Autonomic nervous system: ACE inhibitor structure and taste disturbance: 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.

Try it

Pharmacology · Autonomic nervous system: ACE inhibitor structure and taste disturbance

Sample item

A hypertensive man on an ACE inhibitor complains of a metallic taste and has a maculopapular rash. Which structural feature of the drug is held responsible for these effects?

AA sulfhydryl groupBAn ethyl ester prodrug linkageCA phosphinyl groupDA tetrazole ring

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

The answer and the reasoning

A. A sulfhydryl group

Captopril is the only common ACE inhibitor with a sulfhydryl (thiol) group, which is blamed for taste disturbance, rash and rarely neutropenia and proteinuria. Fosinopril carries a phosphinyl group, and many others are ester prodrugs. A tetrazole ring is found in angiotensin receptor blockers.

Option by option

A. A sulfhydryl group (correct)
Correct. The thiol group of captopril is linked to dysgeusia and rash.
B. An ethyl ester prodrug linkage
An ester linkage makes a prodrug, as in enalapril, and does not cause taste disturbance.
C. A phosphinyl group
A phosphinyl group is found in fosinopril and is not linked to taste change.
D. A tetrazole ring
A tetrazole ring belongs to losartan-type receptor blockers, not to ACE inhibitors.

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, A sulfhydryl group. Captopril is the only common ACE inhibitor with a sulfhydryl (thiol) group, which is blamed for taste disturbance, rash and rarely neutropenia and proteinuria.

Why is "An ethyl ester prodrug linkage" not the answer?

An ester linkage makes a prodrug, as in enalapril, and does not cause taste disturbance.

Why is "A phosphinyl group" not the answer?

A phosphinyl group is found in fosinopril and is not linked to taste change.

Why is "A tetrazole ring" not the answer?

A tetrazole ring belongs to losartan-type receptor blockers, not to ACE inhibitors.

What concept does this question test?

It tests Autonomic nervous system: ACE inhibitor structure and taste disturbance in Pharmacology. Fosinopril carries a phosphinyl group, and many others are ester prodrugs. A tetrazole ring is found in angiotensin receptor blockers.

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 Autonomic nervous system: ACE inhibitor structure and taste disturbance?

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.