Diethylcarbamazine citrate is an important antifilarial agent studied in pharmaceutics and clinical pharmacy for its role in treating lymphatic filariasis and related parasitic infections. This introduction covers synthesis (conversion of the free base to the citrate salt), formulation advantages, mechanism of action (microfilarial surface alteration and host immune clearance), pharmacokinetics, adverse effects such as Mazzotti reactions, therapeutic uses, mass drug administration strategies, and essential quality-control and stability considerations. Content is tailored for B. Pharm students to support practical understanding, assay methods, dosing principles, contraindications and drug interactions. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is diethylcarbamazine citrate (DEC citrate)?
- The citrate salt form of diethylcarbamazine used as an oral antifilarial agent
- An injectable antifungal agent
- A topical antiseptic derived from citrate
- A chelating agent used in analytical chemistry
Correct Answer: The citrate salt form of diethylcarbamazine used as an oral antifilarial agent
Q2. Which statement best describes why the citrate form is used pharmaceutically?
- Citrate form increases water solubility and facilitates oral dosing
- Citrate form makes the drug volatile for inhalation
- Citrate form converts it into a prodrug activated in the kidney
- Citrate form permanently binds to plasma proteins
Correct Answer: Citrate form increases water solubility and facilitates oral dosing
Q3. How is diethylcarbamazine citrate typically prepared in a pharmaceutical context?
- By reacting diethylcarbamazine free base with citric acid to form the citrate salt
- By esterifying diethylcarbamazine with acetic anhydride
- By hydrogenating diethylcarbamazine nitrate
- By complexing diethylcarbamazine with cyclodextrin in water
Correct Answer: By reacting diethylcarbamazine free base with citric acid to form the citrate salt
Q4. What is the primary indicated use of DEC citrate?
- Treatment and control of lymphatic filariasis caused by Wuchereria and Brugia species
- Treatment of bacterial urinary tract infections
- Management of chronic viral hepatitis
- Topical treatment of fungal skin infections
Correct Answer: Treatment and control of lymphatic filariasis caused by Wuchereria and Brugia species
Q5. Which of the following best describes DEC’s mechanism of action?
- Alters microfilarial surface and enhances host immune clearance, with possible direct microfilaricidal effects
- Inhibits fungal cell wall synthesis by blocking ergosterol production
- Acts as a beta-lactam antibiotic inhibiting cell wall synthesis
- Blocks parasite mitochondrial DNA replication exclusively
Correct Answer: Alters microfilarial surface and enhances host immune clearance, with possible direct microfilaricidal effects
Q6. Which parasitic infection is DEC contraindicated or used with extreme caution due to severe inflammatory reactions?
- Onchocerciasis (river blindness)
- Lymphatic filariasis
- Tinea corporis
- Giardiasis
Correct Answer: Onchocerciasis (river blindness)
Q7. What is a common adverse immunologic reaction seen after DEC therapy due to rapid microfilarial death?
- Mazzotti reaction (fever, rash, lymphadenitis)
- Stevens–Johnson syndrome
- Anaphylactic shock due to IgE-mediated allergy
- Serotonin syndrome
Correct Answer: Mazzotti reaction (fever, rash, lymphadenitis)
Q8. Which global public health strategy commonly uses DEC for mass drug administration (MDA)?
- Lymphatic filariasis elimination programs
- Tuberculosis elimination initiatives
- Malaria vector control campaigns
- Universal childhood vaccination programs
Correct Answer: Lymphatic filariasis elimination programs
Q9. In MDA programs, DEC is frequently co-administered with which anthelmintic to enhance coverage?
- Albendazole
- Amoxicillin
- Prednisone
- Fluconazole
Correct Answer: Albendazole
Q10. Which pharmacokinetic property is true for DEC after oral administration?
- Well absorbed orally with renal excretion of parent drug and metabolites
- Poorly absorbed and excreted unchanged in feces
- Not absorbed orally; only active topically
- Eliminated primarily via hepatic bile without renal involvement
Correct Answer: Well absorbed orally with renal excretion of parent drug and metabolites
Q11. Which monitoring parameter is most relevant during DEC therapy for filariasis?
- Microfilarial counts and signs of Mazzotti reaction
- Fasting blood glucose daily
- Serum triglycerides weekly
- Coagulation profile every dose
Correct Answer: Microfilarial counts and signs of Mazzotti reaction
Q12. Which clinical condition besides lymphatic filariasis may be treated with DEC?
- Tropical pulmonary eosinophilia (a hypersensitivity to filarial infection)
- Bacterial meningitis
- Hepatic cirrhosis of viral origin
- Type I diabetes mellitus
Correct Answer: Tropical pulmonary eosinophilia (a hypersensitivity to filarial infection)
Q13. Which statement about DEC and Loa loa infection is correct?
- Patients with high Loa loa microfilarial loads are at risk of severe adverse reactions with DEC
- DEC is the safest first-line treatment for high-load Loa loa infections
- DEC completely prevents ocular complications of Loa loa
- DEC enhances Loa loa transmission by increasing microfilarial shedding
Correct Answer: Patients with high Loa loa microfilarial loads are at risk of severe adverse reactions with DEC
Q14. Which of the following adverse effects is commonly reported with DEC therapy?
- Fever, headache, nausea and itching due to parasite death
- Profound neutropenia within hours of dosing in all patients
- Renal tubular necrosis as the most common toxicity
- Permanent alopecia in most treated individuals
Correct Answer: Fever, headache, nausea and itching due to parasite death
Q15. Which analytical method is commonly used in pharmaceutical quality control to assay DEC in finished products?
- High-performance liquid chromatography (HPLC)
- Atomic absorption spectroscopy
- Thermogravimetric analysis
- Nuclear magnetic resonance as the routine release assay
Correct Answer: High-performance liquid chromatography (HPLC)
Q16. What is a primary reason for including citrate in DEC formulations from a formulation science perspective?
- To improve aqueous solubility and allow consistent tablet/citrate dosing
- To provide a sweet taste as a flavoring agent
- To convert the drug into a gas at room temperature
- To chelate iron in blood after absorption
Correct Answer: To improve aqueous solubility and allow consistent tablet/citrate dosing
Q17. Which precaution is most important before administering DEC in endemic areas?
- Screen for onchocerciasis or high Loa loa microfilarial loads to avoid severe reactions
- Ensure the patient has not received a live vaccine in the past 24 hours
- Obtain liver biopsy to assess hepatic reserve
- Administer broad-spectrum antibiotics prophylactically
Correct Answer: Screen for onchocerciasis or high Loa loa microfilarial loads to avoid severe reactions
Q18. Which formulation consideration is important for DEC tablet manufacture?
- Protect from moisture and store in airtight containers to maintain stability
- Ensure tablets are light-sensitive and packaged in transparent bottles
- Include a high percentage of volatile solvents in the tablet core
- Use only enteric coating to prevent release in the stomach
Correct Answer: Protect from moisture and store in airtight containers to maintain stability
Q19. Which statement about DEC’s regulatory or public health status is correct?
- WHO recommends DEC as part of strategies to eliminate lymphatic filariasis in eligible areas
- DEC has been withdrawn worldwide due to universal resistance
- DEC is only approved for veterinary use
- DEC is exclusively used as a topical antiseptic in WHO programs
Correct Answer: WHO recommends DEC as part of strategies to eliminate lymphatic filariasis in eligible areas
Q20. During formulation development, which excipient property is most relevant for DEC citrate tablets?
- Low hygroscopicity excipients to reduce moisture uptake and maintain potency
- Use of highly oxidative excipients to accelerate degradation
- Prefer excipients that are soluble in strong acids only
- Use volatile oils as the primary binder
Correct Answer: Low hygroscopicity excipients to reduce moisture uptake and maintain potency
Q21. Which analytical parameter is essential in a stability study for DEC tablets?
- Assay of active ingredient over time under ICH humidity/temperature conditions
- Measurement of tablet radioactivity after 1 year
- Assessment of tablet ability to float on water as the primary endpoint
- Evaluation of taste only under accelerated conditions
Correct Answer: Assay of active ingredient over time under ICH humidity/temperature conditions
Q22. Which drug is preferred over DEC for treatment in onchocerciasis-endemic areas due to safety profile?
- Ivermectin
- Penicillin
- Metronidazole
- Amphotericin B
Correct Answer: Ivermectin
Q23. Which of the following best describes the impact of DEC on adult filarial worms?
- DEC primarily targets microfilariae; adult worm sterility or death may be limited and gradual
- DEC instantly dissolves adult worms on contact
- DEC is exclusively ovicidal for filarial eggs but not active against microfilariae
- DEC causes immediate necrosis of adult worms via direct enzyme inhibition
Correct Answer: DEC primarily targets microfilariae; adult worm sterility or death may be limited and gradual
Q24. Which laboratory finding may be transiently altered after DEC treatment due to immune response?
- Peripheral eosinophil count may change and signs of inflammation may appear
- Rapid rise in serum creatine kinase in all patients
- Immediate and permanent aplastic anemia
- Marked increase in serum cholesterol in hours
Correct Answer: Peripheral eosinophil count may change and signs of inflammation may appear
Q25. Which storage instruction is appropriate for DEC citrate tablets in a pharmacy?
- Store in a cool, dry place protected from moisture and excessive heat
- Store frozen at −20°C to preserve activity
- Keep tablets submerged in saline to prevent degradation
- Expose tablets to direct sunlight to maintain potency
Correct Answer: Store in a cool, dry place protected from moisture and excessive heat
Q26. Which adverse ocular outcome risk necessitates caution when using DEC in certain infections?
- Inflammatory eye reactions in onchocerciasis due to rapid microfilarial killing in ocular tissues
- Glaucoma onset due to increased aqueous humor production by DEC
- Permanent retinal detachment caused directly by DEC binding to retinal proteins
- Instant cataract formation in all treated patients
Correct Answer: Inflammatory eye reactions in onchocerciasis due to rapid microfilarial killing in ocular tissues
Q27. Which statement is true regarding drug interactions with DEC?
- Coadministration with other microfilaricidal drugs may increase inflammatory reactions and should be managed carefully
- DEC universally neutralizes all antibiotics if given concurrently
- DEC causes immediate potentiation of anticoagulants leading to bleeding in all patients
- DEC inactivates analgesics rendering them ineffective
Correct Answer: Coadministration with other microfilaricidal drugs may increase inflammatory reactions and should be managed carefully
Q28. From a formulation analysis perspective, which impurity concern is most relevant for DEC tablets?
- Residual solvent and degradation product levels that may form under humid/thermal stress
- Radioactive isotopes introduced during synthesis
- Excessive vitamin content from excipients
- High levels of airborne pollen trapped in tablets
Correct Answer: Residual solvent and degradation product levels that may form under humid/thermal stress
Q29. Which clinical sign should prompt immediate medical review after DEC administration?
- Severe visual disturbances or intense ocular inflammation
- Mild transient thirst that resolves
- Temporary mild loss of taste for a few hours
- Minor dandruff appearing days later
Correct Answer: Severe visual disturbances or intense ocular inflammation
Q30. For B. Pharm students designing patient counseling points, which advice is most appropriate for DEC therapy?
- Inform patients about possible fever, itching and headaches from parasite death and advise to seek care for severe reactions
- Tell patients DEC will cure all parasitic infections permanently after a single dose
- Advise patients to avoid fluids completely while on therapy
- Recommend self-adjusting the dose according to symptom severity
Correct Answer: Inform patients about possible fever, itching and headaches from parasite death and advise to seek care for severe reactions
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