Cardiovascular drugs: ticagrelor adverse effect: 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: ticagrelor adverse effect

Sample item

A man with acute coronary syndrome on aspirin and a reversible P2Y12 antagonist complains of breathlessness. His chest is clear, and ECG, chest film and echocardiogram are unchanged. Which mechanism is proposed for the dyspnoea?

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

The answer and the reasoning

A. Raised adenosine levels from reduced cellular uptake

Ticagrelor is a reversible P2Y12 antagonist that also inhibits adenosine uptake into cells. Raised adenosine is thought to stimulate pulmonary sensory nerves and cause dyspnoea in a sizeable minority of patients, usually mild and without lung disease. It rarely needs withdrawal.

Option by option

  • A. Raised adenosine levels from reduced cellular uptake (correct)

    Correct. Inhibited adenosine reuptake raises adenosine and produces breathlessness without lung pathology.

  • B. Fluid retention from sodium channel activation

    Fluid retention would produce oedema and radiographic changes.

  • C. Pulmonary fibrosis from the antiplatelet agent

    Pulmonary fibrosis is not a feature of P2Y12 antagonists.

  • D. Bronchospasm from cyclo-oxygenase inhibition

    Aspirin-induced bronchospasm would produce wheeze, which is absent here.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Raised adenosine levels from reduced cellular uptake. Ticagrelor is a reversible P2Y12 antagonist that also inhibits adenosine uptake into cells.

Why is "Fluid retention from sodium channel activation" not the answer?

Fluid retention would produce oedema and radiographic changes.

Why is "Pulmonary fibrosis from the antiplatelet agent" not the answer?

Pulmonary fibrosis is not a feature of P2Y12 antagonists.

Why is "Bronchospasm from cyclo-oxygenase inhibition" not the answer?

Aspirin-induced bronchospasm would produce wheeze, which is absent here.

What concept does this question test?

It tests Cardiovascular drugs: ticagrelor adverse effect in Pharmacology. Raised adenosine is thought to stimulate pulmonary sensory nerves and cause dyspnoea in a sizeable minority of patients, usually mild and without lung disease. It rarely needs withdrawal.

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: ticagrelor adverse effect?

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.