General principles of chemotherapy MCQs With Answer

General principles of chemotherapy are essential for B.Pharm students, covering drug classification, mechanisms of action, pharmacokinetics, dosing strategies, toxicity management, and resistance mechanisms. This concise, exam-oriented introduction and MCQ set examines cytotoxic agents, targeted therapies, alkylating agents, antimetabolites, natural products, and hormonal drugs, with emphasis on cell cycle specificity, therapeutic index, dose-limiting toxicities, combination regimens, and pharmacovigilance. Key terms include chemotherapy principles, mechanism of action, drug resistance, dose intensity, myelosuppression, tumor lysis syndrome, and supportive care. These questions deepen understanding of clinical use, safety, and rational regimen design relevant to pharmacy practice and pharmacology courses. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which characteristic best defines a cell cycle-specific chemotherapeutic agent?

• Acts only on cells in a particular phase of the cell cycle
• Damages DNA irrespective of cell cycle phase
• Is activated only in hypoxic tumor regions
• Irreversibly inhibits growth factor receptors

Correct Answer: Acts only on cells in a particular phase of the cell cycle

Q2. Alkylating agents primarily exert antitumor effects by which mechanism?

• Inhibition of microtubule polymerization
• Cross-linking DNA strands leading to replication arrest
• Inhibition of thymidylate synthase
• Blocking growth factor receptors

Correct Answer: Cross-linking DNA strands leading to replication arrest

Q3. Which of the following is a major dose-limiting toxicity common to many cytotoxic chemotherapies?

• Neurogenic bladder
• Myelosuppression
• Hypothyroidism
• Hyperglycemia

Correct Answer: Myelosuppression

Q4. Antimetabolites such as 5-fluorouracil (5-FU) exert anticancer effects principally by:

• Alkylating guanine residues in DNA
• Inhibiting dihydrofolate reductase directly
• Inhibiting thymidylate synthase and disrupting DNA synthesis
• Blocking topoisomerase II

Correct Answer: Inhibiting thymidylate synthase and disrupting DNA synthesis

Q5. Cell cycle nonspecific agents are most effective when:

• Administered continuously over long periods
• Given only during S phase
• Active irrespective of tumor cell proliferation phase
• Targeting only G2 phase cells

Correct Answer: Active irrespective of tumor cell proliferation phase

Q6. Which statement describes the rationale for combination chemotherapy?

• Combining drugs with identical mechanisms magnifies the same toxicity
• Using agents with non-overlapping toxicities and different mechanisms enhances tumor kill and reduces resistance
• Combination therapy is only used to reduce cost of treatment
• Combining drugs prevents the need for supportive care

Correct Answer: Using agents with non-overlapping toxicities and different mechanisms enhances tumor kill and reduces resistance

Q7. Tumor lysis syndrome is most likely to occur with which scenario?

• Slow-growing indolent tumors treated conservatively
• Rapid tumor cell death after effective chemotherapy in high tumor burden malignancies
• Chronic low-dose hormonal therapy
• Topical application of cytotoxic drugs

Correct Answer: Rapid tumor cell death after effective chemotherapy in high tumor burden malignancies

Q8. Which growth factor is commonly used to manage chemotherapy-induced neutropenia?

• Erythropoietin
• Filgrastim (G-CSF)
• Interleukin-2
• Thrombopoietin mimetic

Correct Answer: Filgrastim (G-CSF)

Q9. Multidrug resistance in tumor cells is frequently mediated by which protein?

• P-glycoprotein (MDR1, ABCB1)
• Caspase-3
• Topoisomerase I
• Cytochrome P450 3A4

Correct Answer: P-glycoprotein (MDR1, ABCB1)

Q10. Which anticancer drug class interferes with microtubule dynamics?

• Alkylating agents
• Antimetabolites
• Vinca alkaloids and taxanes
• Topoisomerase inhibitors only

Correct Answer: Vinca alkaloids and taxanes

Q11. Methotrexate toxicity can be reduced by which rescue agent?

• Leucovorin (folinic acid)
• Vitamin B12
• Allopurinol
• Aminocaproic acid

Correct Answer: Leucovorin (folinic acid)

Q12. Which pharmacokinetic property is most important when considering dosing frequency of a chemotherapeutic agent?

• Volume of distribution only
• Plasma protein binding exclusively
• Elimination half-life and schedule-dependent efficacy
• Color and taste of formulation

Correct Answer: Elimination half-life and schedule-dependent efficacy

Q13. The therapeutic index of many chemotherapeutic drugs is narrow. This implies:

• Wide margin of safety between effective and toxic doses
• Toxic and therapeutic doses are close, requiring careful dosing and monitoring
• They are safe for over-the-counter use
• No need for dose adjustments in organ dysfunction

Correct Answer: Toxic and therapeutic doses are close, requiring careful dosing and monitoring

Q14. Which targeted therapy blocks the epidermal growth factor receptor (EGFR) by acting as a monoclonal antibody?

• Imatinib
• Trastuzumab
• Cetuximab
• Sunitinib

Correct Answer: Cetuximab

Q15. Which chemotherapeutic drug is well-known for causing hemorrhagic cystitis as a toxicity?

• Cyclophosphamide (and ifosfamide)
• Vincristine
• Bleomycin
• 5-fluorouracil

Correct Answer: Cyclophosphamide (and ifosfamide)

Q16. Which agent is commonly used to prevent febrile neutropenia-related infections in high-risk chemotherapy patients?

• Probenecid
• G-CSF prophylaxis
• Oral corticosteroids only
• NSAIDs as needed

Correct Answer: G-CSF prophylaxis

Q17. Topoisomerase II inhibitors such as etoposide cause DNA damage by:

• Cross-linking DNA strands
• Stabilizing the DNA-topoisomerase II cleavable complex causing double-strand breaks
• Inhibiting folate metabolism
• Interfering with microtubule assembly

Correct Answer: Stabilizing the DNA-topoisomerase II cleavable complex causing double-strand breaks

Q18. Which drug is a prodrug that requires hepatic activation to form its active alkylating metabolite?

• Cisplatin
• Cyclophosphamide
• Paclitaxel
• 5-fluorouracil

Correct Answer: Cyclophosphamide

Q19. Extravasation of vesicant chemotherapy agents requires immediate management because:

• It causes only mild transient discomfort
• It can lead to severe local tissue necrosis if not promptly treated
• It indicates systemic overdose
• It improves drug delivery to tumor

Correct Answer: It can lead to severe local tissue necrosis if not promptly treated

Q20. Which biomarker-guided therapy is appropriate for HER2-positive breast cancer?

• Imatinib
• Trastuzumab
• Bevacizumab
• Cetuximab

Correct Answer: Trastuzumab

Q21. Which statement about dose intensity in chemotherapy is correct?

• Reducing dose intensity improves tumor control
• Higher dose intensity may increase tumor cell kill but also increases toxicity
• Dose intensity is unrelated to scheduling
• Dose intensity refers only to the oral bioavailability

Correct Answer: Higher dose intensity may increase tumor cell kill but also increases toxicity

Q22. Which supportive drug reduces the risk of neutropenic fever by lowering uric acid in tumor lysis syndrome?

• Allopurinol
• Doxorubicin
• Ondansetron
• Metoclopramide

Correct Answer: Allopurinol

Q23. Which adverse effect is characteristically associated with bleomycin?

• Cardiotoxicity with cumulative dose
• Pulmonary fibrosis and interstitial pneumonitis
• Severe myelosuppression as primary toxicity
• Nephrotoxicity leading to renal failure

Correct Answer: Pulmonary fibrosis and interstitial pneumonitis

Q24. Which mechanism best explains pharmacologic resistance due to decreased drug activation?

• Increased drug efflux via P-glycoprotein
• Mutation of target receptor decreasing binding
• Loss or decreased expression of enzymes required to convert prodrug to active form
• Enhanced DNA repair in tumor cells

Correct Answer: Loss or decreased expression of enzymes required to convert prodrug to active form

Q25. Which chemotherapeutic agent is most associated with cardiomyopathy and cumulative dose-dependent cardiotoxicity?

• Cisplatin
• Doxorubicin (anthracyclines)
• Vinblastine
• 5-fluorouracil

Correct Answer: Doxorubicin (anthracyclines)

Q26. Checkpoint inhibitors in cancer immunotherapy target molecules such as:

• P-glycoprotein on tumor cells
• PD-1/PD-L1 and CTLA-4 to enhance immune response against tumors
• Topoisomerases to cause DNA breaks
• Microtubules to prevent mitosis

Correct Answer: PD-1/PD-L1 and CTLA-4 to enhance immune response against tumors

Q27. Which monitoring parameter is essential before administering cisplatin?

• Serum creatinine and renal function assessment
• Pulmonary function only
• Thyroid function tests
• Blood glucose level only

Correct Answer: Serum creatinine and renal function assessment

Q28. Intrathecal administration of chemotherapy is primarily used to treat or prevent:

• Hepatic metastases
• CNS (central nervous system) involvement or leptomeningeal disease
• Bone marrow infiltration only
• Cutaneous metastases

Correct Answer: CNS (central nervous system) involvement or leptomeningeal disease

Q29. Which chemotherapeutic agent is known for causing peripheral neuropathy as a prominent side effect?

• Cyclophosphamide
• Vincristine
• Fluorouracil
• Bleomycin

Correct Answer: Vincristine

Q30. Pharmacovigilance in chemotherapy practice primarily involves:

• Only approving new chemotherapeutic agents
• Monitoring, reporting, and managing adverse drug reactions and ensuring safe use of anticancer drugs
• Manufacturing chemotherapy drugs
• Marketing strategies for oncology drugs

Correct Answer: Monitoring, reporting, and managing adverse drug reactions and ensuring safe use of anticancer drugs

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