Chlorambucil is a classical nitrogen mustard alkylating agent frequently tested in pharmacology for cancer chemotherapy. This Chlorambucil MCQs With Answer set is tailored for B. Pharm students to build deep knowledge of mechanism of action, pharmacokinetics, dosing strategies, therapeutic uses, adverse effects, drug interactions, resistance mechanisms and monitoring requirements. Questions move beyond basics to cover DNA alkylation chemistry, hepatic metabolism to active metabolites, clinical indications such as chronic lymphocytic leukemia, long-term toxicities including myelosuppression and secondary malignancies, and practical patient counseling points. Use these items to strengthen clinical reasoning and exam readiness. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which pharmacologic class does chlorambucil belong to?
- Alkylating agent (nitrogen mustard)
- Antimetabolite (folate antagonist)
- Topoisomerase inhibitor
- Monoclonal antibody
Correct Answer: Alkylating agent (nitrogen mustard)
Q2. What is the primary mechanism of action of chlorambucil?
- Inhibition of dihydrofolate reductase
- Alkylation of DNA leading to interstrand cross-links
- Microtubule stabilization
- Topoisomerase II inhibition
Correct Answer: Alkylation of DNA leading to interstrand cross-links
Q3. Chlorambucil is best described as which type of cell cycle agent?
- Cell cycle specific (S-phase)
- Cell cycle specific (M-phase)
- Cell cycle non-specific
- Only active in G0 phase
Correct Answer: Cell cycle non-specific
Q4. Which of the following is a principal clinical indication for chlorambucil?
- Chronic lymphocytic leukemia (CLL)
- Acute promyelocytic leukemia (APL)
- Metastatic colorectal cancer
- Breast cancer adjuvant therapy
Correct Answer: Chronic lymphocytic leukemia (CLL)
Q5. What is the usual route of administration for chlorambucil in most regimens?
- Oral tablet
- Intravenous infusion
- Intramuscular injection
- Topical application
Correct Answer: Oral tablet
Q6. Which active metabolite is formed during hepatic metabolism of chlorambucil?
- Phenylacetic acid mustard
- 5-Fluorouracil
- Vincristine sulfate
- Methotrexate polyglutamate
Correct Answer: Phenylacetic acid mustard
Q7. What is the dose‑limiting toxicity most commonly associated with chlorambucil?
- Myelosuppression (particularly neutropenia)
- Cardiotoxicity
- Nephrotoxicity
- Pulmonary fibrosis
Correct Answer: Myelosuppression (particularly neutropenia)
Q8. Which of the following adverse effects is classically linked to chlorambucil?
- Infertility and gonadal toxicity
- Severe peripheral neuropathy
- Ototoxicity
- Skin photosensitivity only
Correct Answer: Infertility and gonadal toxicity
Q9. Chlorambucil is contraindicated or strongly cautioned in which situation?
- Pregnancy due to teratogenicity
- Isolated hyperlipidemia
- Controlled hypertension without other issues
- Transient viral upper respiratory infection
Correct Answer: Pregnancy due to teratogenicity
Q10. Which statement about chlorambucil’s plasma protein binding is correct?
- It is highly protein bound
- It has negligible protein binding
- It binds exclusively to red blood cells
- Protein binding is only observed in renal failure
Correct Answer: It is highly protein bound
Q11. How are chlorambucil and its metabolites primarily eliminated from the body?
- Renal excretion of metabolites
- Exhalation via lungs
- Unchanged biliary excretion in feces
- Secretion in sweat
Correct Answer: Renal excretion of metabolites
Q12. Which laboratory test is essential to monitor before and during chlorambucil therapy?
- Complete blood count (CBC) with differential
- Fasting blood glucose only
- Serum amylase exclusively
- Urine pregnancy test only at baseline
Correct Answer: Complete blood count (CBC) with differential
Q13. A common cellular mechanism of resistance to chlorambucil is:
- Increased glutathione conjugation and enhanced DNA repair
- Overexpression of thymidylate synthase
- Loss of tubulin binding sites
- Increased uptake transporters for the drug
Correct Answer: Increased glutathione conjugation and enhanced DNA repair
Q14. Which combination is historically used in some regimens for CLL with chlorambucil?
- Chlorambucil combined with prednisone
- Chlorambucil combined with insulin
- Chlorambucil combined with amoxicillin
- Chlorambucil combined with aspirin only
Correct Answer: Chlorambucil combined with prednisone
Q15. How quickly do patients typically show clinical response to chlorambucil in indolent lymphoid malignancies?
- Slow onset: often weeks to months
- Immediate improvement within hours
- Complete remission within 48 hours
- No delayed response; only acute effects
Correct Answer: Slow onset: often weeks to months
Q16. Which atom in DNA is the principal alkylation target of nitrogen mustards like chlorambucil?
- N7 position of guanine
- C5 of cytosine
- Phosphate backbone oxygen
- Adenine N1 position
Correct Answer: N7 position of guanine
Q17. Long-term use of chlorambucil has been associated with which serious late complication?
- Secondary acute myeloid leukemia (AML)
- Chronic obstructive pulmonary disease
- Type 1 diabetes mellitus
- Primary biliary cirrhosis
Correct Answer: Secondary acute myeloid leukemia (AML)
Q18. Beyond oncology, chlorambucil has been used in which non-malignant condition?
- Certain refractory autoimmune disorders (e.g., nephrotic syndrome)
- Acute bacterial infections
- Type 2 diabetes control
- Hyperthyroidism
Correct Answer: Certain refractory autoimmune disorders (e.g., nephrotic syndrome)
Q19. In which organ impairment is dose reduction or caution most important for chlorambucil?
- Severe hepatic impairment
- Uncomplicated myopia
- Isolated toenail fungus
- Controlled hypothyroidism
Correct Answer: Severe hepatic impairment
Q20. Which is an appropriate storage recommendation for chlorambucil tablets?
- Store at room temperature in a tight container, protect from moisture
- Store frozen at -20°C
- Store in direct sunlight to preserve potency
- Store in a humid bathroom environment
Correct Answer: Store at room temperature in a tight container, protect from moisture
Q21. Which statement about chlorambucil pharmacokinetics is correct?
- It undergoes extensive hepatic metabolism to active and inactive metabolites
- It is excreted unchanged in large amounts in feces
- It is not metabolized and is biologically inert
- It is exclusively metabolized by gut flora
Correct Answer: It undergoes extensive hepatic metabolism to active and inactive metabolites
Q22. Chlorambucil may show cross-resistance with which drug class?
- Other alkylating agents
- Topical antifungals
- Beta‑lactam antibiotics
- H2 receptor antagonists
Correct Answer: Other alkylating agents
Q23. Which enzyme family is important in detoxification and resistance to chlorambucil?
- Glutathione S-transferases (GSTs)
- Monoamine oxidases (MAOs)
- Acetylcholinesterases
- Cyclooxygenases (COX)
Correct Answer: Glutathione S-transferases (GSTs)
Q24. Which counseling point is most appropriate regarding fertility for patients starting chlorambucil?
- Discuss risk of permanent sterility and consider sperm/ovarian preservation
- There is no risk to fertility, no counseling needed
- Fertility is enhanced during therapy
- Chlorambucil acts as a contraceptive and prevents pregnancy
Correct Answer: Discuss risk of permanent sterility and consider sperm/ovarian preservation
Q25. Concomitant use of chlorambucil with which of the following increases hematologic toxicity?
- Other myelosuppressive cytotoxic drugs
- Topical emollients
- Oral electrolyte supplements
- Vitamin C at dietary doses
Correct Answer: Other myelosuppressive cytotoxic drugs
Q26. Which monitoring parameter specifically assesses hepatic effects that may influence chlorambucil dosing?
- Serum transaminases and bilirubin
- Fasting glucose only
- Urine ketones exclusively
- Serum creatine kinase only
Correct Answer: Serum transaminases and bilirubin
Q27. Typical administration schedules for chlorambucil include:
- Daily low-dose oral therapy or intermittent pulse dosing
- Continuous intravenous infusion for 6 months only
- Single intramuscular injection as lifelong therapy
- Only topical pulses applied weekly
Correct Answer: Daily low-dose oral therapy or intermittent pulse dosing
Q28. Which patient education point is important for someone taking oral chlorambucil?
- Report fever, sore throat or signs of infection immediately
- Stop all other medications without consulting clinician
- Double the dose if a dose is missed
- There is no need for regular blood tests once therapy starts
Correct Answer: Report fever, sore throat or signs of infection immediately
Q29. Which statement about chlorambucil and pregnancy is correct?
- It is teratogenic and contraindicated during pregnancy
- It is safe and recommended during pregnancy
- It enhances fetal development
- It has no documented effects on pregnancy
Correct Answer: It is teratogenic and contraindicated during pregnancy
Q30. Which overall description best summarizes chlorambucil’s anticancer action?
- An oral nitrogen mustard alkylating agent that is cell cycle non‑specific and causes DNA cross‑links
- A topoisomerase I inhibitor given only intravenously
- An antimetabolite that selectively targets thymidylate synthase
- A targeted tyrosine kinase inhibitor with oral bioavailability
Correct Answer: An oral nitrogen mustard alkylating agent that is cell cycle non‑specific and causes DNA cross‑links
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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