Drugs in pregnancy: hydroxychloroquine in lupus: 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: hydroxychloroquine in lupus

Sample item

A woman with SLE in remission on hydroxychloroquine finds she is 6 weeks pregnant and asks if she should stop it. What is the best advice?

ASwitch to methotrexateBContinue it, since stopping raises the risk of lupus flareCStop it and start cyclophosphamideDStop it at once because it is teratogenic

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

The answer and the reasoning

B. Continue it, since stopping raises the risk of lupus flare

Hydroxychloroquine is considered compatible with pregnancy and lactation, and continuing it reduces flares and may lower the risk of congenital heart block in anti-Ro positive women. Cyclophosphamide and methotrexate are teratogenic.

Option by option

A. Switch to methotrexate
Methotrexate is teratogenic and is contraindicated in pregnancy.
B. Continue it, since stopping raises the risk of lupus flare (correct)
Correct. Hydroxychloroquine is compatible with pregnancy and reduces flares.
C. Stop it and start cyclophosphamide
Cyclophosphamide is teratogenic and is not a substitute for a well-controlled patient.
D. Stop it at once because it is teratogenic
It is not considered teratogenic at therapeutic doses, and stopping increases flare risk.

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 B, Continue it, since stopping raises the risk of lupus flare. Hydroxychloroquine is considered compatible with pregnancy and lactation, and continuing it reduces flares and may lower the risk of congenital heart block in anti-Ro positive women.

Why is "Switch to methotrexate" not the answer?

Methotrexate is teratogenic and is contraindicated in pregnancy.

Why is "Stop it and start cyclophosphamide" not the answer?

Cyclophosphamide is teratogenic and is not a substitute for a well-controlled patient.

Why is "Stop it at once because it is teratogenic" not the answer?

It is not considered teratogenic at therapeutic doses, and stopping increases flare risk.

What concept does this question test?

It tests Drugs in pregnancy: hydroxychloroquine in lupus in Pharmacology. Cyclophosphamide and methotrexate are teratogenic.

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: hydroxychloroquine in lupus?

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.