Prednisolone MCQs With Answer

Prednisolone MCQs With Answer

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Prednisolone MCQs With Answer is a focused review designed for B. Pharm students to master prednisolone’s pharmacology, pharmacokinetics, therapeutic uses and adverse effects. This brief, keyword-rich guide covers mechanism of action at glucocorticoid receptors, dose equivalence, routes of administration, metabolism by CYP3A4, monitoring for adrenal suppression and Cushingoid features, drug interactions, contraindications and special populations. Emphasis is placed on clinical reasoning, dosing principles, formulation differences and safety monitoring to deepen understanding beyond basics. Work through these clinically oriented questions to strengthen recall and application for exams and practice. Now let’s test your knowledge with 30 MCQs on this topic.

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

  • Inhibition of cyclooxygenase enzymes only
  • Activation of intracellular glucocorticoid receptors altering gene transcription
  • Blocking adrenergic receptors in immune cells
  • Neutralizing circulating cytokines directly

Correct Answer: Activation of intracellular glucocorticoid receptors altering gene transcription

Q2. Which statement correctly describes prednisolone in relation to prednisone?

  • Prednisone is the active metabolite; prednisolone is a prodrug
  • Prednisolone is the active metabolite; prednisone is a prodrug converted in the liver
  • Both are inactive until converted to dexamethasone
  • Prednisone and prednisolone are identical in chemical structure

Correct Answer: Prednisolone is the active metabolite; prednisone is a prodrug converted in the liver

Q3. Which dose is approximately equivalent to 5 mg of prednisolone?

  • Hydrocortisone 20 mg
  • Dexamethasone 5 mg
  • Methylprednisolone 10 mg
  • Betamethasone 5 mg

Correct Answer: Hydrocortisone 20 mg

Q4. A potent CYP3A4 inhibitor like ketoconazole will most likely cause which effect on prednisolone?

  • Decrease prednisolone metabolism leading to increased plasma levels
  • No change in prednisolone levels because it is not metabolized hepatically
  • Convert prednisolone into an inactive prodrug
  • Increase renal clearance of prednisolone

Correct Answer: Decrease prednisolone metabolism leading to increased plasma levels

Q5. Which long-term adverse effect is classically associated with chronic prednisolone therapy?

  • Parkinsonism
  • Cushingoid features (central obesity, moon face, buffalo hump)
  • Autoimmune neutropenia
  • Hypersalivation

Correct Answer: Cushingoid features (central obesity, moon face, buffalo hump)

Q6. Which laboratory parameter is essential to monitor during long-term systemic prednisolone therapy?

  • Blood glucose
  • Serum amylase only
  • Serum digoxin level
  • Arterial blood gases routinely

Correct Answer: Blood glucose

Q7. Systemic prednisolone is contraindicated in which condition?

  • Systemic fungal infection
  • Rheumatoid arthritis requiring bridging therapy
  • Acute asthma exacerbation
  • Severe allergic reaction after epinephrine

Correct Answer: Systemic fungal infection

Q8. Abrupt cessation of long-term high-dose prednisolone is most likely to cause:

  • Rebound hypertension only
  • Adrenal suppression leading to acute adrenal insufficiency if stopped abruptly
  • Immediate resolution of all steroid adverse effects
  • Permanent immunity to future steroid therapy

Correct Answer: Adrenal suppression leading to acute adrenal insufficiency if stopped abruptly

Q9. Which route of administration provides the fastest systemic onset of prednisolone?

  • Intravenous administration
  • Topical cream
  • Ophthalmic drops
  • Oral delayed-release tablet

Correct Answer: Intravenous administration

Q10. How is prednisolone classified regarding pregnancy risk (traditional FDA category)?

  • Category A — safe in pregnancy
  • Category B — no risk in animal studies
  • Category C — use only if benefits outweigh risks
  • Category X — contraindicated in pregnancy

Correct Answer: Category C — use only if benefits outweigh risks

Q11. Prednisolone binds primarily to which plasma proteins?

  • Alpha-1 acid glycoprotein only
  • Primarily bound to albumin and corticosteroid-binding globulin (transcortin)
  • Hemoglobin exclusively
  • Fibrinogen and complement proteins

Correct Answer: Primarily bound to albumin and corticosteroid-binding globulin (transcortin)

Q12. What is the typical elimination half-life of prednisolone?

  • Approximately 2–4 hours (short plasma half-life)
  • 24–48 hours (very long half-life)
  • 10 minutes (ultra-short)
  • 7–14 days (accumulative half-life)

Correct Answer: Approximately 2–4 hours (short plasma half-life)

Q13. Which is a common clinical use of short-course oral prednisolone?

  • Immediate management of acute asthma exacerbations
  • First-line cure of bacterial pneumonia without antibiotics
  • Primary treatment of insulin-dependent diabetes
  • Permanent replacement therapy for hypothyroidism

Correct Answer: Immediate management of acute asthma exacerbations

Q14. Why are corticosteroid regimens often tapered rather than stopped abruptly after long-term therapy?

  • To prevent rebound serotonin syndrome
  • To allow recovery of hypothalamic–pituitary–adrenal (HPA) axis and avoid adrenal insufficiency
  • To keep the patient dependent on medication
  • Because tapering increases drug potency

Correct Answer: To allow recovery of hypothalamic–pituitary–adrenal (HPA) axis and avoid adrenal insufficiency

Q15. Which intracellular mediator is induced by prednisolone that inhibits phospholipase A2?

  • COX-2
  • Lipocortin (annexin-1)
  • Interleukin-2
  • Bradykinin

Correct Answer: Lipocortin (annexin-1)

Q16. What important pediatric concern should be monitored during prolonged prednisolone therapy?

  • Excessive tooth eruption
  • Growth suppression — monitor growth and use lowest effective dose
  • Permanent blue-green eye color change
  • Excessive muscle hypertrophy

Correct Answer: Growth suppression — monitor growth and use lowest effective dose

Q17. Which drug interaction would likely decrease prednisolone plasma concentrations?

  • CYP3A4 inducer such as rifampicin
  • CYP3A4 inhibitor such as itraconazole
  • Concurrent oral vitamin C
  • Topical antifungal cream

Correct Answer: CYP3A4 inducer such as rifampicin

Q18. Which statement best describes ocular use of prednisolone acetate eye drops?

  • They are used to treat ocular inflammation but may raise intraocular pressure and worsen infections
  • They permanently cure glaucoma
  • They have no effect on intraocular pressure
  • They are safe to use with active bacterial keratitis without antibiotics

Correct Answer: They are used to treat ocular inflammation but may raise intraocular pressure and worsen infections

Q19. Regarding vaccinations, which is correct for patients on high-dose systemic prednisolone?

  • All live vaccines are recommended immediately
  • Live vaccines are contraindicated in patients on high-dose systemic prednisolone
  • Vaccination status is irrelevant during immunosuppression
  • Live vaccines enhance steroid efficacy

Correct Answer: Live vaccines are contraindicated in patients on high-dose systemic prednisolone

Q20. Chronic prednisolone therapy is most likely to cause which skeletal complication?

  • Osteoporosis and increased fracture risk
  • Osteopetrosis
  • Hypertrophic osteopathy
  • Immediate bone growth acceleration

Correct Answer: Osteoporosis and increased fracture risk

Q21. Which dose of methylprednisolone is approximately equivalent to 5 mg prednisolone?

  • Methylprednisolone 4 mg
  • Methylprednisolone 8 mg
  • Methylprednisolone 0.5 mg
  • Methylprednisolone 20 mg

Correct Answer: Methylprednisolone 4 mg

Q22. What characteristic change in peripheral white blood cells is caused by prednisolone?

  • Neutropenia with lymphocytosis
  • Neutrophilia with lymphopenia due to demargination and redistribution
  • Pancytopenia
  • Eosinophilia without other changes

Correct Answer: Neutrophilia with lymphopenia due to demargination and redistribution

Q23. In patients with severe hepatic impairment which corticosteroid is preferred and why?

  • Prednisolone is preferred because it is active and does not require hepatic activation
  • Prednisone is preferred because it bypasses hepatic metabolism
  • Dexamethasone is always contraindicated in liver disease
  • No steroid can be used in hepatic impairment

Correct Answer: Prednisolone is preferred because it is active and does not require hepatic activation

Q24. What is a common role of low-dose prednisolone in rheumatoid arthritis therapy?

  • Bridging therapy to control symptoms until slower-acting DMARDs take effect
  • Curative monotherapy eliminating the need for DMARDs
  • Primary therapy to regenerate cartilage
  • Only used in infectious arthritis

Correct Answer: Bridging therapy to control symptoms until slower-acting DMARDs take effect

Q25. At the gene level prednisolone exerts anti-inflammatory effects mainly by:

  • Binding cytosolic glucocorticoid receptors and modulating gene transcription via glucocorticoid response elements
  • Directly blocking DNA replication machinery
  • Inhibiting RNA polymerase II irreversibly
  • Stimulating histamine release from mast cells

Correct Answer: Binding cytosolic glucocorticoid receptors and modulating gene transcription via glucocorticoid response elements

Q26. Which electrolyte disturbance is commonly associated with systemic prednisolone use?

  • Hyperkalemia with hyponatremia
  • Sodium retention and potassium loss (hypokalemia) due to mineralocorticoid activity
  • Severe hypermagnesemia only
  • No change in sodium or potassium handling

Correct Answer: Sodium retention and potassium loss (hypokalemia) due to mineralocorticoid activity

Q27. Prednisolone is primarily eliminated by which processes?

  • Renal excretion of unchanged drug only
  • Hepatic metabolism to inactive metabolites and renal excretion
  • Exhalation through lungs
  • Sequestration in adipose tissue with no metabolism

Correct Answer: Hepatic metabolism to inactive metabolites and renal excretion

Q28. Which skin adverse effect may result from topical or systemic corticosteroid use?

  • Skin thinning and delayed wound healing
  • Increased epidermal proliferation leading to thickened skin
  • Permanent tattooing
  • Increased hair melanin production only

Correct Answer: Skin thinning and delayed wound healing

Q29. Which drug can act as a glucocorticoid receptor antagonist in Cushing’s syndrome management?

  • Mifepristone
  • Metformin
  • Amoxicillin
  • Propranolol

Correct Answer: Mifepristone

Q30. What is the rationale for administering prednisolone in the morning?

  • To coincide with peak food absorption only
  • Once daily morning dosing to reduce HPA axis suppression and mimic diurnal cortisol rhythm
  • Because it is inactive at night
  • To avoid interactions with vitamin D synthesis

Correct Answer: Once daily morning dosing to reduce HPA axis suppression and mimic diurnal cortisol rhythm

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