Anticancer drugs: irinotecan diarrhoea: 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: irinotecan diarrhoea

Sample item

During an irinotecan infusion a patient develops abdominal cramps, sweating, lacrimation and watery diarrhoea within 30 minutes. Which drug best treats this acute event?

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

The answer and the reasoning

C. Atropine

Irinotecan causes two types of diarrhoea. The early form, during or within hours of infusion, is cholinergic from acetylcholinesterase inhibition and responds to atropine. The late form, after 24 hours, is due to the active metabolite SN-38 damaging the mucosa and is treated with loperamide, with octreotide for refractory cases.

Option by option

  • A. High-dose loperamide

    Loperamide is used for the late-onset diarrhoea, not the acute cholinergic syndrome.

  • B. Cholestyramine

    Cholestyramine is not standard treatment for this acute syndrome.

  • C. Atropine (correct)

    Correct. Early cholinergic diarrhoea with sweating and lacrimation responds to antimuscarinic therapy.

  • D. Octreotide

    Octreotide is reserved for refractory late diarrhoea.

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, Atropine. Irinotecan causes two types of diarrhoea.

Why is "High-dose loperamide" not the answer?

Loperamide is used for the late-onset diarrhoea, not the acute cholinergic syndrome.

Why is "Cholestyramine" not the answer?

Cholestyramine is not standard treatment for this acute syndrome.

Why is "Octreotide" not the answer?

Octreotide is reserved for refractory late diarrhoea.

What concept does this question test?

It tests Anticancer drugs: irinotecan diarrhoea in Pharmacology. The early form, during or within hours of infusion, is cholinergic from acetylcholinesterase inhibition and responds to atropine. The late form, after 24 hours, is due to the active metabolite SN-38 damaging the mucosa and is treated with loperamide, with octreotide for refractory cases.

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: irinotecan diarrhoea?

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.