Endocrine drugs: transdermal oestrogen and thrombosis: 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: transdermal oestrogen and thrombosis

Sample item

A 52-year-old woman with obesity needs menopausal hormone therapy and the clinician wants the lowest additional thrombotic risk. Which route and reasoning are best?

ATransdermal oestradiol, as it bypasses the liverBOral conjugated oestrogen, which has no hepatic effectCOral ethinyloestradiol, which is hepatically inertDIntramuscular testosterone, which is oestrogen-sparing

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

The answer and the reasoning

A. Transdermal oestradiol, as it bypasses the liver

Oral oestrogen passes through the liver and raises clotting factors and other hepatic proteins, increasing venous thromboembolism risk. Transdermal oestradiol avoids first-pass metabolism and carries little or no additional VTE risk, particularly relevant in obesity.

Option by option

A. Transdermal oestradiol, as it bypasses the liver (correct)
Correct. Transdermal delivery bypasses first-pass hepatic effects on coagulation.
B. Oral conjugated oestrogen, which has no hepatic effect
Oral oestrogens do act on the liver and increase clotting factor synthesis.
C. Oral ethinyloestradiol, which is hepatically inert
Ethinyloestradiol has marked hepatic effects and a higher thrombotic risk.
D. Intramuscular testosterone, which is oestrogen-sparing
Testosterone is not a menopausal oestrogen therapy and does not treat vasomotor symptoms reliably.

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 A, Transdermal oestradiol, as it bypasses the liver. Oral oestrogen passes through the liver and raises clotting factors and other hepatic proteins, increasing venous thromboembolism risk.

Why is "Oral conjugated oestrogen, which has no hepatic effect" not the answer?

Oral oestrogens do act on the liver and increase clotting factor synthesis.

Why is "Oral ethinyloestradiol, which is hepatically inert" not the answer?

Ethinyloestradiol has marked hepatic effects and a higher thrombotic risk.

Why is "Intramuscular testosterone, which is oestrogen-sparing" not the answer?

Testosterone is not a menopausal oestrogen therapy and does not treat vasomotor symptoms reliably.

What concept does this question test?

It tests Endocrine drugs: transdermal oestrogen and thrombosis in Pharmacology. Transdermal oestradiol avoids first-pass metabolism and carries little or no additional VTE risk, particularly relevant in obesity.

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 Endocrine drugs: transdermal oestrogen and thrombosis?

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.