Cardiovascular drugs: nitrate tolerance in workers: 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: nitrate tolerance in workers

Sample item

Workers in a nitroglycerin factory get headache and dizziness on Monday that settle by the end of the week and return after the weekend break. What explains this pattern?

AAllergy that builds up during the working weekBTolerance that fades during time off workCInduction of hepatic enzymes that persists for weeksDAccumulation of nitrite in the blood over days

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

The answer and the reasoning

B. Tolerance that fades during time off work

Continuous exposure to organic nitrates produces tolerance through depletion of sulfhydryl groups and generation of free radicals. Tolerance is lost within a day or two off exposure, so symptoms return on Monday. Therapeutic nitrates use a nitrate-free interval for the same reason.

Option by option

A. Allergy that builds up during the working week
Allergy would worsen with repeated exposure rather than settle.
B. Tolerance that fades during time off work (correct)
Correct. Tolerance builds with continuous exposure and fades after a short break.
C. Induction of hepatic enzymes that persists for weeks
Enzyme induction would not vanish over a weekend.
D. Accumulation of nitrite in the blood over days
Nitrite accumulation would cause worsening methaemoglobinaemia, not improvement.

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, Tolerance that fades during time off work. Continuous exposure to organic nitrates produces tolerance through depletion of sulfhydryl groups and generation of free radicals.

Why is "Allergy that builds up during the working week" not the answer?

Allergy would worsen with repeated exposure rather than settle.

Why is "Induction of hepatic enzymes that persists for weeks" not the answer?

Enzyme induction would not vanish over a weekend.

Why is "Accumulation of nitrite in the blood over days" not the answer?

Nitrite accumulation would cause worsening methaemoglobinaemia, not improvement.

What concept does this question test?

It tests Cardiovascular drugs: nitrate tolerance in workers in Pharmacology. Tolerance is lost within a day or two off exposure, so symptoms return on Monday. Therapeutic nitrates use a nitrate-free interval for the same reason.

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 Cardiovascular drugs: nitrate tolerance in workers?

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.