Drugs in pregnancy: leflunomide washout: 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 · Drugs in pregnancy: leflunomide washout

Sample item

A woman with rheumatoid arthritis on leflunomide wishes to conceive. Because the active metabolite persists in the body for months, which drug is used to accelerate its elimination?

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

The answer and the reasoning

C. Cholestyramine

Teriflunomide, the active metabolite of leflunomide, has a very long half-life because of enterohepatic recirculation. Cholestyramine binds it in the gut, interrupting this cycle and lowering the level quickly, and plasma levels are checked before conception.

Option by option

  • A. Folinic acid

    Folinic acid rescues cells from methotrexate and does not remove teriflunomide.

  • B. Probenecid

    Probenecid blocks renal tubular secretion of organic acids and would not accelerate elimination.

  • C. Cholestyramine (correct)

    Correct. Cholestyramine interrupts enterohepatic recirculation of teriflunomide.

  • D. Sodium bicarbonate

    Sodium bicarbonate alkalinises urine, which helps weak acids such as salicylate, not teriflunomide.

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, Cholestyramine. Teriflunomide, the active metabolite of leflunomide, has a very long half-life because of enterohepatic recirculation.

Why is "Folinic acid" not the answer?

Folinic acid rescues cells from methotrexate and does not remove teriflunomide.

Why is "Probenecid" not the answer?

Probenecid blocks renal tubular secretion of organic acids and would not accelerate elimination.

Why is "Sodium bicarbonate" not the answer?

Sodium bicarbonate alkalinises urine, which helps weak acids such as salicylate, not teriflunomide.

What concept does this question test?

It tests Drugs in pregnancy: leflunomide washout in Pharmacology. Cholestyramine binds it in the gut, interrupting this cycle and lowering the level quickly, and plasma levels are checked before conception.

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 Drugs in pregnancy: leflunomide washout?

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.