Cardiology: niacin flushing: practice question

A General 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.

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General Medicine · Cardiology: niacin flushing

Sample item

A man with low HDL cholesterol is started on nicotinic acid and develops facial flushing within an hour of each dose. Which measure reduces this effect?

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

The answer and the reasoning

B. Aspirin taken before the dose

Nicotinic acid flushing is mediated by prostaglandin D2 released from skin cells after activation of the GPR109A receptor. Aspirin, taken about 30 minutes before the dose, blocks prostaglandin synthesis, while antihistamines are of little use. Taking the dose with food also helps.

Option by option

  • A. Taking the dose on an empty stomach

    An empty stomach increases absorption and makes flushing worse, not better.

  • B. Aspirin taken before the dose (correct)

    Correct. Aspirin blocks the prostaglandin-mediated flushing.

  • C. A beta-blocker taken with the dose

    A beta-blocker does not act on the prostaglandin pathway and can worsen hypotension.

  • D. A cetirizine tablet before the dose

    Histamine is not the main mediator, so an antihistamine gives little relief.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Aspirin taken before the dose. Nicotinic acid flushing is mediated by prostaglandin D2 released from skin cells after activation of the GPR109A receptor.

Why is "Taking the dose on an empty stomach" not the answer?

An empty stomach increases absorption and makes flushing worse, not better.

Why is "A beta-blocker taken with the dose" not the answer?

A beta-blocker does not act on the prostaglandin pathway and can worsen hypotension.

Why is "A cetirizine tablet before the dose" not the answer?

Histamine is not the main mediator, so an antihistamine gives little relief.

What concept does this question test?

It tests Cardiology: niacin flushing in General Medicine. Aspirin, taken about 30 minutes before the dose, blocks prostaglandin synthesis, while antihistamines are of little use. Taking the dose with food also helps.

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 Cardiology: niacin flushing?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General 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.