Benzamides – Sulpiride MCQs With Answer
Sulpiride is a substituted benzamide antipsychotic widely covered in B. Pharm pharmacology courses. This concise, student-focused introduction highlights sulpiride’s mechanism as a selective dopamine D2/D3 antagonist, its dose-dependent presynaptic versus postsynaptic effects, clinical uses in schizophrenia and gastrointestinal dysmotility, and important considerations like hyperprolactinaemia, extrapyramidal reactions, renal excretion, and drug interactions. Understanding sulpiride’s pharmacokinetics, therapeutic indications, adverse effect profile, and comparison with other benzamides strengthens exam preparedness and clinical reasoning. Keywords: Benzamides, Sulpiride, D2 antagonist, antipsychotic, pharmacology, adverse effects, pharmacokinetics, B. Pharm MCQs. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. What is the primary pharmacological class of sulpiride?
- Tricyclic antidepressant
- Substituted benzamide antipsychotic
- Benzodiazepine anxiolytic
- Typical opioid analgesic
Correct Answer: Substituted benzamide antipsychotic
Q2. Which receptor subtype does sulpiride primarily antagonize?
- 5-HT2A receptor
- NMDA receptor
- Dopamine D2/D3 receptors
- Alpha-1 adrenergic receptor
Correct Answer: Dopamine D2/D3 receptors
Q3. Sulpiride’s clinical antipsychotic effect at high doses is mainly due to blockade of which receptors?
- Presynaptic D2 autoreceptors only
- Postsynaptic D2 receptors
- Serotonin transporters
- GABA-A receptors
Correct Answer: Postsynaptic D2 receptors
Q4. At low doses, sulpiride preferentially blocks which type of receptor, potentially improving negative symptoms?
- Postsynaptic D2 receptors
- Presynaptic D2 autoreceptors
- M1 muscarinic receptors
- Histamine H1 receptors
Correct Answer: Presynaptic D2 autoreceptors
Q5. Which of the following is a licensed clinical indication for sulpiride in many countries?
- Asthma management
- Schizophrenia
- Type 2 diabetes
- Parkinson’s disease monotherapy
Correct Answer: Schizophrenia
Q6. Apart from antipsychotic use, sulpiride is sometimes used for which gastrointestinal indication due to D2 antagonism?
- Peptic ulcer helicobacter eradication
- Gastroesophageal reflux disease maintenance therapy
- Functional dyspepsia and prokinetic effect
- Pancreatitis management
Correct Answer: Functional dyspepsia and prokinetic effect
Q7. The endocrine adverse effect most commonly associated with sulpiride is:
- Hypothyroidism
- Hyperprolactinaemia
- Cushingoid features
- Adrenal insufficiency
Correct Answer: Hyperprolactinaemia
Q8. Hyperprolactinaemia from sulpiride arises due to blockade of dopamine receptors in which pathway?
- Nigrostriatal pathway
- Tuberoinfundibular pathway
- Mesolimbic pathway
- Mesocortical pathway
Correct Answer: Tuberoinfundibular pathway
Q9. Which extrapyramidal adverse effect can occur with sulpiride, especially at higher doses?
- Neuroleptic malignant syndrome only
- Extrapyramidal symptoms like parkinsonism and akathisia
- Peripheral neuropathy exclusively
- Opioid-like respiratory depression
Correct Answer: Extrapyramidal symptoms like parkinsonism and akathisia
Q10. How is sulpiride mainly eliminated from the body?
- Hepatic metabolism to active metabolites
- Extensive biliary excretion
- Primarily renal excretion of unchanged drug
- Exhaled via lungs as volatile metabolite
Correct Answer: Primarily renal excretion of unchanged drug
Q11. Which patient group requires dose adjustment when prescribing sulpiride?
- Patients with hepatic impairment only
- Patients with renal impairment
- Patients with normal renal and hepatic function
- Young healthy adults only
Correct Answer: Patients with renal impairment
Q12. Compared to many typical antipsychotics, sulpiride generally has:
- High anticholinergic activity
- Significant antihistaminic sedation
- Relatively selective dopamine blockade with low anticholinergic effects
- Strong alpha-adrenergic agonism
Correct Answer: Relatively selective dopamine blockade with low anticholinergic effects
Q13. Which hormonal side effect might present as galactorrhea in a patient taking sulpiride?
- Elevated cortisol
- Increased prolactin levels
- Decreased thyroid stimulating hormone
- Reduced growth hormone
Correct Answer: Increased prolactin levels
Q14. Combining sulpiride with which drug class can reduce its antipsychotic effect?
- Dopamine agonists such as levodopa
- Selective serotonin reuptake inhibitors only
- Beta blockers
- Calcium channel blockers
Correct Answer: Dopamine agonists such as levodopa
Q15. Sulpiride is structurally related to which other substituted benzamide often used clinically?
- Haloperidol
- Amisulpride
- Risperidone
- Olanzapine
Correct Answer: Amisulpride
Q16. Which laboratory parameter should be monitored periodically in patients on long-term sulpiride therapy?
- Serum creatinine and renal function
- Fasting blood glucose exclusively
- Serum bilirubin only
- Thyroid autoantibodies
Correct Answer: Serum creatinine and renal function
Q17. Which psychiatric symptoms are sulpiride and other benzamides particularly effective against at higher doses?
- Cognitive impairment only
- Positive symptoms like hallucinations and delusions
- Primary mood swings without psychosis
- Autistic spectrum deficits
Correct Answer: Positive symptoms like hallucinations and delusions
Q18. A major clinical advantage of sulpiride over some older antipsychotics is:
- Absence of any motor side effects
- Greater selectivity for dopamine receptors with fewer anticholinergic effects
- Guaranteed absence of hyperprolactinaemia
- Single-dose lifetime therapy
Correct Answer: Greater selectivity for dopamine receptors with fewer anticholinergic effects
Q19. Which symptom suggests a patient on sulpiride may be developing hyperprolactinaemia?
- Dry mouth and blurred vision
- Galactorrhea and amenorrhea in women
- Severe constipation
- Weight loss and polyuria
Correct Answer: Galactorrhea and amenorrhea in women
Q20. Which of the following is a contraindication for sulpiride?
- Known hypersensitivity to sulpiride
- Controlled benign prostatic hyperplasia without symptoms
- Well-controlled epilepsy with no recent seizures
- History of well-managed hypothyroidism
Correct Answer: Known hypersensitivity to sulpiride
Q21. Which of the following best explains sulpiride’s limited anticholinergic side effects?
- High affinity for muscarinic receptors
- Negligible affinity for muscarinic receptors
- Strong blockade of H1 receptors instead
- Prodrug conversion to anticholinergic metabolite
Correct Answer: Negligible affinity for muscarinic receptors
Q22. An acute dystonic reaction to sulpiride would typically be treated with:
- Benzodiazepines only
- Anticholinergic agents such as benztropine or procyclidine
- High-dose sulpiride
- Immediate beta-blocker therapy
Correct Answer: Anticholinergic agents such as benztropine or procyclidine
Q23. What is the likely effect of sulpiride on seizure threshold?
- It raises the seizure threshold significantly
- It has no known effects on seizures
- It may lower seizure threshold in susceptible individuals
- It cures epilepsy
Correct Answer: It may lower seizure threshold in susceptible individuals
Q24. Which adverse cardiac effect should clinicians be aware of with many antipsychotics including benzamides?
- Only bradycardia without ECG changes
- Potential for QT interval prolongation
- Guaranteed myocardial infarction within weeks
- No cardiovascular effects
Correct Answer: Potential for QT interval prolongation
Q25. Sulpiride’s sedative effects are generally:
- Pronounced due to strong H1 blockade
- Minimal to moderate because of low antihistaminic activity
- Nonexistent in all patients
- Due to antimuscarinic activity
Correct Answer: Minimal to moderate because of low antihistaminic activity
Q26. If a pregnant woman requires antipsychotic treatment, sulpiride use should be decided based on:
- Safety profile, clinical necessity, and risk-benefit assessment
- Automatic contraindication in all pregnancies
- Switching to highest possible dose immediately
- Stopping all psychotropic drugs without consulting physician
Correct Answer: Safety profile, clinical necessity, and risk-benefit assessment
Q27. In comparison with metoclopramide, sulpiride differs in that it is primarily used for:
- Systemic antibiotics enhancement
- Antipsychotic therapy as well as some prokinetic uses
- Analgesic adjuvant therapy
- Antiviral activity
Correct Answer: Antipsychotic therapy as well as some prokinetic uses
Q28. Which symptom cluster is most associated with nigrostriatal D2 blockade from sulpiride?
- Improvement in cognitive deficits
- Extrapyramidal symptoms like rigidity and bradykinesia
- Increased appetite only
- Enhanced memory recall
Correct Answer: Extrapyramidal symptoms like rigidity and bradykinesia
Q29. Which metabolic parameter is least likely to be significantly affected by sulpiride compared with some atypical antipsychotics?
- Weight gain and metabolic syndrome are more pronounced with sulpiride
- Severe dyslipidaemia typical of sulpiride
- Marked glucose dysregulation typical of some atypical antipsychotics rather than sulpiride
- Immediate and severe insulin resistance in all patients
Correct Answer: Marked glucose dysregulation typical of some atypical antipsychotics rather than sulpiride
Q30. Which neurotransmitter system is directly antagonized by sulpiride leading to antipsychotic effects?
- Cholinergic system
- Dopaminergic system
- GABAergic system
- Glutamatergic system
Correct Answer: Dopaminergic system
Q31. A patient on sulpiride develops restlessness and inability to sit still; this is termed:
- Tardive dyskinesia
- Akathisia
- Neuroleptic malignant syndrome
- Orthostatic hypotension
Correct Answer: Akathisia
Q32. Long-term use of sulpiride may lead to which tardive movement disorder?
- Tardive dyskinesia
- Acute dystonia exclusively
- Bell’s palsy
- Essential tremor unrelated to medication
Correct Answer: Tardive dyskinesia
Q33. Which of the following interactions is clinically significant with sulpiride?
- Co-administration with strong CYP3A4 inhibitors reduces sulpiride levels significantly
- Concomitant use with other dopamine antagonists increases risk of additive side effects
- It inactivates warfarin leading to clotting
- It neutralizes insulin causing hyperglycemia
Correct Answer: Concomitant use with other dopamine antagonists increases risk of additive side effects
Q34. Which adverse syndrome, though rare, is potentially life-threatening and associated with antipsychotics including sulpiride?
- Neuroleptic malignant syndrome
- Acute pancreatitis unrelated to drugs
- Viral myocarditis exclusively
- Immediate renal failure in all patients
Correct Answer: Neuroleptic malignant syndrome
Q35. Which clinical sign would suggest neuroleptic malignant syndrome in a patient on sulpiride?
- Low-grade fever with stable muscle tone
- Hyperthermia, rigidity, autonomic instability and elevated CK
- Mild headache only
- Improved psychotic symptoms with no physical changes
Correct Answer: Hyperthermia, rigidity, autonomic instability and elevated CK
Q36. Tapering or discontinuing sulpiride abruptly may lead to which withdrawal phenomenon?
- Immediate permanent cure of psychosis
- Rebound psychosis or cholinergic rebound
- Instantaneous improvement of cognition
- No effect and always safe to stop suddenly
Correct Answer: Rebound psychosis or cholinergic rebound
Q37. Which formulation or route of administration is sulpiride commonly available in for oral therapy?
- Intravenous infusion only
- Oral tablets or capsules
- Transdermal patch exclusively
- Nasal spray only
Correct Answer: Oral tablets or capsules
Q38. Which adverse sexual effect can be caused by sulpiride due to increased prolactin?
- Enhanced libido
- Sexual dysfunction such as decreased libido and erectile dysfunction
- Immediate fertility improvement
- Resolution of menstrual irregularities
Correct Answer: Sexual dysfunction such as decreased libido and erectile dysfunction
Q39. Which monitoring is particularly important in elderly patients receiving sulpiride?
- Regular audiometry testing
- Assessment of orthostatic hypotension and extrapyramidal symptoms
- Continuous liver biopsy
- Daily PET scans
Correct Answer: Assessment of orthostatic hypotension and extrapyramidal symptoms
Q40. Compared with typical high-potency antipsychotics like haloperidol, sulpiride’s affinity profile is generally:
- More selective for D2/D3 with less non-dopaminergic receptor activity
- Higher antimuscarinic binding causing more dry mouth
- Complete serotonin blockade causing serotonin syndrome
- Exclusive GABA agonism
Correct Answer: More selective for D2/D3 with less non-dopaminergic receptor activity
Q41. Which patient symptom would prompt immediate discontinuation and urgent assessment for neuroleptic malignant syndrome?
- Mild dry mouth
- High fever with severe muscle rigidity
- Occasional yawning
- Transient dizziness lasting seconds
Correct Answer: High fever with severe muscle rigidity
Q42. Sulpiride’s mechanism leading to prokinetic effects in the gut primarily involves blockade of:
- Peripheral muscarinic receptors
- Enteric D2 receptors increasing gastrointestinal motility
- Substance P receptors exclusively
- Gastrin secretion inhibition only
Correct Answer: Enteric D2 receptors increasing gastrointestinal motility
Q43. Which pharmacodynamic property explains sulpiride’s ability to cause increased prolactin?
- Stimulation of tuberoinfundibular dopamine release
- Antagonism of D2 receptors on lactotroph cells in the pituitary
- Direct stimulation of prolactin secretion by serotonin receptors
- Activation of growth hormone axis
Correct Answer: Antagonism of D2 receptors on lactotroph cells in the pituitary
Q44. In drug comparison questions, which benzamide is commonly contrasted with sulpiride for similar pharmacology?
- Chlorpromazine
- Amisulpride
- Fluoxetine
- Liothyronine
Correct Answer: Amisulpride
Q45. Which adverse haematological effect can rarely occur with antipsychotics and should be monitored for?
- Agranulocytosis
- Immediate hemophilia
- Universal leukocytosis in all patients
- Guaranteed anemia within 24 hours
Correct Answer: Agranulocytosis
Q46. Which clinical strategy may be used to manage antipsychotic-induced hyperprolactinaemia?
- Switch to an antipsychotic with lower prolactin elevation potential
- Increase the sulpiride dose indefinitely
- Always stop antipsychotic treatment abruptly
- Ignore symptoms until irreversible
Correct Answer: Switch to an antipsychotic with lower prolactin elevation potential
Q47. For B. Pharm students, which concept explains differential effects of low versus high doses of sulpiride?
- Nonlinear renal clearance only
- Dose-dependent presynaptic versus postsynaptic D2 receptor blockade
- Conversion to an active opioid metabolite
- Time-dependent accumulation in adipose tissue
Correct Answer: Dose-dependent presynaptic versus postsynaptic D2 receptor blockade
Q48. Which clinical sign should prompt measurement of serum prolactin in a patient taking sulpiride?
- Excessive sweating alone
- Galactorrhea, menstrual irregularities or sexual dysfunction
- Occasional transient headache
- Improved appetite
Correct Answer: Galactorrhea, menstrual irregularities or sexual dysfunction
Q49. In terms of pharmacokinetics, the clinician should be mindful that sulpiride’s plasma levels may be increased in:
- Patients with severe renal impairment
- Young healthy adults with normal renal function
- Patients on a high-fiber diet only
- Those with isolated mild seasonal allergies
Correct Answer: Patients with severe renal impairment
Q50. For exam-focused revision, which learning point about sulpiride is most essential for B. Pharm students?
- It is a substituted benzamide that selectively blocks D2/D3 receptors and can cause hyperprolactinaemia and extrapyramidal effects
- It is an SSRI that primarily increases serotonin levels
- It cures schizophrenia permanently with one dose
- It is primarily an antihypertensive agent
Correct Answer: It is a substituted benzamide that selectively blocks D2/D3 receptors and can cause hyperprolactinaemia and extrapyramidal effects
