Psoriasis: drug therapy and systemic agents MCQs With Answer

Introduction:

Psoriasis: drug therapy and systemic agents MCQs With Answer is a focused question bank designed for M.Pharm students studying Pharmacotherapeutics I (MPP 102T). This collection emphasizes pharmacology, mechanisms of action, clinical indications, dosing principles, monitoring requirements, adverse effects and drug interactions for systemic agents used in psoriasis management. Questions range from conventional systemic drugs (methotrexate, ciclosporin, acitretin) to small molecules (apremilast, JAK inhibitors) and biologics (TNF, IL‑17, IL‑12/23, IL‑23 inhibitors). Each MCQ tests applied knowledge needed for safe, evidence‑based therapy selection and monitoring in moderate to severe psoriasis and psoriatic arthritis. Answers are provided to aid revision and clinical reasoning.

Q1. Which of the following best describes the primary mechanism of action of methotrexate in psoriasis?

• Inhibition of calcineurin leading to reduced IL‑2 production
• Inhibition of dihydrofolate reductase causing reduced DNA synthesis and increased adenosine anti‑inflammatory effects
• Selective blockade of TNF‑alpha receptors on T cells
• Activation of retinoic acid receptors altering keratinocyte differentiation

Correct Answer: Inhibition of dihydrofolate reductase causing reduced DNA synthesis and increased adenosine anti‑inflammatory effects

Q2. What is the recommended folate supplementation strategy to reduce methotrexate toxicity in psoriasis patients?

• Daily folic acid 5 mg with no pause from methotrexate
• Folic acid 1–5 mg daily except on the day of weekly methotrexate dose (or 5–10 mg once weekly after MTX dose)
• Folinic acid 50 mg daily for 3 days each week
• No supplementation is recommended because it reduces efficacy

Correct Answer: Folic acid 1–5 mg daily except on the day of weekly methotrexate dose (or 5–10 mg once weekly after MTX dose)

Q3. Which laboratory tests are essential prior to and during methotrexate therapy for psoriasis?

• Baseline and periodic complete blood count, liver function tests, and renal function tests
• Only baseline urinalysis and skin biopsy
• Monthly fasting blood glucose and ECG monitoring
• Daily liver ultrasound and PSA levels

Correct Answer: Baseline and periodic complete blood count, liver function tests, and renal function tests

Q4. Which statement about oral acitretin (a systemic retinoid) is correct?

• Acitretin is safe in pregnancy if stopped one month before conception
• It is teratogenic and contraception is required during treatment and for several years after discontinuation if alcohol is consumed
• Acitretin acts primarily by inhibiting TNF‑alpha
• It causes nephrotoxicity as its main dose‑limiting toxicity

Correct Answer: It is teratogenic and contraception is required during treatment and for several years after discontinuation if alcohol is consumed

Q5. What is a key monitoring parameter for patients receiving systemic ciclosporin for psoriasis?

• Regular measurement of fasting glucose only
• Periodic assessment of renal function (serum creatinine) and blood pressure
• Frequent thyroid function tests
• Monthly measurement of serum uric acid exclusively

Correct Answer: Periodic assessment of renal function (serum creatinine) and blood pressure

Q6. Which of the following is the correct rationale for counselling tuberculosis screening before initiating TNF‑alpha inhibitors?

• TNF inhibitors have no effect on latent infections, so screening is unnecessary
• TNF blockade impairs granuloma maintenance, increasing risk of reactivation of latent TB
• TNF inhibitors prevent TB reactivation by enhancing macrophage killing
• Only active TB, not latent TB, is a concern with TNF inhibitors

Correct Answer: TNF blockade impairs granuloma maintenance, increasing risk of reactivation of latent TB

Q7. Which biologic targets the IL‑17A cytokine and is associated with an increased risk of mucocutaneous candidiasis?

• Ustekinumab
• Etanercept
• Secukinumab
• Guselkumab

Correct Answer: Secukinumab

Q8. How do IL‑23 p19 inhibitors (e.g., guselkumab, risankizumab) differ mechanistically from ustekinumab?

• IL‑23 p19 inhibitors block both IL‑12 and IL‑23, whereas ustekinumab blocks only IL‑23
• IL‑23 p19 inhibitors selectively block the p19 subunit of IL‑23, while ustekinumab blocks the shared p40 subunit of IL‑12 and IL‑23
• Ustekinumab is a small molecule JAK inhibitor, IL‑23 p19 inhibitors are monoclonal antibodies
• They are identical in target and clinical effects with no differences

Correct Answer: IL‑23 p19 inhibitors selectively block the p19 subunit of IL‑23, while ustekinumab blocks the shared p40 subunit of IL‑12 and IL‑23

Q9. Which adverse effect is most characteristically associated with apremilast therapy?

• Severe nephrotoxicity with proteinuria
• Significant weight gain and edema
• Gastrointestinal upset (nausea, diarrhea) and weight loss
• Painless jaundice in most patients

Correct Answer: Gastrointestinal upset (nausea, diarrhea) and weight loss

Q10. Which systemic agent is most appropriate for short‑term rapid control of severe, unstable psoriasis flares because of its fast onset of action?

• Acitretin
• Ciclosporin
• Topical calcipotriol only
• Phototherapy

Correct Answer: Ciclosporin

Q11. For women of childbearing potential, which systemic psoriasis therapy is absolutely contraindicated during pregnancy?

• Etanercept
• Acitretin
• Ciclosporin (short courses may be used if benefits outweigh risks)
• Topical corticosteroids

Correct Answer: Acitretin

Q12. Which drug interaction is clinically important with ciclosporin therapy?

• Concurrent use with azole antifungals may increase ciclosporin levels via CYP3A4 inhibition
• Co‑administration with metformin increases ciclosporin clearance
• NSAIDs markedly reduce ciclosporin immunosuppressive effect by CYP induction
• Antacids double ciclosporin bioavailability

Correct Answer: Concurrent use with azole antifungals may increase ciclosporin levels via CYP3A4 inhibition

Q13. Why are systemic corticosteroids generally avoided in chronic plaque psoriasis?

• They have no anti‑inflammatory effect on skin
• Withdrawal can precipitate severe pustular or erythrodermic flares and long‑term use increases rebound risk
• They increase IL‑17 production and worsen disease immediately
• They are contraindicated because they inactivate methotrexate

Correct Answer: Withdrawal can precipitate severe pustular or erythrodermic flares and long‑term use increases rebound risk

Q14. Which monitoring is specifically recommended for patients receiving JAK inhibitors for psoriatic disease?

• No monitoring is required beyond clinical assessment
• Periodic CBC, liver enzymes, lipid profile and vigilance for thromboembolic events
• Only monthly chest X‑ray
• Frequent urinalysis for proteinuria is the sole requirement

Correct Answer: Periodic CBC, liver enzymes, lipid profile and vigilance for thromboembolic events

Q15. Which statement about anti‑drug antibodies (immunogenicity) to biologic therapies is correct?

• Concomitant methotrexate can reduce the formation of anti‑drug antibodies to some biologics
• Anti‑drug antibodies enhance biologic efficacy by stabilizing the drug
• All biologics are entirely non‑immunogenic and never induce antibodies
• Anti‑drug antibodies occur only with oral small molecules

Correct Answer: Concomitant methotrexate can reduce the formation of anti‑drug antibodies to some biologics

Q16. Which systemic agent for psoriasis commonly requires lipid monitoring because it can raise triglycerides and cholesterol?

• Methotrexate
• Acitretin
• Cyclosporine
• Topical vitamin D analogues

Correct Answer: Acitretin

Q17. Which of the following is the main advantage of combining methotrexate with a biologic agent in psoriasis management?

• Combination always eliminates need for monitoring
• Methotrexate increases biologic half‑life and always cures psoriasis permanently
• Combination may improve clinical response and reduce anti‑drug antibody formation, but increases infection risk
• There is no pharmacological rationale, and combined use is strictly contraindicated

Correct Answer: Combination may improve clinical response and reduce anti‑drug antibody formation, but increases infection risk

Q18. Which biologic class is most strongly associated with worsening or new onset congestive heart failure and must be used cautiously?

• IL‑23 p19 inhibitors
• TNF‑alpha inhibitors
• IL‑17 inhibitors
• PDE4 inhibitors

Correct Answer: TNF‑alpha inhibitors

Q19. Which systemic therapy is particularly useful in pustular psoriasis and may help normalize keratinocyte differentiation?

• Acitretin
• Topical emollients only
• Long‑term systemic antibiotics as monotherapy
• Oral iron supplementation

Correct Answer: Acitretin

Q20. Regarding treatment duration, which statement about ciclosporin use in psoriasis is most accurate?

• Ciclosporin is ideal for indefinite long‑term therapy because it lacks cumulative toxicity
• Ciclosporin is typically used as a short‑term bridge therapy (often limited to months) due to nephrotoxicity and hypertension risks
• Ciclosporin requires no dose adjustment for renal impairment
• Ciclosporin is only effective when combined with systemic steroids

Correct Answer: Ciclosporin is typically used as a short‑term bridge therapy (often limited to months) due to nephrotoxicity and hypertension risks

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