Cyproheptadine hydrochloride MCQs With Answer is a focused study aid for B.Pharm students exploring this first‑generation H1 antihistamine with notable antiserotonergic and anticholinergic properties. This introduction covers mechanism of action, pharmacokinetics, clinical uses (allergic disorders, appetite stimulation, adjunct in serotonin syndrome), adverse effects (sedation, dry mouth, anticholinergic effects), drug interactions, toxicity and management. Emphasis is placed on receptor pharmacology, hepatic metabolism, monitoring considerations, contraindications and prudent use in special populations. These targeted questions help build deeper understanding for exams and clinical practice. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which best describes the primary pharmacological action of cyproheptadine?
- Selective H2 receptor agonist
- H1 antihistamine and 5‑HT2 (serotonin) receptor antagonist
- Beta‑adrenergic blocker with antihistamine activity
- Monoamine oxidase inhibitor
Correct Answer: H1 antihistamine and 5‑HT2 (serotonin) receptor antagonist
Q2. Which clinical indication is commonly associated with cyproheptadine use?
- Type 1 diabetes mellitus
- Allergic rhinitis and appetite stimulation
- Anticoagulation for deep vein thrombosis
- First‑line therapy for bacterial infections
Correct Answer: Allergic rhinitis and appetite stimulation
Q3. The appetite‑stimulating effect of cyproheptadine is primarily due to antagonism of which receptor?
- Beta‑2 adrenergic receptor
- H1 histamine receptor
- 5‑HT2 serotonin receptor
- D2 dopamine receptor
Correct Answer: 5‑HT2 serotonin receptor
Q4. Which adverse effect is most frequently observed with cyproheptadine therapy?
- Severe hypertension
- Extrapyramidal symptoms
- Marked sedation
- Hypoglycemia
Correct Answer: Marked sedation
Q5. Cyproheptadine should be used cautiously or avoided in patients with which condition due to its anticholinergic activity?
- Chronic otitis media
- Narrow‑angle glaucoma
- Hyperthyroidism
- Iron deficiency anemia
Correct Answer: Narrow‑angle glaucoma
Q6. The primary route of metabolism for cyproheptadine is:
- Renal tubular secretion of unchanged drug
- Hepatic metabolism (CYP mediated) with formation of metabolites
- Exhalation unchanged via lungs
- Metabolism by intestinal flora only
Correct Answer: Hepatic metabolism (CYP mediated) with formation of metabolites
Q7. What is the approximate elimination half‑life of cyproheptadine in adults?
- 15 minutes
- 1–2 hours
- Approximately 8 hours
- 3–4 days
Correct Answer: Approximately 8 hours
Q8. In cases of severe anticholinergic delirium due to cyproheptadine overdose, which agent may be used as a specific antidotal therapy?
- Flumazenil
- Naloxone
- Physostigmine (acetylcholinesterase inhibitor)
- Activated charcoal only
Correct Answer: Physostigmine (acetylcholinesterase inhibitor)
Q9. Which class of concomitant medications increases the risk of additive sedation when taken with cyproheptadine?
- CNS depressants such as benzodiazepines and alcohol
- Oral contraceptives
- Topical antibiotics
- Proton pump inhibitors
Correct Answer: CNS depressants such as benzodiazepines and alcohol
Q10. Which common oral dosage form and strength is cyproheptadine typically supplied as?
- 100 mg extended‑release tablet
- 4 mg oral tablet
- 1 mg/mL intravenous solution
- 250 mg intramuscular depot injection
Correct Answer: 4 mg oral tablet
Q11. What is the usual onset of action after oral administration of cyproheptadine?
- 15–60 minutes
- 24–48 hours
- One week
- Within seconds
Correct Answer: 15–60 minutes
Q12. In the management of serotonin syndrome, cyproheptadine is used because it antagonizes which receptor involved in serotonin‑mediated toxicity?
- NMDA receptor
- 5‑HT2 receptor
- GABA‑A receptor
- H2 receptor
Correct Answer: 5‑HT2 receptor
Q13. Which of the following is NOT a typical pharmacological effect of cyproheptadine?
- Antihistaminic (H1) effects
- Antiserotonergic (5‑HT2) effects
- Muscarinic receptor antagonism (anticholinergic)
- Direct beta‑cell insulin secretion stimulation
Correct Answer: Direct beta‑cell insulin secretion stimulation
Q14. Which population requires extra caution when prescribing cyproheptadine due to increased sensitivity to anticholinergic and sedative effects?
- Healthy young adults aged 20–30
- Elderly patients
- Professional athletes
- Patients with well‑controlled hypertension only
Correct Answer: Elderly patients
Q15. The anticholinergic adverse effects of cyproheptadine (e.g., dry mouth, urinary retention) are due to blockade of which receptor type?
- Muscarinic acetylcholine receptors
- Nicotinic acetylcholine receptors
- Opioid receptors
- Serotonin 5‑HT3 receptors
Correct Answer: Muscarinic acetylcholine receptors
Q16. Cyproheptadine has been used off‑label in migraine management primarily because of its action on which neurotransmitter system?
- Dopaminergic D1 receptor agonism
- Serotonergic (5‑HT2) blockade
- Glycine receptor potentiation
- Enhancement of glutamate release
Correct Answer: Serotonergic (5‑HT2) blockade
Q17. Is routine therapeutic drug monitoring (blood levels) required for cyproheptadine in clinical practice?
- Yes, mandatory for all patients
- No, routine therapeutic drug monitoring is not required
- Only via cerebrospinal fluid measurements
- Yes, daily serum levels are standard
Correct Answer: No, routine therapeutic drug monitoring is not required
Q18. Which statement accurately describes the elimination of cyproheptadine?
- Eliminated unchanged exclusively in feces
- Primarily metabolized in liver; metabolites excreted in urine and bile
- Excreted unchanged via sweat
- Completely metabolized to carbon dioxide and water only
Correct Answer: Primarily metabolized in liver; metabolites excreted in urine and bile
Q19. Cyproheptadine belongs to which class of antihistamines?
- Second‑generation selective H1 antihistamines
- First‑generation H1 antihistamines
- H2 receptor antagonists
- Corticosteroids
Correct Answer: First‑generation H1 antihistamines
Q20. Which anticholinergic effect is commonly reported by patients taking cyproheptadine?
- Excessive tearing
- Dry mouth
- Increased salivation
- Diarrhea
Correct Answer: Dry mouth
Q21. The mechanism by which cyproheptadine increases appetite involves antagonism of which combination of receptors?
- H1 histamine and 5‑HT2 serotonin receptors
- H2 histamine and beta‑adrenergic receptors
- Dopamine D2 and NMDA receptors
- GABA‑B and mu‑opioid receptors
Correct Answer: H1 histamine and 5‑HT2 serotonin receptors
Q22. Long‑term use of cyproheptadine in elderly patients is most likely to worsen which clinical issue?
- Bone mineral density
- Cognitive impairment and risk of falls due to sedation and anticholinergic burden
- Visual acuity improvement
- Increased muscle mass
Correct Answer: Cognitive impairment and risk of falls due to sedation and anticholinergic burden
Q23. Orthostatic hypotension seen with cyproheptadine is primarily mediated via blockade of which receptor type?
- Alpha‑1 adrenergic receptors
- GABA receptors
- Histamine H2 receptors
- Serotonin 5‑HT1A receptors
Correct Answer: Alpha‑1 adrenergic receptors
Q24. Dose adjustment of cyproheptadine should be considered in patients with which organ impairment?
- Severe hepatic impairment
- Broken bones only
- Mild seasonal allergies only
- Recent uncomplicated appendectomy
Correct Answer: Severe hepatic impairment
Q25. Which concurrent substance is most likely to potentiate the sedative effects of cyproheptadine?
- Vitamin C supplements
- Alcohol
- Topical emollients
- Oral iron preparations
Correct Answer: Alcohol
Q26. Compared to its activity at H1 and 5‑HT2 receptors, cyproheptadine has minimal activity at which receptor?
- H1 histamine receptor
- 5‑HT2 serotonin receptor
- H2 histamine receptor
- Muscarinic acetylcholine receptor
Correct Answer: H2 histamine receptor
Q27. A key sign of anticholinergic toxicity in cyproheptadine overdose is:
- Miosis (constricted pupils)
- Mydriasis (dilated pupils)
- Hypersalivation
- Excessive sweating
Correct Answer: Mydriasis (dilated pupils)
Q28. The mechanism of action of physostigmine in reversing severe cyproheptadine toxicity is:
- Competitive H1 receptor blockade
- Acetylcholinesterase inhibition increasing synaptic acetylcholine
- Serotonin reuptake inhibition
- Direct serotonin receptor agonism
Correct Answer: Acetylcholinesterase inhibition increasing synaptic acetylcholine
Q29. Which monitoring parameter is most relevant when cyproheptadine is used chronically for appetite stimulation?
- Regular liver biopsies
- Body weight and sedation assessment
- Continuous EEG monitoring
- Daily complete blood counts
Correct Answer: Body weight and sedation assessment
Q30. What is the usual legal status of cyproheptadine in most countries with regard to dispensing?
- Over‑the‑counter (no restrictions)
- Prescription‑only medication
- Controlled substance schedule I
- Veterinary use only
Correct Answer: Prescription‑only medication
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