Miscellaneous anticancer drugs – Cisplatin MCQs With Answer

Cisplatin is a classic miscellaneous anticancer drug widely covered in B.Pharm pharmacology. As a platinum compound used in chemotherapy, cisplatin’s keywords include DNA cross-linking, platinum coordination complex, nephrotoxicity, ototoxicity, myelosuppression, amifostine protection, hydration protocols, dose-limiting toxicity, and renal elimination. Understanding cisplatin’s mechanism of action, clinical indications (testicular, ovarian, bladder, lung cancers), adverse effect profile, drug interactions, and resistance mechanisms is essential for safe dispensing and patient counseling. This concise, keyword-rich overview prepares you for applied questions on dosing, monitoring, and toxicity prevention. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. What is the primary mechanism of action of cisplatin?

• Inhibition of topoisomerase II
• Formation of DNA cross-links (intra- and inter-strand) leading to apoptosis
• Antimetabolite inhibition of thymidylate synthase
• Microtubule stabilization preventing mitosis

Correct Answer: Formation of DNA cross-links (intra- and inter-strand) leading to apoptosis

Q2. Which toxicity is classically dose-limiting for cisplatin?

• Hepatotoxicity
• Cardiotoxicity
• Nephrotoxicity
• Pulmonary fibrosis

Correct Answer: Nephrotoxicity

Q3. Which supportive measure is most important to reduce cisplatin-induced nephrotoxicity?

• Pre- and post-infusion hydration with saline
• Prophylactic antibiotics
• Concurrent high-dose vitamin C
• Avoiding all electrolyte monitoring

Correct Answer: Pre- and post-infusion hydration with saline

Q4. Which agent is used as a cytoprotective drug to reduce cisplatin toxicity?

• Mesna
• Amifostine
• Leucovorin
• Filgrastim

Correct Answer: Amifostine

Q5. The most common ototoxic effect of cisplatin is:

• Conductive hearing loss due to middle ear effusion
• Sensorineural hearing loss, especially high-frequency
• Tinnitus with temporary conductive loss only
• Central auditory processing disorder

Correct Answer: Sensorineural hearing loss, especially high-frequency

Q6. Which electrolyte disturbance is frequently associated with cisplatin therapy?

• Hyperkalemia
• Hypocalcemia
• Hypernatremia
• Hypomagnesemia

Correct Answer: Hypomagnesemia

Q7. Cisplatin is primarily eliminated by which route?

• Hepatic metabolism and biliary excretion
• Renal excretion
• Pulmonary exhalation
• Skin secretion

Correct Answer: Renal excretion

Q8. Which cancer is cisplatin considered a cornerstone therapy for, often curative in combination regimens?

• Pancreatic adenocarcinoma
• Testicular germ cell tumors
• Basal cell carcinoma
• Chronic lymphocytic leukemia

Correct Answer: Testicular germ cell tumors

Q9. A pharmacologic mechanism of resistance to cisplatin includes:

• Decreased DNA repair capacity
• Increased drug uptake into cancer cells
• Increased detoxification by glutathione and metallothioneins
• Enhanced microtubule polymerization

Correct Answer: Increased detoxification by glutathione and metallothioneins

Q10. Compared to cisplatin, carboplatin typically has:

• Greater nephrotoxicity and ototoxicity
• Less nephrotoxicity but more myelosuppression
• Identical toxicity profile
• No renal elimination

Correct Answer: Less nephrotoxicity but more myelosuppression

Q11. Which monitoring test is essential before each cisplatin dose?

• Serum bilirubin
• Renal function tests (serum creatinine, BUN)
• Fasting blood glucose
• Thyroid function tests

Correct Answer: Renal function tests (serum creatinine, BUN)

Q12. Which clinical symptom should prompt urgent evaluation for cisplatin-induced neurotoxicity?

• Peripheral paresthesias and sensory loss
• Isolated mild headache
• Transient blurred vision resolving in minutes
• Intermittent sneezing

Correct Answer: Peripheral paresthesias and sensory loss

Q13. Cisplatin forms coordination complexes with which atom in DNA bases leading to cross-links?

• Oxygen of thymine
• N7 position of guanine
• Phosphate backbone oxygen
• 2′ hydroxyl of ribose

Correct Answer: N7 position of guanine

Q14. Which of the following regimens includes cisplatin commonly used for testicular cancer?

• CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
• BEP (bleomycin, etoposide, cisplatin)
• FOLFIRI (folinic acid, fluorouracil, irinotecan)
• ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine)

Correct Answer: BEP (bleomycin, etoposide, cisplatin)

Q15. Which patient factor increases risk of severe cisplatin toxicity?

• Pre-existing renal impairment
• Young age with normal renal function
• Prior history of eczema
• Well-controlled hypertension only

Correct Answer: Pre-existing renal impairment

Q16. Which of these is an early sign of cisplatin nephrotoxicity?

• Rising serum creatinine and decreased urine output
• Decreased liver enzymes
• Bradycardia without other symptoms
• Improved appetite

Correct Answer: Rising serum creatinine and decreased urine output

Q17. Which premedication is recommended to help prevent hypersensitivity and reduce renal toxicity during cisplatin infusion?

• High-dose opioid analgesics only
• Antiemetics plus vigorous IV hydration and magnesium supplementation as needed
• Oral insulin before infusion
• Intramuscular penicillin

Correct Answer: Antiemetics plus vigorous IV hydration and magnesium supplementation as needed

Q18. Cisplatin’s major effect on the cell cycle is best described as:

• Specific inhibition of G1 phase only
• Cell-cycle nonspecific DNA damage leading to apoptosis
• Exclusive arrest in M phase by spindle disruption
• Only S-phase inhibition by antimetabolite action

Correct Answer: Cell-cycle nonspecific DNA damage leading to apoptosis

Q19. Which laboratory parameter should be checked to monitor for cisplatin-induced electrolyte disturbances?

• Serum magnesium and potassium
• Serum amylase only
• Hemoglobin A1c
• Serum uric acid only

Correct Answer: Serum magnesium and potassium

Q20. Which statement about cisplatin formulation and administration is correct?

• Cisplatin is given orally and does not require IV hydration
• Cisplatin is administered IV and requires adequate hydration to reduce nephrotoxicity
• Cisplatin is contraindicated for IV use
• Cisplatin is inhaled as a nebulized solution

Correct Answer: Cisplatin is administered IV and requires adequate hydration to reduce nephrotoxicity

Q21. Which adverse effect is more pronounced with cisplatin than with carboplatin?

• Severe thrombocytopenia
• Nephrotoxicity and ototoxicity
• Hair loss only
• Mucocutaneous pigmentation

Correct Answer: Nephrotoxicity and ototoxicity

Q22. Which drug interaction increases the risk of cisplatin nephrotoxicity?

• Concurrent use of loop diuretics like furosemide without monitoring
• Concurrent acetaminophen at usual doses
• Topical corticosteroids
• Oral contraceptives

Correct Answer: Concurrent use of loop diuretics like furosemide without monitoring

Q23. Which clinical scenario is a relative contraindication to cisplatin?

• Active urinary tract infection only
• Pre-existing severe renal impairment
• History of controlled migraine headaches
• Mild seasonal allergies

Correct Answer: Pre-existing severe renal impairment

Q24. The role of chloride in cisplatin pharmacology is that:

• Low chloride concentration in plasma makes cisplatin inactive
• Intracellular aquation (replacement of chloride) activates cisplatin to form reactive species
• Chloride binds DNA preventing cisplatin action
• Chloride supplementation cures ototoxicity

Correct Answer: Intracellular aquation (replacement of chloride) activates cisplatin to form reactive species

Q25. Long-term sequelae of cisplatin therapy can include:

• Permanent sensorineural hearing loss and chronic neuropathy
• Long-term hyperpigmentation only
• Improved renal function
• Resolution of hypomagnesemia without treatment

Correct Answer: Permanent sensorineural hearing loss and chronic neuropathy

Q26. Which pharmacokinetic property is true for cisplatin?

• Extensive hepatic metabolism via CYP450 enzymes
• High protein binding and prolonged terminal half-life in tissues
• Rapid exhalation unchanged in breath
• Elimination primarily by fecal route

Correct Answer: High protein binding and prolonged terminal half-life in tissues

Q27. In the context of B.Pharm patient counseling, which advice is important for a patient receiving cisplatin?

• Avoid reporting any new ringing in the ears as it is unrelated
• Maintain hydration, report decreased urine output, and report hearing changes
• Stop taking all prescribed medications without consulting the oncologist
• Skip renal function tests during chemotherapy

Correct Answer: Maintain hydration, report decreased urine output, and report hearing changes

Q28. Which lab abnormality may indicate cisplatin-induced tubular dysfunction?

• Glycosuria with normal blood glucose and hypomagnesemia
• Isolated high HDL cholesterol
• Low serum bicarbonate with normal electrolytes
• Elevated amylase only

Correct Answer: Glycosuria with normal blood glucose and hypomagnesemia

Q29. Which strategy can be used to reduce cisplatin neurotoxicity risk?

• High cumulative doses without break
• Dose reduction or switching to less neurotoxic platinum agents when neuropathy develops
• Ignoring symptoms until severe
• Simultaneous high-dose vitamin B12 only

Correct Answer: Dose reduction or switching to less neurotoxic platinum agents when neuropathy develops

Q30. Which statement best describes cisplatin’s place in chemotherapy?

• Cisplatin is obsolete and no longer used clinically
• Cisplatin remains a key platinum-based chemotherapeutic with specific indications and notable toxicities requiring careful monitoring
• Cisplatin is an antibiotic used for bacterial infections
• Cisplatin is only used topically for skin conditions

Correct Answer: Cisplatin remains a key platinum-based chemotherapeutic with specific indications and notable toxicities requiring careful monitoring

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