Biologic medicines for skin diseases MCQs With Answer

Biologic medicines for skin diseases are targeted therapeutic proteins designed to modulate specific immune pathways involved in dermatologic disorders such as psoriasis, atopic dermatitis, and hidradenitis suppurativa. This quiz set focuses on mechanisms of action, clinical indications, pharmacokinetics, safety monitoring, immunogenicity, biosimilars, and practical aspects of biologic use relevant to M.Pharm students. Questions emphasize understanding of cytokine targets (TNF, IL-12/23, IL-23, IL-17, IL-4/13), route and frequency of administration, adverse effect profiles, pre-treatment screening, and therapeutic drug monitoring. The aim is to reinforce mechanistic knowledge and clinical decision-making necessary for rational biologic therapy in dermatology.

Q1. Which cytokine subunit is directly targeted by ustekinumab in psoriasis therapy?

• The p40 subunit shared by IL-12 and IL-23
• The p19 subunit unique to IL-23
• IL-17A homodimer
• IL-4 receptor alpha chain

Correct Answer: The p40 subunit shared by IL-12 and IL-23

Q2. Which of the following biologics is an IL-17A inhibitor commonly used for moderate-to-severe plaque psoriasis?

• Secukinumab
• Infliximab
• Ustekinumab
• Dupilumab

Correct Answer: Secukinumab

Q3. Before initiating anti-TNF therapy for psoriasis, which screening test is mandatory due to risk of reactivation?

• Tuberculosis screening with IGRA or tuberculin skin test
• Complete lipid profile
• Anti-double stranded DNA antibodies
• Serum IgE level

Correct Answer: Tuberculosis screening with IGRA or tuberculin skin test

Q4. Which statement best describes a biosimilar in the context of biologic dermatologic agents?

• A follow-on biologic shown to be highly similar in quality, safety, and efficacy to a licensed reference biologic
• A generic small-molecule copy identical to the original protein biologic
• An unrelated recombinant protein used for similar indications
• A chemically synthesized analogue with identical amino acid sequence

Correct Answer: A follow-on biologic shown to be highly similar in quality, safety, and efficacy to a licensed reference biologic

Q5. Which adverse effect is most classically associated with IL-17 blockade (e.g., secukinumab, ixekizumab)?

• Increased risk of mucocutaneous Candida infections
• Severe neutropenia
• Renal tubular necrosis
• Hyperglycemia

Correct Answer: Increased risk of mucocutaneous Candida infections

Q6. Dupilumab exerts its effect in atopic dermatitis primarily by inhibiting which pathway?

• IL-4 and IL-13 signalling via IL-4Rα blockade
• TNF-α receptor blockade
• IL-23 p19 subunit blockade
• CTLA-4 mediated T-cell co-stimulation

Correct Answer: IL-4 and IL-13 signalling via IL-4Rα blockade

Q7. Which pharmacokinetic property is generally true for monoclonal antibody biologics used in dermatology?

• Long terminal half-life allowing dosing intervals of weeks to months
• Extensive oral bioavailability greater than 50%
• Primary hepatic CYP450 metabolism similar to small molecules
• Rapid renal excretion as intact proteins

Correct Answer: Long terminal half-life allowing dosing intervals of weeks to months

Q8. The development of anti-drug antibodies (ADA) against a therapeutic monoclonal antibody most likely leads to which clinical consequence?

• Reduced drug efficacy and possible infusion/injection reactions
• Enhanced potency and prolonged duration of action
• Conversion of the biologic into a small-molecule drug
• Immediate improvement in therapeutic index

Correct Answer: Reduced drug efficacy and possible infusion/injection reactions

Q9. Which biologic is specifically indicated for hidradenitis suppurativa and acts by blocking TNF-α?

• Adalimumab
• Guselkumab
• Broda lumab
• Risankizumab

Correct Answer: Adalimumab

Q10. For IL-23 inhibitors, which subunit is the unique target that differentiates them from IL-12/23 inhibitors?

• p19 subunit
• p40 subunit
• p35 subunit
• p17 subunit

Correct Answer: p19 subunit

Q11. Which monitoring parameter is most important during long-term biologic therapy to detect serious infection risk?

• Clinical assessment for signs and symptoms of infection and periodic latent TB screening as indicated
• Fasting blood glucose every month
• Baseline and monthly ECGs
• Urine protein-creatinine ratio weekly

Correct Answer: Clinical assessment for signs and symptoms of infection and periodic latent TB screening as indicated

Q12. Which route and formulation is commonly used for maintenance dosing of many dermatologic monoclonal antibodies?

• Subcutaneous injection at home at fixed intervals
• Oral tablet taken twice daily
• Topical cream applied to lesions
• Inhalation aerosol weekly

Correct Answer: Subcutaneous injection at home at fixed intervals

Q13. Which biologic mechanism would be least appropriate for treatment of chronic plaque psoriasis based on current evidence?

• Inhibition of IL-4/IL-13 only (Dupilumab is primarily for atopic dermatitis)
• Targeting IL-23 p19 subunit
• Neutralising IL-17A cytokine
• Blocking TNF-α activity

Correct Answer: Inhibition of IL-4/IL-13 only (Dupilumab is primarily for atopic dermatitis)

Q14. Therapeutic drug monitoring (TDM) for monoclonal antibodies in dermatology aims to measure which of the following?

• Serum trough drug concentration and anti-drug antibody levels
• Urine excretion rate of intact antibody
• Serum CYP enzyme activity
• Skin surface drug concentration

Correct Answer: Serum trough drug concentration and anti-drug antibody levels

Q15. Which biologic has a black-box warning or known serious risk for bowel disease exacerbation and must be used cautiously in inflammatory bowel disease patients?

• Brodalumab (IL-17 receptor antagonist) due to potential worsening of Crohn’s disease
• Ustekinumab due to risk of myocardial infarction
• Guselkumab due to severe nephrotoxicity
• Dupilumab due to thromboembolism

Correct Answer: Brodalumab (IL-17 receptor antagonist) due to potential worsening of Crohn’s disease

Q16. Which statement about immunogenicity mitigation strategies for biologics is correct?

• Concurrent methotrexate co-therapy can reduce anti-drug antibody formation for some biologics
• Giving biologics orally prevents immunogenicity
• Switching frequently between biologics eliminates ADA risk
• Immunogenicity is not influenced by route of administration

Correct Answer: Concurrent methotrexate co-therapy can reduce anti-drug antibody formation for some biologics

Q17. Which laboratory test is recommended prior to starting biologic therapy due to risk of viral reactivation?

• Hepatitis B surface antigen and Hepatitis B core antibody screening
• Serum complement C3 and C4 only
• ANA titer exclusively
• Vitamin D levels

Correct Answer: Hepatitis B surface antigen and Hepatitis B core antibody screening

Q18. A small-molecule JAK inhibitor differs from biologic monoclonal antibodies primarily because:

• It is orally bioavailable and targets intracellular signalling kinases rather than extracellular cytokines
• It is a large protein that must be injected and neutralises cytokine receptors externally
• It always has a longer half-life than monoclonal antibodies
• It is structurally identical to endogenous antibodies

Correct Answer: It is orally bioavailable and targets intracellular signalling kinases rather than extracellular cytokines

Q19. For a patient planning pregnancy, which general counseling about biologic exposure is most appropriate for many monoclonal antibodies used in dermatology?

• Most IgG1 monoclonal antibodies cross the placenta in the second and third trimester; benefit-risk discussion is required and some may be continued with specialist advice
• All biologics are strictly contraindicated at any time during pregnancy without exception
• Biologics increase teratogenic risk and must be replaced with high-dose systemic corticosteroids only
• No special considerations; biologics never cross the placenta

Correct Answer: Most IgG1 monoclonal antibodies cross the placenta in the second and third trimester; benefit-risk discussion is required and some may be continued with specialist advice

Q20. Which practical storage and handling instruction is important for maintaining biologic potency?

• Store refrigerated (per manufacturer guidance), protect from freezing and follow recommended reconstitution/use timelines
• Freeze at −20°C to extend shelf life indefinitely
• Store at room temperature for months to improve tolerability
• Expose to direct sunlight prior to injection to reduce immunogenicity

Correct Answer: Store refrigerated (per manufacturer guidance), protect from freezing and follow recommended reconstitution/use timelines

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