Central Nervous System Pharmacology Practice Questions

Q: Rivastigmine & donepezil are drugs used predominantly in the management of ?

Dementia. ***Dementia*** - **Rivastigmine** and **donepezil** are **acetylcholinesterase inhibitors** that increase acetylcholine levels in the brain. - This mechanism is primarily used to improve **cognitive function** in patients with **Alzheimer's disease** and other forms of dementia. *Dissociation* - Dissociation involves a mental process causing a lack of connection between thoughts, memory, and identity, and is not typically treated with cholinesterase inhibitors. - Management often involves **psychotherapy** and sometimes anti-anxiety medications or antidepressants, if comorbid conditions are present. *Delusions* - Delusions are fixed, false beliefs often associated with psychotic disorders like **schizophrenia** or severe mood disorders. - Treatment primarily involves **antipsychotic medications**, not acetylcholinesterase inhibitors. *Depression* - Depression is a mood disorder characterized by persistent sadness and loss of interest. - It is typically treated with **antidepressants** (e.g., SSRIs, SNRIs), psychotherapy, or lifestyle changes, none of which include rivastigmine or donepezil.

Q: All of the following can be used in increased intracranial tension (ICT) except:

Ketamine. ***Ketamine*** - **Ketamine** is known to increase **cerebral blood flow** and **intracranial pressure (ICP)**, making it contraindicated in situations of increased ICT. - Its mechanism involves **cerebral vasodilation** and direct central nervous system stimulation, which can exacerbate existing intracranial hypertension. *Thiopentone* - **Thiopentone** is a barbiturate that reduces cerebral metabolic rate, leading to decreased **cerebral blood flow** and **ICP**. - It is often used for neuroprotection and to manage acute increases in ICT due to its potent vasoconstrictive effects on cerebral vessels. *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** that reduces **cerebrospinal fluid (CSF) production**, thus lowering ICT. - It is particularly useful in conditions like **idiopathic intracranial hypertension (pseudotumor cerebri)** where CSF overproduction contributes to elevated pressure. *Mannitol* - **Mannitol** is an **osmotic diuretic** that creates an osmotic gradient, drawing water from the brain parenchyma into the intravascular space, thereby reducing brain volume and **ICP**. - It is a rapid-acting agent frequently used in emergency settings for acute management of increased ICT.

Q: Which of the following is used in the treatment of Multiple Sclerosis:

Interferon Beta. ***Interferon Beta*** - **Interferon beta** is a disease-modifying therapy commonly used for **relapsing-remitting multiple sclerosis (RRMS)** to reduce the frequency and severity of relapses. - It works by modulating the immune system, decreasing inflammation and preventing demyelination in the central nervous system. *Interferon Alpha* - **Interferon alpha** is primarily used in the treatment of certain **cancers** (e.g., leukemia, melanoma) and **viral infections** (e.g., chronic hepatitis B and C). - It does not have a recognized role in the standard treatment protocols for multiple sclerosis. *Infliximab* - **Infliximab** is a **monoclonal antibody** that targets **tumor necrosis factor-alpha (TNF-α)** and is used in the treatment of inflammatory conditions like rheumatoid arthritis, Crohn's disease, and ulcerative colitis. - While TNF-α plays a role in inflammation, **anti-TNF therapy** has been shown to potentially worsen MS and is generally contraindicated. *Interferon gamma* - **Interferon gamma** is a pro-inflammatory cytokine that can exacerbate MS symptoms and **increase disease activity**. - It is **not used** in the treatment of multiple sclerosis and in fact, some studies suggest it may be detrimental.

Q: Which of the following drugs is commonly used in narcoanalysis?

Thiopentone. ***Thiopentone*** - **Thiopentone** (a **barbiturate**) is commonly used in narcoanalysis due to its ability to induce a **trance-like state**, lowering inhibitions and making individuals more suggestible. - In this state, it's believed that a person's conscious defenses are reduced, potentially leading to the disclosure of information that might otherwise be withheld. *Scopolamine* - While sometimes referred to as "truth serum," **scopolamine** (an **anticholinergic**) primarily causes disorientation, confusion, and amnesia, making it unsuitable for reliable information extraction in narcoanalysis. - Its effects can lead to unreliable and hallucinated responses rather than factual memories. *Opium* - **Opium** is a narcotic analgesic that causes sedation and euphoria but does not reliably facilitate the extraction of truthful information for investigative purposes. - It can depress the central nervous system, but the effects are not conducive to a clear, communicative state required for narcoanalysis. *Atropine* - **Atropine** is an **anticholinergic** drug primarily used to block muscarinic acetylcholine receptors, leading to effects like pupil dilation, dry mouth, and increased heart rate. - It does not induce the specific mental state required for narcoanalysis and would instead cause significant physiological side effects and confusion.

Q: Which is given to prevent relapse in multiple sclerosis?

IFN-beta. ***Correct: IFN-beta*** - **Interferon-beta** is a disease-modifying therapy (DMT) commonly prescribed to **reduce the frequency and severity of relapses** and slow disease progression in **relapsing-remitting multiple sclerosis (RRMS)** [1], [2]. - Its mechanism of action involves **modulating the immune system**, reducing inflammation, and preventing immune cells from attacking the myelin sheath in the central nervous system. *Incorrect: Corticosteroids* - **Corticosteroids** (e.g., methylprednisolone) are primarily used for **acute treatment of MS relapses** to shorten their duration and severity, not for long-term relapse prevention [1]. - Their long-term use is limited by significant side effects, making them unsuitable as chronic preventive therapy [1]. *Incorrect: IFN-gamma* - **Interferon-gamma** has been shown to **exacerbate MS symptoms** and increase relapse rates, making it contraindicated in MS treatment. - It promotes a **pro-inflammatory immune response**, which is detrimental in an autoimmune demyelinating disease like MS. *Incorrect: Cyclosporine* - **Cyclosporine** is an immunosuppressant primarily used to prevent **organ transplant rejection** and in some severe autoimmune conditions. - While it has immunomodulatory properties, it is **not a first-line or standard treatment for MS relapse prevention** due to its significant toxicity profile (e.g., nephrotoxicity) and less favorable efficacy compared to approved DMTs.

Q: All of the following are Anticholinesterases used in Alzheimer's disease except

Memantine. ***Memantine*** - While used in Alzheimer's disease, **memantine** is an **NMDA receptor antagonist**, not an anticholinesterase. - It works by blocking excessive **glutamatergic stimulation**, which is implicated in neurodegeneration. *Donepezil* - **Donepezil** is an **acetylcholinesterase inhibitor** used to treat mild to moderate Alzheimer's disease. - It increases the availability of **acetylcholine** in the synaptic cleft, improving cognitive function. *Rivastigmine* - **Rivastigmine** is a **cholinesterase inhibitor** that acts on both **acetylcholinesterase** and **butyrylcholinesterase**. - It is approved for the treatment of mild to moderate Alzheimer's disease and Parkinson's disease dementia. *Galantamine* - **Galantamine** is an **acetylcholinesterase inhibitor** and an **allosteric potentiator of nicotinic acetylcholine receptors**. - It enhances cholinergic neurotransmission and is used in the treatment of mild to moderate Alzheimer's disease.

Q: All of the following can be used for prophylaxis of migraine except

Sumatriptan. ***Sumatriptan*** - Sumatriptan is a **triptan**, a class of drugs primarily used for the **acute treatment** of migraine attacks, not for prophylaxis. - It works by constricting intracranial blood vessels and inhibiting pro-inflammatory neuropeptide release. *Topiramate* - **Topiramate** is an **antiepileptic drug** commonly used for migraine prophylaxis, especially in patients with associated epilepsy. - Its mechanism of action involves various pathways, including modulation of **GABA** and **glutamate** receptors. *Valproate* - **Valproate** (Divalproex sodium) is another **antiepileptic drug** effective in preventing migraine headaches. - It works by increasing **GABA** levels in the brain and stabilizing neuronal membranes. *Propranolol* - **Propranolol** is a **beta-blocker** widely used for migraine prophylaxis, particularly in patients with co-occurring hypertension or anxiety. - It acts by preventing cerebral vasodilation and influencing central serotonergic pathways.

Q: Opioid antagonist that can be given orally –

Naltrexone. ***Naltrexone*** - **Naltrexone** is an opioid antagonist used for treating **opioid dependence** and alcohol dependence. - It has good oral bioavailability and is administered orally, typically as a daily dose. *Pentazocine* - **Pentazocine** is an opioid agonist-antagonist, primarily acting as an **agonist** at kappa opioid receptors and a weak antagonist or partial agonist at mu opioid receptors. - It is not a pure opioid antagonist and thus cannot reverse opioid effects effectively. *Naloxone* - **Naloxone** is a pure opioid antagonist primarily used to reverse **acute opioid overdose** due to its rapid onset and short duration of action. - While it can be given orally, it has very **low oral bioavailability** due to extensive first-pass metabolism, making it unsuitable for chronic oral administration. *Nalbuphine* - **Nalbuphine** is an opioid agonist-antagonist, similar to pentazocine, acting as an **agonist** at kappa opioid receptors and an antagonist at mu opioid receptors. - It is typically administered parenterally for pain relief and is not used as an oral opioid antagonist.

Q: A young male, Farhan, suffers from a seizure disorder which is characterized by tonic rigidity of limbs followed in 20-30 seconds by tremors progressing to massive jerking of the body. This clonic phase lasts for 1-3 minutes. The anti-seizure drug of choice for this patient is:

Valproic acid. ***Valproic acid***\n- The description of tonic rigidity followed by tremors and massive jerking of the body is characteristic of a **generalized tonic-clonic seizure (GTCS)** [1], [2].\n- **Valproic acid** is a **broad-spectrum antiepileptic drug** and is considered the **drug of choice** for GTCS due to its efficacy across multiple seizure types and favorable profile for long-term management [1].\n- It is the **most commonly recommended first-line agent** for newly diagnosed GTCS in most clinical guidelines [1].\n\n*Clonazepam*\n- **Clonazepam** is a benzodiazepine primarily used for absence seizures, myoclonic seizures, and status epilepticus [1].\n- While it has broad anti-seizure activity, it is **not first-line monotherapy** for long-term management of GTCS due to concerns about **tolerance, dependence, and sedation** [1].\n\n*Ethosuximide*\n- **Ethosuximide** is **specifically indicated only for absence seizures** (petit mal seizures).\n- It has **no efficacy against tonic-clonic seizures** and would be completely inappropriate for this patient.\n\n*Fosphenytoin*\n- **Fosphenytoin** is a prodrug of phenytoin and is an effective treatment for generalized tonic-clonic seizures [1].\n- While phenytoin/fosphenytoin is a valid first-line option for GTCS, **valproic acid is generally preferred** as the drug of choice due to its **broader spectrum of activity**, better tolerability profile, and effectiveness across more seizure types [1].\n- Fosphenytoin is commonly used in both acute management (status epilepticus) and chronic therapy, but requires monitoring for side effects like gingival hyperplasia, hirsutism, and drug interactions.

Q: All of the following drugs are used in prophylaxis of migraine, except

Levetiracetam. ***Levetiracetam*** - **Levetiracetam** is an antiepileptic drug primarily used for the treatment of seizures. - It is **not indicated** or commonly used for the prophylaxis of migraine. *Propranolol* - **Propranolol** is a non-selective beta-blocker that is a well-established and effective medication for migraine prophylaxis. - It helps reduce the frequency and severity of migraine attacks. *Topiramate* - **Topiramate** is an antiepileptic drug that is also approved and widely used for migraine prophylaxis. - Its mechanism of action in migraine prevention includes modulating neurotransmitters and ion channels. *Flunarizine* - **Flunarizine** is a calcium channel blocker commonly used for migraine prophylaxis, especially in Europe and other regions. - It helps stabilize vascular tone and neuronal excitability, reducing migraine frequency.

Question 1

Rivastigmine & donepezil are drugs used predominantly in the management of ?

Accepted Answer

Dementia

Answer

Dissociation

Answer

Delusions

Answer

Depression

Question 2

All of the following can be used in increased intracranial tension (ICT) except:

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Acetazolamide

Answer

Mannitol

Question 3

Which of the following is used in the treatment of Multiple Sclerosis:

Accepted Answer

Interferon Beta

Answer

Interferon Alpha

Answer

Infliximab

Answer

Interferon gamma

Question 4

Which of the following drugs is commonly used in narcoanalysis?

Accepted Answer

Thiopentone

Answer

Scopolamine

Answer

Opium

Answer

Atropine

Question 5

Which is given to prevent relapse in multiple sclerosis?

Accepted Answer

IFN-beta

Answer

Corticosteroids

Answer

IFN-gamma

Answer

Cyclosporine

Question 6

All of the following are Anticholinesterases used in Alzheimer's disease except

Accepted Answer

Memantine

Answer

Donepezil

Answer

Rivastigmine

Answer

Galantamine

Question 7

All of the following can be used for prophylaxis of migraine except

Accepted Answer

Sumatriptan

Answer

Topiramate

Answer

Valproate

Answer

Propranolol

Question 8

Opioid antagonist that can be given orally –

Accepted Answer

Naltrexone

Answer

Pentazocine

Answer

Naloxone

Answer

Nalbuphine

Question 9

A young male, Farhan, suffers from a seizure disorder which is characterized by tonic rigidity of limbs followed in 20-30 seconds by tremors progressing to massive jerking of the body. This clonic phase lasts for 1-3 minutes. The anti-seizure drug of choice for this patient is:

Accepted Answer

Valproic acid

Answer

Clonazepam

Answer

Ethosuximide

Answer

Fosphenytoin

Question 10

All of the following drugs are used in prophylaxis of migraine, except

Accepted Answer

Levetiracetam

Answer

Propranolol

Answer

Topiramate

Answer

Flunarizine

Central Nervous System Pharmacology — MCQs

Central Nervous System Pharmacology — MCQs

On this page

Practice by Chapter

Want unlimited practice?