Cardiovascular drugs: P2Y12 inhibitors and prior stroke: 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 · Cardiovascular drugs: P2Y12 inhibitors and prior stroke

Sample item

A 70-year-old man with an ischaemic stroke six months ago presents with an NSTEMI, and PCI is planned. Which P2Y12 inhibitor is contraindicated because it increases intracranial bleeding in patients with a previous stroke or TIA?

ATicagrelorBPrasugrelCCangrelorDClopidogrel

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

The answer and the reasoning

B. Prasugrel

Prasugrel gives faster and stronger platelet inhibition than clopidogrel but increased major and fatal bleeding in patients with previous stroke or TIA, so it is contraindicated in them. Clopidogrel remains the usual choice after stroke. Age over 75 years and low body weight also call for caution.

Option by option

A. Ticagrelor
Ticagrelor is not contraindicated by a previous ischaemic stroke.
B. Prasugrel (correct)
Correct. It is contraindicated after prior stroke or TIA because of intracranial haemorrhage.
C. Cangrelor
Cangrelor is a short-acting intravenous agent without this contraindication.
D. Clopidogrel
Clopidogrel is the usual P2Y12 inhibitor in patients with prior cerebrovascular disease.

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, Prasugrel. Prasugrel gives faster and stronger platelet inhibition than clopidogrel but increased major and fatal bleeding in patients with previous stroke or TIA, so it is contraindicated in them.

Why is "Ticagrelor" not the answer?

Ticagrelor is not contraindicated by a previous ischaemic stroke.

Why is "Cangrelor" not the answer?

Cangrelor is a short-acting intravenous agent without this contraindication.

Why is "Clopidogrel" not the answer?

Clopidogrel is the usual P2Y12 inhibitor in patients with prior cerebrovascular disease.

What concept does this question test?

It tests Cardiovascular drugs: P2Y12 inhibitors and prior stroke in Pharmacology. Clopidogrel remains the usual choice after stroke. Age over 75 years and low body weight also call for caution.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Cardiovascular drugs: P2Y12 inhibitors and prior stroke?

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.