Toxicology: cocaethylene: practice question

A Forensic Medicine 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.

Try it

Forensic Medicine · Toxicology: cocaethylene

Sample item

A man dies of a cardiac arrest after using cocaine along with a large amount of alcohol. The laboratory reports a metabolite formed in the liver only when both were taken together, which is more cardiotoxic and longer acting than cocaine. What is it?

ABenzoylecgonineBCocaethyleneCEcgonine methyl esterDNorcocaine

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

The answer and the reasoning

B. Cocaethylene

When cocaine and ethanol are taken together, the liver forms cocaethylene by transesterification. It has a longer half-life and is more cardiotoxic than cocaine, which partly explains the greater risk of sudden death. Benzoylecgonine is the main inactive urinary metabolite used in drug screening.

Option by option

A. Benzoylecgonine
Benzoylecgonine forms from cocaine alone and is the main inactive urinary metabolite.
B. Cocaethylene (correct)
Correct. This active metabolite arises only with co-ingestion of ethanol.
C. Ecgonine methyl ester
Ecgonine methyl ester forms from cocaine alone by hydrolysis and is inactive.
D. Norcocaine
Norcocaine forms from cocaine alone by N-demethylation, with no need for ethanol.

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.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is B, Cocaethylene. When cocaine and ethanol are taken together, the liver forms cocaethylene by transesterification.

Why is "Benzoylecgonine" not the answer?

Benzoylecgonine forms from cocaine alone and is the main inactive urinary metabolite.

Why is "Ecgonine methyl ester" not the answer?

Ecgonine methyl ester forms from cocaine alone by hydrolysis and is inactive.

Why is "Norcocaine" not the answer?

Norcocaine forms from cocaine alone by N-demethylation, with no need for ethanol.

What concept does this question test?

It tests Toxicology: cocaethylene in Forensic Medicine. It has a longer half-life and is more cardiotoxic than cocaine, which partly explains the greater risk of sudden death. Benzoylecgonine is the main inactive urinary metabolite used in drug screening.

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 Toxicology: cocaethylene?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine 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.