xanthine oxidase without this oxidant burden.

  • D. Rasburicase (correct)

    Correct. The hydrogen peroxide produced causes haemolysis in G6PD-deficient cells.

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 D, Rasburicase. Rasburicase is a recombinant urate oxidase that converts uric acid to the more soluble allantoin and generates hydrogen peroxide.

Why is "Allopurinol" not the answer?

Allopurinol inhibits xanthine oxidase and does not cause oxidative haemolysis.

Why is "Intravenous saline hydration" not the answer?

Hydration is the cornerstone of tumour lysis prevention.

Why is "Febuxostat" not the answer?

Febuxostat inhibits xanthine oxidase without this oxidant burden.

What concept does this question test?

It tests Anticancer drugs: tumour lysis and G6PD in Pharmacology. In G6PD deficiency, red cells cannot handle this oxidant load, so haemolysis and methaemoglobinaemia result and the drug is contraindicated. Allopurinol and intravenous hydration can be used instead.

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 Anticancer drugs: tumour lysis and G6PD?

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.