Alkaloids from the Vinca genus are essential anticancer agents and a core subject for B.Pharm students. Vinca alkaloids—vincristine, vinblastine, vindesine and vinorelbine—are complex indole alkaloids derived from Catharanthus roseus with specialized biosynthesis, distinctive structure–activity relationships, and a primary mechanism of microtubule destabilization. Understanding pharmacology, pharmacokinetics, dose-limiting toxicities (peripheral neuropathy, myelosuppression), clinical indications, resistance mechanisms, drug interactions (CYP3A4/P-gp), analytical assays and safe handling is critical for oncology pharmacy practice. The material also addresses formulation, dosing calculations, administration routes, vesicant management, and quality control for hospital settings. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which plant species is the primary natural source of clinically important Vinca alkaloids?
- Catharanthus roseus (formerly Vinca rosea)
- Rauwolfia serpentina
- Atropa belladonna
- Camptotheca acuminata
Correct Answer: Catharanthus roseus (formerly Vinca rosea)
Q2. Vinca alkaloids exert their anticancer effect primarily by which mechanism?
- Inhibition of topoisomerase I
- Microtubule destabilization and inhibition of polymerization
- Alkylation of DNA bases
- Inhibition of dihydrofolate reductase
Correct Answer: Microtubule destabilization and inhibition of polymerization
Q3. Which cell cycle phase is most affected by Vinca alkaloids?
- G1 phase
- S phase
- G2 phase
- M (mitotic) phase
Correct Answer: M (mitotic) phase
Q4. Which Vinca alkaloid is most commonly associated with peripheral neuropathy as its dose-limiting toxicity?
- Vinblastine
- Vincristine
- Vinorelbine
- Vindesine
Correct Answer: Vincristine
Q5. Which Vinca alkaloid is particularly associated with prominent myelosuppression (bone marrow toxicity)?
- Vincristine
- Vinblastine
- Vinorelbine
- Vindesine
Correct Answer: Vinblastine
Q6. Which structural class best describes Vinca alkaloids?
- Quinolone alkaloids
- Benzylisoquinoline alkaloids
- Indole-dimer alkaloids (bisindole alkaloids)
- Pyrrolizidine alkaloids
Correct Answer: Indole-dimer alkaloids (bisindole alkaloids)
Q7. The biosynthesis of Vinca alkaloids involves the coupling of which two major precursors?
- Serotonin and acetate
- Tryptamine and secologanin
- Tyrosine and cinnamic acid
- Squalene and isopentenyl pyrophosphate
Correct Answer: Tryptamine and secologanin
Q8. Which Vinca alkaloid is commonly used in pediatric acute lymphoblastic leukemia protocols?
- Vinblastine
- Vincristine
- Vinorelbine
- Vindesine
Correct Answer: Vincristine
Q9. Which of the following is an important clinical use of vinblastine?
- Chronic myeloid leukemia maintenance therapy
- Hodgkin’s lymphoma treatment
- Alzheimer’s disease symptomatic therapy
- Management of bacterial infections
Correct Answer: Hodgkin’s lymphoma treatment
Q10. Vinorelbine is a semisynthetic derivative primarily used in which cancer type?
- Breast cancer only
- Non-small cell lung cancer (NSCLC)
- Prostate cancer
- Glioblastoma multiforme
Correct Answer: Non-small cell lung cancer (NSCLC)
Q11. Which cytochrome enzyme system is most relevant for hepatic metabolism and drug interactions of many Vinca alkaloids?
- CYP1A2
- CYP2D6
- CYP3A4
- CYP2C9
Correct Answer: CYP3A4
Q12. A major mechanism of acquired resistance to Vinca alkaloids in tumor cells is:
- Overexpression of thymidylate synthase
- Increased drug efflux by P-glycoprotein (MDR1)
- Enhanced DNA repair enzymes
- Loss of topoisomerase II
Correct Answer: Increased drug efflux by P-glycoprotein (MDR1)
Q13. Which administration route is absolutely contraindicated for vincristine due to fatal outcomes?
- Intravenous infusion
- Intramuscular injection
- Intrathecal administration
- Central venous line infusion
Correct Answer: Intrathecal administration
Q14. Regarding vesicant properties, which statement is correct about many Vinca alkaloids?
- They are non-vesicant and safe for extravasation
- They are vesicants and extravasation can cause severe local tissue necrosis
- They cause only mild irritation on extravasation without tissue injury
- They neutralize extravasated vesicants and reduce injury
Correct Answer: They are vesicants and extravasation can cause severe local tissue necrosis
Q15. Which laboratory method is commonly used for quantitative assay and quality control of Vinca alkaloids in formulations?
- High-performance liquid chromatography (HPLC)
- Gram staining
- ELISA for antibodies
- UV spectrophotometry without separation
Correct Answer: High-performance liquid chromatography (HPLC)
Q16. Dose adjustments of vincristine are particularly required in which organ impairment?
- Renal impairment
- Hepatic impairment
- Pancreatic insufficiency
- Thyroid dysfunction
Correct Answer: Hepatic impairment
Q17. Which clinical syndrome can be associated with vincristine therapy due to its neurologic effects?
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Rhabdomyolysis
- Cardiac arrhythmias as primary toxicity
- Severe hypoglycemia
Correct Answer: Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Q18. Which monitoring parameter is most important before administering vinblastine?
- Platelet count and absolute neutrophil count
- Blood glucose
- Serum amylase
- Serum magnesium
Correct Answer: Platelet count and absolute neutrophil count
Q19. Which statement best describes the site of binding of Vinca alkaloids on tubulin?
- They bind to the taxane site and stabilize microtubules
- They bind to the colchicine site exclusively
- They bind to the Vinca-binding domain on β-tubulin, inhibiting polymerization
- They intercalate into DNA and secondarily affect tubulin
Correct Answer: They bind to the Vinca-binding domain on β-tubulin, inhibiting polymerization
Q20. In formulation practice, vincristine is commonly provided as which pharmaceutical form?
- Oral tablets for outpatient administration
- Topical cream for local tumors
- Lyophilized powder for reconstitution for IV injection
- Inhalation solution
Correct Answer: Lyophilized powder for reconstitution for IV injection
Q21. A pharmacist should avoid mixing vincristine with which of the following in the same IV line without adequate flushing?
- Normal saline
- Dextrose 5% in water (D5W)
- Other chemotherapeutic agents or incompatible drugs
- Heparin flush
Correct Answer: Other chemotherapeutic agents or incompatible drugs
Q22. Which analytical technique is useful for structural elucidation of Vinca alkaloids during research and development?
- Nuclear magnetic resonance (NMR) spectroscopy
- Gram staining
- Osmolality testing
- pH paper strip
Correct Answer: Nuclear magnetic resonance (NMR) spectroscopy
Q23. Which adverse effect is more closely linked to vinorelbine compared with vincristine and vinblastine?
- Severe peripheral neuropathy as the predominant toxicity
- Higher incidence of neutropenia and febrile neutropenia
- Cardiotoxicity equivalent to anthracyclines
- Profound renal tubular acidosis
Correct Answer: Higher incidence of neutropenia and febrile neutropenia
Q24. Which pharmacokinetic property is typical of Vinca alkaloids?
- High oral bioavailability
- Extensive tissue distribution and high protein binding
- Excretion primarily unchanged in urine
- Minimal hepatic metabolism
Correct Answer: Extensive tissue distribution and high protein binding
Q25. Which statement about vincristine dosing is correct?
- Doses are typically expressed in mg/kg for all adult patients
- Dosing commonly uses mg/m2 body surface area and caps are often used to reduce neurotoxicity
- Vincristine is dosed orally once daily
- No dose modifications are needed in hepatic impairment
Correct Answer: Dosing commonly uses mg/m2 body surface area and caps are often used to reduce neurotoxicity
Q26. Which of the following is an important handling precaution for pharmacy staff when preparing Vinca alkaloid injections?
- They may be prepared without PPE because they are non-toxic to staff
- Use of biological safety cabinet, gloves and cytotoxic handling precautions is required
- They can be prepared on an open bench if labeled clearly
- No special disposal procedures are necessary
Correct Answer: Use of biological safety cabinet, gloves and cytotoxic handling precautions is required
Q27. Which semisynthetic Vinca derivative was developed to improve tolerability and target activity compared to parent compounds?
- Vincristine sulfate
- Vinblastine acetate
- Vinorelbine
- Reserpine
Correct Answer: Vinorelbine
Q28. A common quality control parameter for injectable Vinca formulations is:
- Sterility testing and particulate matter assessment
- Fragrance testing
- Viscosity comparable to ophthalmic drops
- Color matching to a reference cream
Correct Answer: Sterility testing and particulate matter assessment
Q29. Which patient counseling point is relevant for a patient receiving vincristine?
- Monitor for signs of infection and report fever promptly
- Expect immediate hair regrowth within days
- No need to report numbness or tingling in hands or feet
- It is safe to self-administer intrathecally at home
Correct Answer: Monitor for signs of infection and report fever promptly
Q30. In pharmacology, the difference in primary toxicities between vincristine and vinblastine is largely explained by:
- Differences in DNA intercalation potency
- Differences in tissue distribution, cellular uptake and selectivity for neural versus hematopoietic cells
- Vincristine being administered orally while vinblastine is IV
- Vinblastine’s role as a monoclonal antibody
Correct Answer: Differences in tissue distribution, cellular uptake and selectivity for neural versus hematopoietic cells
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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