Antiepileptic and neurodegenerative disease pharmacotherapy MCQs With Answer

Antiepileptic and Neurodegenerative Disease Pharmacotherapy MCQs With Answer

This quiz set is designed for M.Pharm students preparing for advanced pharmacology examinations and clinical practice. It focuses on antiepileptic drugs (AEDs) and pharmacotherapy for neurodegenerative diseases such as Parkinson’s and Alzheimer’s disease. Questions cover mechanisms of action, pharmacokinetics, adverse effects, drug interactions, therapeutic monitoring, and recent advances in drug development. Each item tests conceptual depth and applied knowledge relevant to formulation scientists, clinical pharmacologists, and pharmacists involved in CNS drug therapy. Use these MCQs to identify knowledge gaps, reinforce understanding of molecular targets and pathways, and prepare for higher-level assessments and case-based problem solving.

Q1. Which mechanism best explains carbamazepine’s primary antiepileptic action?

• Enhancement of GABA-A receptor-mediated chloride influx
• Blockade of T-type calcium channels in thalamic neurons
• Use-dependent blockade of voltage-gated sodium channels
• Inhibition of glutamate release via NMDA receptor antagonism

Correct Answer: Use-dependent blockade of voltage-gated sodium channels

Q2. Levetiracetam’s anticonvulsant effect is most closely associated with binding to which synaptic protein?

• Sodium channel alpha subunit (Nav1.1)
• Synaptic vesicle protein 2A (SV2A)
• GABA transaminase (GABA-T)
• NMDA receptor NR2B subunit

Correct Answer: Synaptic vesicle protein 2A (SV2A)

Q3. Which antiepileptic drug is most likely to induce hepatic cytochrome P450 enzymes and reduce effectiveness of oral contraceptives?

• Valproate
• Lamotrigine
• Carbamazepine
• Levetiracetam

Correct Answer: Carbamazepine

Q4. Which adverse effect is characteristically associated with long-term high-dose valproate therapy?

• Gingival hyperplasia
• Teratogenic neural tube defects and hepatotoxicity
• Weight loss and hypoglycemia
• Kidney stone formation

Correct Answer: Teratogenic neural tube defects and hepatotoxicity

Q5. Which pharmacological strategy is used by benzodiazepines to control acute status epilepticus?

• Direct agonism at NMDA receptors to reduce excitotoxicity
• Positive allosteric modulation of GABA-A receptors to enhance inhibitory tone
• Inhibition of voltage-gated potassium channels to hyperpolarize neurons
• Blockade of synaptic vesicle release by SV2A binding

Correct Answer: Positive allosteric modulation of GABA-A receptors to enhance inhibitory tone

Q6. In Parkinson’s disease, which combination therapy aims to enhance central dopamine while reducing peripheral metabolism?

• Carbidopa with levodopa
• Selegiline with bromocriptine
• Entacapone with dopamine agonists only
• Donepezil with memantine

Correct Answer: Carbidopa with levodopa

Q7. Which drug is a reversible acetylcholinesterase inhibitor commonly used in mild-to-moderate Alzheimer’s disease?

• Memantine
• Rivastigmine
• Levodopa
• Amantadine

Correct Answer: Rivastigmine

Q8. Which statement best describes the role of NMDA receptor antagonists like memantine in Alzheimer’s therapy?

• They increase acetylcholine synthesis in basal forebrain neurons
• They block excessive glutamate-mediated excitotoxicity while sparing physiological NMDA activity
• They act as monoamine oxidase inhibitors to prevent dopamine breakdown
• They chelate beta-amyloid and prevent plaque formation

Correct Answer: They block excessive glutamate-mediated excitotoxicity while sparing physiological NMDA activity

Q9. Which antiepileptic drug’s metabolism can cause autoinduction leading to time-dependent increases in clearance?

• Gabapentin
• Phenytoin
• Carbamazepine
• Topiramate

Correct Answer: Carbamazepine

Q10. Which AED is contraindicated in pregnancy due to highest known teratogenic risk and should be avoided when possible?

• Lamotrigine
• Valproate
• Levetiracetam
• Ethosuximide

Correct Answer: Valproate

Q11. Which therapeutic approach is used by catechol-O-methyltransferase (COMT) inhibitors in Parkinson’s disease treatment?

• Prevent dopamine reuptake into presynaptic terminals
• Reduce peripheral and central methylation of levodopa to prolong levodopa half-life
• Directly stimulate D2 dopamine receptors as agonists
• Inhibit acetylcholinesterase to improve cognition

Correct Answer: Reduce peripheral and central methylation of levodopa to prolong levodopa half-life

Q12. Which antiepileptic drug is most appropriate as first-line therapy for absence seizures?

• Carbamazepine
• Ethosuximide
• Phenytoin
• Gabapentin

Correct Answer: Ethosuximide

Q13. Which mechanism is primarily responsible for phenytoin’s nonlinear (Michaelis-Menten) pharmacokinetics at higher doses?

• Zero-order renal excretion at therapeutic concentrations
• Saturation of hepatic metabolic enzymes (capacity-limited metabolism)
• Autoinduction causing exponential increase in clearance
• Active tubular secretion saturation in kidneys

Correct Answer: Saturation of hepatic metabolic enzymes (capacity-limited metabolism)

Q14. Which dopamine agonist is associated with impulse control disorders (e.g., gambling, hypersexuality) in Parkinson’s patients?

• Amantadine
• Pramipexole
• Entacapone
• Rivastigmine

Correct Answer: Pramipexole

Q15. Which adverse effect profile is most characteristic of topiramate and must be monitored clinically?

• Nephrolithiasis, cognitive slowing, metabolic acidosis
• Severe hepatotoxicity and pancreatitis
• Weight gain and hyperammonemia
• Excessive salivation and bradycardia

Correct Answer: Nephrolithiasis, cognitive slowing, metabolic acidosis

Q16. Which of the following agents acts by inhibiting monoamine oxidase B (MAO-B) and is used as adjunct therapy in early Parkinson’s disease?

• Selegiline
• Baclofen
• Memantine
• Carbamazepine

Correct Answer: Selegiline

Q17. Which AED is most suitable for focal seizures in a patient with significant hepatic impairment requiring minimal hepatic metabolism?

• Felbamate
• Gabapentin
• Carbamazepine
• Phenobarbital

Correct Answer: Gabapentin

Q18. In Alzheimer’s disease, which therapeutic target is being pursued by disease-modifying monoclonal antibodies recently developed for clinical use?

• Alpha-synuclein aggregation
• Tau phosphorylation enzymes
• Beta-amyloid oligomers and plaques
• Dopamine transporter blockade

Correct Answer: Beta-amyloid oligomers and plaques

Q19. Which laboratory parameter should be routinely monitored in a patient receiving long-term valproate therapy?

• Thyroid function tests
• Liver function tests and platelet count
• Serum creatine kinase
• Fasting blood glucose only

Correct Answer: Liver function tests and platelet count

Q20. Which pharmacodynamic interaction increases the risk of severe CNS depression when combining benzodiazepines with which antiepileptic drug class or agent?

• Combining benzodiazepines with serotonergic AEDs like felbamate
• Combining benzodiazepines with barbiturates or phenobarbital-like agents
• Combining benzodiazepines with enzyme-inducing AEDs increases sedation
• Combining benzodiazepines with levetiracetam causes severe respiratory depression

Correct Answer: Combining benzodiazepines with barbiturates or phenobarbital-like agents

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