Psychopharmacology: benzodiazepines in liver disease: 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 · Psychopharmacology: benzodiazepines in liver disease

Sample item

A patient with alcoholic cirrhosis needs a benzodiazepine for withdrawal. Which choice is safest because it does not undergo hepatic oxidation?

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

The answer and the reasoning

B. Lorazepam

Lorazepam, oxazepam and temazepam (LOT) are metabolised mainly by glucuronidation, which is spared in liver disease and the elderly, and they have no active metabolites. Diazepam and chlordiazepoxide have long-acting active metabolites that accumulate.

Option by option

  • A. Chlordiazepoxide

    Chlordiazepoxide is oxidised and has long-acting metabolites.

  • B. Lorazepam (correct)

    Correct. Lorazepam is conjugated directly and is preferred in hepatic impairment.

  • C. Diazepam

    Diazepam undergoes oxidation with active metabolites that accumulate.

  • D. Flurazepam

    Flurazepam has a very long-acting active metabolite.

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 B, Lorazepam. Lorazepam, oxazepam and temazepam (LOT) are metabolised mainly by glucuronidation, which is spared in liver disease and the elderly, and they have no active metabolites.

Why is "Chlordiazepoxide" not the answer?

Chlordiazepoxide is oxidised and has long-acting metabolites.

Why is "Diazepam" not the answer?

Diazepam undergoes oxidation with active metabolites that accumulate.

Why is "Flurazepam" not the answer?

Flurazepam has a very long-acting active metabolite.

What concept does this question test?

It tests Psychopharmacology: benzodiazepines in liver disease in Psychiatry. Diazepam and chlordiazepoxide have long-acting active metabolites that accumulate.

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 Psychopharmacology: benzodiazepines in liver disease?

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.