Amantadine and Rimantadine MCQs With Answer

Amantadine and Rimantadine MCQs With Answer help B. Pharm students master the pharmacology, mechanism, clinical uses, and safety profiles of two classic antiviral agents. These M2 ion-channel blockers target Influenza A by preventing viral uncoating; amantadine also has antiparkinsonian effects through dopaminergic and NMDA-related actions. Key learning points include differences in pharmacokinetics (renal excretion vs hepatic metabolism), common and serious adverse effects (CNS effects, anticholinergic symptoms), resistance mechanisms (M2 protein mutations), indications, contraindications, and important drug interactions. This focused set of questions emphasizes applied knowledge and clinical reasoning to prepare you for exams and practice. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which viral protein is the primary target of amantadine and rimantadine?

• M2 ion channel (matrix protein)
• Hemagglutinin
• Neuraminidase
• NS1 protein

Correct Answer: M2 ion channel (matrix protein)

Q2. What is the main clinical antiviral indication for amantadine and rimantadine?

• Influenza A prophylaxis and treatment
• Influenza B treatment
• Herpes simplex infections
• Respiratory syncytial virus (RSV)

Correct Answer: Influenza A prophylaxis and treatment

Q3. Which statement best distinguishes rimantadine from amantadine?

• Rimantadine generally causes fewer central nervous system side effects
• Rimantadine is excreted unchanged in urine to a greater extent
• Rimantadine blocks neuraminidase instead of M2
• Rimantadine is only active against influenza B

Correct Answer: Rimantadine generally causes fewer central nervous system side effects

Q4. The antiviral action of these drugs occurs at which stage of the viral life cycle?

• Uncoating/viral penetration
• Attachment to host cell
• Viral RNA replication
• Assembly and budding

Correct Answer: Uncoating/viral penetration

Q5. Which adverse effect is most characteristically associated with amantadine?

• CNS symptoms such as agitation, insomnia, hallucinations
• Severe hepatotoxicity with jaundice
• Profound thrombocytopenia
• Ototoxicity leading to hearing loss

Correct Answer: CNS symptoms such as agitation, insomnia, hallucinations

Q6. Which pharmacokinetic property is true for amantadine?

• Primarily excreted unchanged by the kidneys
• Extensive hepatic metabolism as the main elimination route
• Not orally bioavailable
• Delivered only by intravenous infusion

Correct Answer: Primarily excreted unchanged by the kidneys

Q7. Resistance to amantadine and rimantadine most commonly arises from mutations in which viral component?

• M2 ion channel protein
• Hemagglutinin receptor-binding site
• Polymerase acidic protein (PA)
• Neuraminidase active site

Correct Answer: M2 ion channel protein

Q8. Amantadine has a secondary therapeutic use in neurology. What is it?

• Treatment of Parkinson’s disease symptoms
• Anticonvulsant for epilepsy
• Treatment of Alzheimer’s disease
• Peripheral neuropathy therapy

Correct Answer: Treatment of Parkinson’s disease symptoms

Q9. Which drug interaction is most relevant with amantadine?

• Enhanced CNS stimulation with anticholinergic or sympathomimetic agents
• Marked increase in bleeding with warfarin
• Decreased effect of oral contraceptives
• Severe hypoglycemia with insulin

Correct Answer: Enhanced CNS stimulation with anticholinergic or sympathomimetic agents

Q10. Which patient population requires dose adjustment when using amantadine?

• Patients with renal impairment
• Patients with controlled hypertension only
• Healthy young adults without comorbidities
• Patients with hyperthyroidism

Correct Answer: Patients with renal impairment

Q11. The primary mechanism by which rimantadine reduces influenza A replication is by:

• Blocking the M2 proton channel and preventing uncoating
• Inhibiting neuraminidase to prevent viral release
• Cross-linking viral RNA strands
• Stimulating host interferon production directly

Correct Answer: Blocking the M2 proton channel and preventing uncoating

Q12. Which of the following is correct about influenza B susceptibility to amantadine and rimantadine?

• Influenza B is generally resistant to M2 inhibitors
• Influenza B is more sensitive than A to M2 inhibitors
• Both A and B are equally sensitive to amantadine
• These drugs are first-line for influenza B

Correct Answer: Influenza B is generally resistant to M2 inhibitors

Q13. Which laboratory monitoring is most appropriate during prolonged amantadine therapy in high-risk patients?

• Renal function tests (serum creatinine, eGFR)
• Liver function tests only
• Coagulation profile (PT/INR)
• Serum amylase and lipase

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

Q14. A patient on amantadine develops livedo reticularis and ankle edema. This adverse effect is most likely related to:

• Peripheral vascular effects of amantadine
• Immune-mediated thrombocytopenia
• Direct hepatic necrosis
• Renal tubular acidosis

Correct Answer: Peripheral vascular effects of amantadine

Q15. Which statement about rimantadine metabolism is accurate?

• Rimantadine undergoes hepatic metabolism to hydroxylated metabolites
• Rimantadine is excreted entirely unchanged in urine
• Rimantadine is not metabolized and accumulates in bile
• Rimantadine is activated by renal enzymes to an active metabolite

Correct Answer: Rimantadine undergoes hepatic metabolism to hydroxylated metabolites

Q16. In which scenario are amantadine and rimantadine least likely to be effective?

• During a seasonal outbreak dominated by influenza B with known M2 resistance
• Early treatment of confirmed influenza A within 48 hours
• Prophylaxis in exposed nursing home residents when influenza A predominates
• Short-term therapy for influenza A in young healthy adults

Correct Answer: During a seasonal outbreak dominated by influenza B with known M2 resistance

Q17. Which symptom would most suggest amantadine toxicity in an elderly patient?

• Acute confusion and hallucinations
• Isolated hypertension without other signs
• Profound diarrhea with dehydration
• Marked jaundice and pruritus

Correct Answer: Acute confusion and hallucinations

Q18. What is the primary reason for limited current clinical use of M2 inhibitors like amantadine?

• High rates of viral resistance among circulating influenza A strains
• Lack of oral formulations
• Excessive cost compared with alternatives
• They are ineffective in all influenza strains

Correct Answer: High rates of viral resistance among circulating influenza A strains

Q19. Which exam-style pharmacology concept best explains amantadine’s antiparkinsonian effect?

• Enhancement of dopamine release and NMDA antagonism
• Direct agonism at dopamine D2 receptors only
• Inhibition of acetylcholinesterase centrally
• Blocking monoamine oxidase-B irreversibly

Correct Answer: Enhancement of dopamine release and NMDA antagonism

Q20. Which adverse effect is more commonly associated with rimantadine than with amantadine?

• Gastrointestinal upset (nausea) at higher doses
• Severe psychosis as first-line toxicity
• Marked renal failure in normal dosages
• Profound neutropenia routinely

Correct Answer: Gastrointestinal upset (nausea) at higher doses

Q21. For exam questions on mechanism, blocking M2 channels prevents acidification of which cellular compartment?

• Endosome (viral uncoating compartment)
• Golgi apparatus
• Mitochondrial matrix
• Ribosomal subunit

Correct Answer: Endosome (viral uncoating compartment)

Q22. Which clinical scenario would contraindicate use of amantadine without careful consideration?

• Patient with severe renal impairment
• Young adult with uncomplicated influenza A
• Mild seasonal allergic rhinitis
• Uncomplicated common cold due to rhinovirus

Correct Answer: Patient with severe renal impairment

Q23. When comparing CNS penetration, which is true?

• Amantadine penetrates the CNS more readily than rimantadine
• Neither drug crosses the blood–brain barrier
• Rimantadine has significantly greater CNS effects than amantadine
• Both are restricted to peripheral compartments only

Correct Answer: Amantadine penetrates the CNS more readily than rimantadine

Q24. Which laboratory or clinical finding would suggest rimantadine accumulation or toxicity?

• Worsening dizziness and pronounced gastrointestinal symptoms
• Elevated serum bilirubin without symptoms
• Isolated hyperkalemia on blood test
• Brisk bleeding from minor wounds

Correct Answer: Worsening dizziness and pronounced gastrointestinal symptoms

Q25. Regarding resistance development, which practice most contributes to reduced effectiveness of amantadine clinically?

• Widespread use leading to selection of resistant influenza A strains
• Limited prescription leading to underexposure
• Combination therapy with neuraminidase inhibitors
• Strict short-course therapy only during outbreaks

Correct Answer: Widespread use leading to selection of resistant influenza A strains

Q26. For a patient with Parkinsonism being treated with amantadine, which adverse psychiatric effect should be monitored?

• Confusion, hallucinations, and mood changes
• Progressive aphasia
• Enhanced long-term memory recall
• Improved sleep architecture without side effects

Correct Answer: Confusion, hallucinations, and mood changes

Q27. Which formulation and route are typical for both amantadine and rimantadine in outpatient use?

• Oral tablets or capsules
• Topical cream application
• Inhaled dry powder
• Intramuscular injection only

Correct Answer: Oral tablets or capsules

Q28. A rapid test identifies influenza A in a hospitalized patient. Starting therapy with an M2 inhibitor is most effective if begun within:

• The first 48 hours of symptom onset
• After 5 days for maximal benefit
• Only after laboratory confirmation of subtype
• When viral shedding has ceased

Correct Answer: The first 48 hours of symptom onset

Q29. Which of the following adverse effects is more specifically associated with rimantadine in some patients?

• Mild-to-moderate gastrointestinal upset such as nausea
• Severe CNS depression in all patients
• Marked renal tubular necrosis routinely
• Permanent hearing loss after a single dose

Correct Answer: Mild-to-moderate gastrointestinal upset such as nausea

Q30. From a pharmacology exam perspective, which statement summarizes key differences between the two drugs?

• Amantadine is renally excreted with more CNS effects; rimantadine is metabolized hepatically and better tolerated
• Both drugs are identical in metabolism and side-effect profile
• Rimantadine causes more severe CNS effects and is renally excreted
• Amantadine exclusively treats influenza B while rimantadine treats bacterial infections

Correct Answer: Amantadine is renally excreted with more CNS effects; rimantadine is metabolized hepatically and better tolerated

G S Sachin

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.

Mail- Sachin@pharmacyfreak.com