OTC medicines: rational use and counseling MCQs With Answer

Introduction:

OTC medicines play a central role in self-care and primary health management. For M.Pharm students, mastering rational use and patient counseling of OTC products is essential to ensure safety, efficacy, and prevention of misuse. This blog provides focused multiple-choice questions that probe pharmacology, regulatory classification, contraindications, interactions, patient communication, and pharmacovigilance related to commonly used OTC agents. The questions are designed to deepen clinical reasoning, emphasize evidence-based selection, and strengthen counseling skills for diverse patient scenarios including pediatrics, pregnancy, comorbidities, and polypharmacy. Use these MCQs to assess knowledge, prepare for exams, and refine practical counseling approaches in hospital and community pharmacy settings.

Q1. Which regulatory criterion primarily distinguishes an over-the-counter (OTC) medicine from a prescription-only medicine?

• Requirement for specialist administration
• Known safety profile for self-selection and self-administration
• Higher cost than prescription drugs
• Indication for rare diseases only

Correct Answer: Known safety profile for self-selection and self-administration

Q2. Which counseling point is most critical when advising a patient purchasing an OTC NSAID for chronic musculoskeletal pain?

• Encourage combining with anticoagulants for better pain relief
• Advise maximum daily dose, take with food to reduce GI upset, and check for cardiovascular and renal risks
• Recommend stopping prescription antihypertensives while on NSAID
• Suggest doubling dose if no effect after one day

Correct Answer: Advise maximum daily dose, take with food to reduce GI upset, and check for cardiovascular and renal risks

Q3. A parent asks for an OTC antipyretic for a 3-year-old child with fever. Which statement reflects the safest immediate recommendation?

• Give aspirin because it is most effective
• Use age-appropriate dose of paracetamol or ibuprofen and avoid aspirin due to Reye’s syndrome risk
• Administer adult-strength ibuprofen tablet split in half
• Start combination paracetamol and aspirin to control fever quickly

Correct Answer: Use age-appropriate dose of paracetamol or ibuprofen and avoid aspirin due to Reye’s syndrome risk

Q4. Which OTC antihistamine is preferred for daytime use due to minimal sedation?

• First-generation diphenhydramine
• Chlorpheniramine
• Second-generation loratadine
• Hydroxyzine

Correct Answer: Second-generation loratadine

Q5. When counseling a patient on an OTC antacid containing aluminum hydroxide, which interaction is most important to mention?

• Increases absorption of tetracyclines
• May chelate and reduce absorption of fluoroquinolones and tetracyclines
• Enhances efficacy of levothyroxine
• Has no clinically relevant drug interactions

Correct Answer: May chelate and reduce absorption of fluoroquinolones and tetracyclines

Q6. Which OTC topical product requires counseling about not using on large areas or broken skin due to systemic corticosteroid absorption?

• Hydrocortisone 1% cream
• Benzoyl peroxide 5% gel
• Topical clotrimazole 1% cream
• Aloe vera gel

Correct Answer: Hydrocortisone 1% cream

Q7. For OTC cold remedies containing decongestants, which patient group needs specific caution and counseling?

• Patients with well-controlled eczema
• Patients with ischemic heart disease or uncontrolled hypertension
• Patients with seasonal allergies only
• Young adults with no comorbidities

Correct Answer: Patients with ischemic heart disease or uncontrolled hypertension

Q8. In the context of rational OTC use, what is the pharmacist’s primary responsibility when a patient requests an OTC antibiotic substitute?

• Dispense an OTC antibiotic alternative immediately
• Explain antibiotics are prescription-only, assess the condition, recommend symptomatic OTC therapy, and refer if bacterial infection suspected
• Prescribe based on patient’s prior experience
• Recommend higher doses of OTC analgesics to mask infection

Correct Answer: Explain antibiotics are prescription-only, assess the condition, recommend symptomatic OTC therapy, and refer if bacterial infection suspected

Q9. Which labeling element is legally important on OTC products to facilitate safe self-medication?

• Physician’s office address
• Active ingredient, strength, indications, directions for use, warnings, and contraindications
• Only the brand name and manufacturer logo
• Discount coupons for repeat purchases

Correct Answer: Active ingredient, strength, indications, directions for use, warnings, and contraindications

Q10. What is the best counseling point for a patient using nicotine replacement therapy (NRT) gum as an OTC aid to quit smoking?

• Chew rapidly and swallow to speed nicotine delivery
• Use the “chew and park” method, avoid acidic beverages around chewing, and follow dosing frequency for cravings
• Use NRT gum continuously throughout the day without limits
• Combine NRT gum with smoking to reduce harm immediately

Correct Answer: Use the “chew and park” method, avoid acidic beverages around chewing, and follow dosing frequency for cravings

Q11. Which OTC analgesic is contraindicated or used with extreme caution in patients with severe liver impairment?

• Ibuprofen
• Aspirin
• Paracetamol (acetaminophen)
• Naproxen

Correct Answer: Paracetamol (acetaminophen)

Q12. A patient on warfarin requests an OTC herbal product. Which herbal product is most likely to interact and requires pharmacist warning?

• Ginger capsule in culinary amounts
• St. John’s wort extract
• Standard multivitamin tablet
• Topical chamomile cream

Correct Answer: St. John’s wort extract

Q13. Which of the following is a key indicator of OTC medicine misuse that should prompt pharmacist intervention?

• Short course use according to label
• Frequent repeat purchases of decongestant sprays leading to rebound congestion
• First-time therapy for mild symptom
• Occasional use of lubricant eye drops

Correct Answer: Frequent repeat purchases of decongestant sprays leading to rebound congestion

Q14. Which counseling advice is most appropriate for a pregnant woman seeking an OTC medication for heartburn?

• Recommend misoprostol for gastric protection
• Suggest lifestyle measures first, then antacids containing calcium or magnesium; avoid sodium bicarbonate and consult prescriber for persistent symptoms
• Recommend high-dose ibuprofen for symptomatic relief
• Advise using topical anesthetic gels for internal heartburn

Correct Answer: Suggest lifestyle measures first, then antacids containing calcium or magnesium; avoid sodium bicarbonate and consult prescriber for persistent symptoms

Q15. Regarding pediatric dosing of OTC liquids, what is the safest practice to reduce dosing errors?

• Instruct caregivers to estimate volume using household spoons
• Provide and recommend use of an accurate dosing device (oral syringe) and clarify dose in milliliters
• Advise to give half of an adult dose for all children under 12
• Suggest diluting adult formulations to adjust dose

Correct Answer: Provide and recommend use of an accurate dosing device (oral syringe) and clarify dose in milliliters

Q16. Which OTC cough product class has the weakest consistent evidence for efficacy in acute uncomplicated upper respiratory tract infection?

• Honey for children above one year
• Codeine-containing combination syrups
• Expectorants such as guaifenesin
• Oral dextromethorphan in adults

Correct Answer: Expectorants such as guaifenesin

Q17. For community pharmacists, which practice is most important to promote pharmacovigilance of OTC medicines?

• Only report adverse events for prescription drugs
• Encourage and document patient reports of adverse events for OTC products and submit appropriate reports to the national adverse event database
• Advise patients to stop reporting mild side effects
• Limit counseling time to avoid liability

Correct Answer: Encourage and document patient reports of adverse events for OTC products and submit appropriate reports to the national adverse event database

Q18. Which OTC topical antifungal counseling point is essential for patient adherence and cure?

• Stop treatment as soon as symptoms improve
• Apply for the full recommended duration, continue for 1–2 weeks after lesion resolution to prevent recurrence
• Use once and reassess in two weeks
• Apply higher than recommended frequency for faster cure

Correct Answer: Apply for the full recommended duration, continue for 1–2 weeks after lesion resolution to prevent recurrence

Q19. Which statement best reflects the rationale for placing codeine-containing cough preparations behind the counter or prescription-only in many jurisdictions?

• Codeine has no analgesic or antitussive effect
• Concerns about misuse, dependence, variable metabolism (CYP2D6) and safety in children
• Codeine is ineffective as an antitussive
• To increase pharmacy revenue by requiring prescriptions

Correct Answer: Concerns about misuse, dependence, variable metabolism (CYP2D6) and safety in children

Q20. A patient with chronic kidney disease asks for an OTC antacid for dyspepsia. Which recommendation is most appropriate?

• Recommend magnesium-containing antacids freely
• Avoid aluminum- and magnesium-containing antacids without medical advice; consider calcium carbonate only if approved by the nephrologist
• Suggest frequent high-dose sodium bicarbonate for symptom control
• Encourage prolonged use of OTC proton pump inhibitors without physician consultation

Correct Answer: Avoid aluminum- and magnesium-containing antacids without medical advice; consider calcium carbonate only if approved by the nephrologist

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