Substance use: buprenorphine formulation: practice question

A Psychiatry 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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Psychiatry · Substance use: buprenorphine formulation

Sample item

A patient with opioid dependence is started on buprenorphine tablets that must be dissolved under the tongue and not swallowed. What is the reason for this route?

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

The answer and the reasoning

D. Swallowed drug undergoes extensive first-pass metabolism, with poor oral bioavailability

Buprenorphine has extensive first-pass hepatic metabolism, so oral bioavailability is very low. Sublingual absorption avoids this, giving effective plasma levels. The naloxone in combination tablets is poorly absorbed sublingually but precipitates withdrawal if injected.

Option by option

  • A. Swallowing causes immediate respiratory depression

    Swallowing does not cause respiratory depression; it simply loses most of the dose.

  • B. The drug is destroyed completely by gastric acid

    Gastric acid is not the reason; hepatic first-pass metabolism is.

  • C. Sublingual absorption bypasses the blood-brain barrier

    Sublingual drug still crosses the blood-brain barrier to reach the brain.

  • D. Swallowed drug undergoes extensive first-pass metabolism, with poor oral bioavailability (correct)

    Correct. Sublingual dosing bypasses first-pass metabolism.

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 Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Swallowed drug undergoes extensive first-pass metabolism, with poor oral bioavailability. Buprenorphine has extensive first-pass hepatic metabolism, so oral bioavailability is very low.

Why is "Swallowing causes immediate respiratory depression" not the answer?

Swallowing does not cause respiratory depression; it simply loses most of the dose.

Why is "The drug is destroyed completely by gastric acid" not the answer?

Gastric acid is not the reason; hepatic first-pass metabolism is.

Why is "Sublingual absorption bypasses the blood-brain barrier" not the answer?

Sublingual drug still crosses the blood-brain barrier to reach the brain.

What concept does this question test?

It tests Substance use: buprenorphine formulation in Psychiatry. Sublingual absorption avoids this, giving effective plasma levels. The naloxone in combination tablets is poorly absorbed sublingually but precipitates withdrawal if injected.

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 Substance use: buprenorphine formulation?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry 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.