Endocrine drugs: budesonide in Crohn disease: 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 · Endocrine drugs: budesonide in Crohn disease

Sample item

For mild to moderate ileocaecal Crohn disease, oral controlled-release budesonide is preferred to prednisolone. What is the main reason?

AIt acts as an aminosalicylate and not as a steroidBIt is not absorbed from the intestine at allCIt has mineralocorticoid activity that helps recoveryDHigh first-pass hepatic metabolism keeps systemic steroid exposure low

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

The answer and the reasoning

D. High first-pass hepatic metabolism keeps systemic steroid exposure low

Budesonide is a potent glucocorticoid with about 90 percent first-pass metabolism by hepatic CYP3A4. Its local anti-inflammatory action in the ileum and right colon is retained, with fewer systemic steroid effects such as adrenal suppression. CYP3A4 inhibitors like ketoconazole raise its systemic effect.

Option by option

A. It acts as an aminosalicylate and not as a steroid
Budesonide is a glucocorticoid and is not an aminosalicylate.
B. It is not absorbed from the intestine at all
It is absorbed, but then largely metabolised in the liver on first pass.
C. It has mineralocorticoid activity that helps recovery
Mineralocorticoid activity is minimal and is not a benefit.
D. High first-pass hepatic metabolism keeps systemic steroid exposure low (correct)
Correct. Extensive first-pass metabolism limits systemic steroid effects.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, High first-pass hepatic metabolism keeps systemic steroid exposure low. Budesonide is a potent glucocorticoid with about 90 percent first-pass metabolism by hepatic CYP3A4.

Why is "It acts as an aminosalicylate and not as a steroid" not the answer?

Budesonide is a glucocorticoid and is not an aminosalicylate.

Why is "It is not absorbed from the intestine at all" not the answer?

It is absorbed, but then largely metabolised in the liver on first pass.

Why is "It has mineralocorticoid activity that helps recovery" not the answer?

Mineralocorticoid activity is minimal and is not a benefit.

What concept does this question test?

It tests Endocrine drugs: budesonide in Crohn disease in Pharmacology. Its local anti-inflammatory action in the ileum and right colon is retained, with fewer systemic steroid effects such as adrenal suppression. CYP3A4 inhibitors like ketoconazole raise its systemic effect.

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 Endocrine drugs: budesonide in Crohn disease?

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.