Haematinics: Ferrous gluconate MCQs With Answer

Haematinics: Ferrous gluconate MCQs With Answer — a targeted, student-friendly overview for B. Pharm learners. This introduction highlights haematinics and iron salts with emphasis on ferrous gluconate pharmacology, absorption, bioavailability, formulations, dosage, adverse effects, interactions, monitoring parameters, and clinical uses in iron-deficiency anemia. Detailed points include mechanism of action, pharmacokinetics, hepcidin regulation, therapeutic monitoring (ferritin, TIBC, transferrin saturation), and patient counselling for optimal oral iron therapy. These focused concepts are essential for exams and practical pharmacy practice, providing depth on formulation science, toxicity management, and case-based considerations. Questions include formulation, pharmacokinetics, therapeutic monitoring, toxicity, and clinical case-based scenarios to deepen understanding. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which of the following best describes the primary mechanism by which ferrous gluconate increases haemoglobin levels?

• Acts as a coagulant in blood plasma
• Supplies elemental iron for heme synthesis
• Stimulates erythropoietin release from kidneys
• Inhibits hepcidin synthesis directly

Correct Answer: Supplies elemental iron for heme synthesis

Q2. Ferrous gluconate is categorized under which class of drugs?

• Anticoagulants
• Haematinics
• Antiplatelets
• Vitamin D analogues

Correct Answer: Haematinics

Q3. Approximately how much elemental iron is present in a 300 mg tablet of ferrous gluconate (rounded)?

• 10 mg
• 35 mg
• 65 mg
• 100 mg

Correct Answer: 35 mg

Q4. Which intestinal transporter primarily mediates uptake of ferrous (Fe2+) iron into enterocytes?

• PEPT1
• DMT1 (divalent metal transporter 1)
• OATP1B1
• CTR1 (copper transporter)

Correct Answer: DMT1 (divalent metal transporter 1)

Q5. Which of the following dietary factors enhances absorption of oral ferrous gluconate?

• Calcium supplements
• Tea and coffee
• Ascorbic acid (vitamin C)
• Phytates from cereals

Correct Answer: Ascorbic acid (vitamin C)

Q6. The main site of iron absorption in the gastrointestinal tract is:

• Stomach corpus
• Distal ileum
• Duodenum and proximal jejunum
• Transverse colon

Correct Answer: Duodenum and proximal jejunum

Q7. Which regulatory peptide decreases iron absorption by causing ferroportin internalization?

• Gastrin
• Hepcidin
• Erythropoietin
• Insulin

Correct Answer: Hepcidin

Q8. Compared to ferrous sulfate, ferrous gluconate typically provides:

• Higher elemental iron per tablet
• Lower elemental iron but better gastrointestinal tolerance
• No elemental iron (placebo)
• Identical elemental iron and identical side effect profile

Correct Answer: Lower elemental iron but better gastrointestinal tolerance

Q9. Which laboratory parameter is most specific for iron stores and useful in monitoring response to therapy?

• Serum ferritin
• Serum creatinine
• ALP (alkaline phosphatase)
• Blood glucose

Correct Answer: Serum ferritin

Q10. The classic adverse gastrointestinal effect of oral ferrous salts that patients should be counseled about is:

• Constipation and dark (black) stools
• Profuse watery diarrhea with bleeding
• Severe jaundice
• Loss of taste only

Correct Answer: Constipation and dark (black) stools

Q11. Which of the following drug interactions reduces absorption of oral ferrous gluconate?

• Co-administration with vitamin C
• Co-administration with proton pump inhibitors
• Co-administration with ascorbic acid
• Separation from tetracycline by 2–3 hours

Correct Answer: Co-administration with proton pump inhibitors

Q12. In the event of acute iron overdose with systemic toxicity, the recommended chelating agent is:

• EDTA
• Deferoxamine
• Deferasirox
• Dimercaprol

Correct Answer: Deferoxamine

Q13. Which of the following iron preparations contains the highest percentage of elemental iron by weight?

• Ferrous gluconate
• Ferrous sulfate
• Ferrous fumarate
• Ferric ammonium citrate

Correct Answer: Ferrous fumarate

Q14. Ferrous gluconate is preferred over ferrous sulfate in some patients primarily due to:

• Greater elemental iron content
• Lower cost always
• Better gastrointestinal tolerability
• Intravenous route availability only

Correct Answer: Better gastrointestinal tolerability

Q15. Which of the following tests helps differentiate iron-deficiency anemia from anemia of chronic disease?

• Serum ferritin (low in iron-deficiency)
• Blood urea nitrogen
• Serum sodium
• Serum bilirubin

Correct Answer: Serum ferritin (low in iron-deficiency)

Q16. A pharmacy student is calculating elemental iron: ferrous gluconate tablets of 300 mg provide about how many mg of elemental iron per tablet?

• 5 mg
• 34–36 mg
• 90 mg
• 120 mg

Correct Answer: 34–36 mg

Q17. Which of the following is a correct counseling point for patients starting ferrous gluconate?

• Take with milk to enhance absorption
• Take with orange juice to improve absorption
• Skip doses if stools become dark and never consult
• Avoid vitamin C during therapy

Correct Answer: Take with orange juice to improve absorption

Q18. Which form of oral iron is most likely to cause visible staining of teeth in children if given as a liquid without precautions?

• Ferrous gluconate solution
• Intravenous iron sucrose
• Ferrous fumarate tablets only
• Deferoxamine injection

Correct Answer: Ferrous gluconate solution

Q19. Which condition is least likely to respond to oral ferrous gluconate therapy alone?

• Iron-deficiency anemia due to inadequate intake
• Anemia due to chronic blood loss from menorrhagia
• Pernicious anemia (vitamin B12 deficiency)
• Iron-deficiency in pregnancy (mild to moderate)

Correct Answer: Pernicious anemia (vitamin B12 deficiency)

Q20. Which pharmacokinetic factor primarily decreases oral iron absorption?

• Increased hepcidin levels
• Low gastric pH
• Co-administration with vitamin C
• Rapid gastric emptying

Correct Answer: Increased hepcidin levels

Q21. Sustained-release iron formulations are associated with which of the following disadvantages?

• Better absorption than immediate release
• Reduced gastrointestinal side effects with identical absorption
• Poor absorption because release occurs beyond proximal small intestine
• No interaction with antacids

Correct Answer: Poor absorption because release occurs beyond proximal small intestine

Q22. A common laboratory finding in iron-deficiency anemia is:

• High MCV (mean corpuscular volume)
• Low MCV (microcytosis)
• Marked hyperbilirubinemia
• Elevated platelet count only in pernicious anemia

Correct Answer: Low MCV (microcytosis)

Q23. Which of the following drugs forms chelates with oral iron and reduces its absorption if taken together?

• Penicillin G
• Tetracyclines
• Acetaminophen
• Simvastatin

Correct Answer: Tetracyclines

Q24. In pregnancy, the recommended approach for iron supplementation with ferrous gluconate is generally:

• Avoid all iron throughout pregnancy
• Supplement with appropriate elemental iron and folic acid as indicated
• Use parenteral iron only in first trimester
• Only dietary advice without supplements

Correct Answer: Supplement with appropriate elemental iron and folic acid as indicated

Q25. Which of the following is a sign of iron overload from chronic excessive iron intake?

• Hypopigmented skin
• Hepatomegaly and elevated liver enzymes
• Persistent microcytic anemia
• Hypoglycemia only

Correct Answer: Hepatomegaly and elevated liver enzymes

Q26. The therapeutic effect of ferrous gluconate is primarily monitored by which sequence of laboratory changes?

• Rising reticulocyte count within 7–10 days then rising hemoglobin over weeks
• Immediate rise in hemoglobin within 24 hours
• Decreasing ferritin immediately after starting therapy
• Rapid drop in WBC count

Correct Answer: Rising reticulocyte count within 7–10 days then rising hemoglobin over weeks

Q27. Which of the following oral agents should be separated from ferrous gluconate dosing because they reduce iron absorption?

• Vitamin C supplements
• Calcium carbonate-containing antacids
• Orange juice
• Ascorbic acid tablets

Correct Answer: Calcium carbonate-containing antacids

Q28. Which IV iron formulation historically had the highest risk of serious anaphylactic reactions and therefore requires a test dose?

• Iron dextran (high molecular weight)
• Ferric carboxymaltose
• Iron sucrose
• Ferric gluconate IV

Correct Answer: Iron dextran (high molecular weight)

Q29. The color change to black stools during oral iron therapy is due to:

• Gastrointestinal bleeding only
• Oxidation of unabsorbed iron in the GI tract
• Hepatic metabolism causing pigment excretion
• Direct staining from tablet dyes only

Correct Answer: Oxidation of unabsorbed iron in the GI tract

Q30. Which of the following is the most appropriate advice to maximize oral iron absorption and reduce GI upset?

• Take iron with a heavy meal rich in dairy
• Take iron on an empty stomach or with vitamin C; if intolerant, take with a small amount of food
• Always take iron with antacids
• Take iron only at bedtime with milk

Correct Answer: Take iron on an empty stomach or with vitamin C; if intolerant, take with a small amount of food

Q31. Which of the following statements about elemental iron content is correct?

• Ferrous fumarate ~33% elemental iron
• Ferrous gluconate ~60% elemental iron
• Ferrous sulfate contains no elemental iron
• All ferrous salts have identical elemental iron percentages

Correct Answer: Ferrous fumarate ~33% elemental iron

Q32. A B. Pharm student preparing an extemporaneous ferrous gluconate syrup should be most concerned about which property for product stability?

• Photosensitivity and oxidation of iron
• Radioactive decay
• Boiling point elevation
• Exothermic polymerization

Correct Answer: Photosensitivity and oxidation of iron

Q33. Which condition would most likely require parenteral iron rather than oral ferrous gluconate?

• Mild iron deficiency with good GI tolerance
• Severe iron-deficiency anemia with malabsorption or intolerance to oral iron
• Dietary iron insufficiency easily corrected by food
• Pregnant patient with mild iron deficiency responding to oral iron

Correct Answer: Severe iron-deficiency anemia with malabsorption or intolerance to oral iron

Q34. Which of the following statements about hepcidin is correct?

• Hepcidin increases ferroportin expression to enhance iron export
• Hepcidin decreases intestinal iron absorption by degrading ferroportin
• Hepcidin is secreted by the pancreas to regulate glucose
• Hepcidin directly binds hemoglobin to release iron

Correct Answer: Hepcidin decreases intestinal iron absorption by degrading ferroportin

Q35. Which laboratory finding is typical in anemia of chronic disease compared to iron-deficiency anemia?

• Low ferritin in anemia of chronic disease
• Normal or high ferritin with low serum iron in anemia of chronic disease
• Extremely elevated TIBC only in anemia of chronic disease
• Markedly increased MCV in anemia of chronic disease

Correct Answer: Normal or high ferritin with low serum iron in anemia of chronic disease

Q36. Which statement regarding iron and pregnancy is most accurate?

• Iron requirements decrease during pregnancy
• Routine iron supplementation is often recommended to prevent deficiency
• Iron therapy is contraindicated in pregnancy
• Only parenteral iron is safe in pregnancy

Correct Answer: Routine iron supplementation is often recommended to prevent deficiency

Q37. Which of the following is the best marker to assess recent effective erythropoiesis after starting iron therapy?

• Reticulocyte count increase
• Serum potassium increase
• Serum albumin decrease
• Platelet count decrease

Correct Answer: Reticulocyte count increase

Q38. Which beverage should patients avoid around iron dosing because it inhibits absorption?

• Orange juice
• Black tea
• Fresh lemon water
• Apple juice

Correct Answer: Black tea

Q39. In an iron-deficiency anemia case, which additional supplement is commonly prescribed along with iron to prevent a common coexisting deficiency?

• Vitamin B12 alone
• Folic acid
• Calcium carbonate
• Magnesium sulfate

Correct Answer: Folic acid

Q40. Which pharmacological property explains why ferrous (Fe2+) salts are used for oral iron supplementation rather than ferric (Fe3+) salts?

• Fe3+ is absorbed more readily than Fe2+
• Fe2+ is better absorbed via intestinal transporters than Fe3+
• Fe2+ is unstable in stomach
• Fe3+ cannot form complexes with transferrin

Correct Answer: Fe2+ is better absorbed via intestinal transporters than Fe3+

Q41. A patient on ferrous gluconate reports severe constipation. Which medication could be recommended to manage this side effect?

• Bulk-forming laxative or stool softener (e.g., docusate)
• High-dose iron supplement increase
• Immediate administration of antacid with iron
• Stop fluids completely

Correct Answer: Bulk-forming laxative or stool softener (e.g., docusate)

Q42. What is the recommended laboratory test to evaluate body iron stores prior to initiating therapy?

• Serum ferritin
• Random urine glucose
• Lipid profile
• Serum amylase

Correct Answer: Serum ferritin

Q43. Which of the following adverse effects is specifically a medical emergency in acute iron poisoning?

• Mild constipation
• Severe metabolic acidosis and shock
• Transient taste disturbance
• Benign skin rash not progressing

Correct Answer: Severe metabolic acidosis and shock

Q44. Ferrous gluconate oral liquid formulations should be stored how to maintain stability?

• Exposed to light at room temperature
• Protected from light and tightly capped, stored at recommended temperature
• Frozen at -20°C
• Mixed with milk for storage

Correct Answer: Protected from light and tightly capped, stored at recommended temperature

Q45. In patients with chronic kidney disease receiving erythropoiesis-stimulating agents, iron supplementation (including ferrous gluconate) is important because:

• Iron is unrelated to erythropoiesis
• Increased erythropoiesis consumes iron stores leading to deficiency
• It increases blood pressure dangerously
• Oral iron is always ineffective in CKD

Correct Answer: Increased erythropoiesis consumes iron stores leading to deficiency

Q46. Which of the following is the correct recommendation regarding timing of dosing to maximize iron absorption?

• Take iron with antacids to speed absorption
• Take iron on an empty stomach or between meals unless intolerance occurs
• Always take iron with dairy foods
• Take iron only once monthly

Correct Answer: Take iron on an empty stomach or between meals unless intolerance occurs

Q47. Which parameter decreases early during development of iron-deficiency anemia and helps in early detection?

• Serum ferritin increases first
• Serum ferritin decreases early reflecting reduced stores
• Serum sodium decreases early
• Transferrin saturation increases early

Correct Answer: Serum ferritin decreases early reflecting reduced stores

Q48. Which statement is true regarding enteric-coated iron formulations?

• They have superior absorption compared with immediate-release ferrous salts
• They may reduce GI irritation but can have reduced absorption due to delayed release
• They ensure 100% elemental iron absorption
• They are recommended as first-line for rapid correction of anemia

Correct Answer: They may reduce GI irritation but can have reduced absorption due to delayed release

Q49. Which of the following is an expected hematologic change after several weeks of successful iron therapy?

• Persistent low reticulocyte count forever
• Gradual rise in hemoglobin and restoration of normal MCV
• Immediate normalization of ferritin within 24 hours
• Development of macrocytic anemia

Correct Answer: Gradual rise in hemoglobin and restoration of normal MCV

Q50. For overdose risk awareness, which group is at highest risk of accidental iron poisoning from household iron preparations?

• Elderly individuals with polypharmacy only
• Young children who accidentally ingest adult iron tablets or syrups
• Health-care professionals only
• Adolescents taking multivitamins with no iron

Correct Answer: Young children who accidentally ingest adult iron tablets or syrups

G S Sachin

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.

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