Substance use: cocaine with alcohol: 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: cocaine with alcohol

Sample item

A 30-year-old man who drank heavily while using cocaine develops chest pain and an arrhythmia. A toxicologist says a metabolite formed only when the two are combined increased the cardiotoxicity. What is this metabolite?

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

The answer and the reasoning

A. Cocaethylene

When cocaine and alcohol are taken together, hepatic transesterification forms cocaethylene, which is more cardiotoxic and has a longer action than cocaine alone. Benzoylecgonine is the inactive urinary metabolite used in drug screens.

Option by option

  • A. Cocaethylene (correct)

    Correct. Cocaethylene forms only when cocaine and alcohol are combined.

  • B. Acetaldehyde

    Acetaldehyde is a metabolite of ethanol and is not specific to the combination.

  • C. Norcocaine

    Norcocaine is a minor active metabolite formed by demethylation, with or without alcohol.

  • D. Benzoylecgonine

    Benzoylecgonine is the inactive metabolite detected in urine screens.

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 A, Cocaethylene. When cocaine and alcohol are taken together, hepatic transesterification forms cocaethylene, which is more cardiotoxic and has a longer action than cocaine alone.

Why is "Acetaldehyde" not the answer?

Acetaldehyde is a metabolite of ethanol and is not specific to the combination.

Why is "Norcocaine" not the answer?

Norcocaine is a minor active metabolite formed by demethylation, with or without alcohol.

Why is "Benzoylecgonine" not the answer?

Benzoylecgonine is the inactive metabolite detected in urine screens.

What concept does this question test?

It tests Substance use: cocaine with alcohol in Psychiatry. Benzoylecgonine is the inactive urinary metabolite used in drug screens.

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 Substance use: cocaine with alcohol?

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.