Introduction: Central nervous system (CNS) stimulants are a critical topic for B. Pharm students, covering pharmacology, clinical uses, adverse effects, pharmacokinetics, and drug interactions. This set of CNS stimulants MCQs With Answer focuses on amphetamines, methylphenidate, modafinil, lisdexamfetamine and related agents, emphasizing mechanisms (DAT/NET/VMAT effects), therapeutic indications (ADHD, narcolepsy), toxicity (cardiovascular, psychiatric, dependency), contraindications, monitoring and overdose management. These questions are designed to deepen understanding of molecular targets, formulation differences, prodrugs, regulatory status and safe dispensing practices relevant to pharmacy practice. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is the primary mechanism of action of amphetamine-class CNS stimulants?
- Selective serotonin receptor agonism
- Increase release of norepinephrine and dopamine
- Irreversible monoamine oxidase inhibition
- Blockade of GABA receptors
Correct Answer: Increase release of norepinephrine and dopamine
Q2. Methylphenidate primarily exerts its stimulant effect by which mechanism?
- Inhibition of monoamine oxidase
- Blocking voltage-gated sodium channels
- Inhibition of dopamine and norepinephrine reuptake transporters
- Enhancing GABAergic transmission
Correct Answer: Inhibition of dopamine and norepinephrine reuptake transporters
Q3. Which transporter proteins are main targets for many CNS stimulants used in ADHD?
- SERT and GAT
- DAT and NET
- GLUT and AQP
- Na+/K+ ATPase and Ca2+ channel
Correct Answer: DAT and NET
Q4. Lisdexamfetamine differs from dextroamphetamine because it is:
- A direct dopamine receptor agonist
- An oral prodrug converted to active drug by red blood cells
- Administered parenterally only
- A monoamine oxidase inhibitor
Correct Answer: An oral prodrug converted to active drug by red blood cells
Q5. Which of the following is a common adverse effect of CNS stimulants in children?
- Hyperpigmentation of skin
- Growth suppression and appetite loss
- Renal tubular acidosis
- Persistent constipation
Correct Answer: Growth suppression and appetite loss
Q6. In patients taking amphetamines, co-administration with MAO inhibitors can cause:
- Severe hypotension
- Hypertensive crisis
- Profound sedation
- Neutropenia
Correct Answer: Hypertensive crisis
Q7. Modafinil is best described as:
- A classic amphetamine with high abuse potential
- A wakefulness-promoting agent used in narcolepsy
- An opioid analgesic
- An antipsychotic agent
Correct Answer: A wakefulness-promoting agent used in narcolepsy
Q8. Which monitoring parameter is essential when initiating stimulant therapy in children?
- Serum creatinine monthly
- Height, weight and blood pressure
- Fasting lipid profile weekly
- Liver biopsy after first dose
Correct Answer: Height, weight and blood pressure
Q9. The most appropriate first-line management for acute severe agitation and sympathomimetic toxicity from stimulant overdose is:
- High-dose antipsychotics only
- Benzodiazepines and supportive care
- Immediate beta-blockers alone
- Activated charcoal after 48 hours
Correct Answer: Benzodiazepines and supportive care
Q10. Which cardiovascular condition is a relative contraindication to stimulant therapy due to increased risk of sudden cardiac events?
- Uncontrolled hypertension and structural heart disease
- Mild intermittent asthma
- Controlled hypothyroidism
- Chronic otitis media
Correct Answer: Uncontrolled hypertension and structural heart disease
Q11. Which formulation of methylphenidate provides transdermal delivery?
- Ritalin immediate-release tablet
- Daytrana patch
- Adderall XR capsule
- Modafinil oral tablet
Correct Answer: Daytrana patch
Q12. The stimulant class drug most likely to worsen motor tics or Tourette syndrome is:
- Atomoxetine
- Methylphenidate
- Guanfacine
- Clonidine
Correct Answer: Methylphenidate
Q13. Which regulatory schedule typically applies to amphetamine and methylphenidate preparations in many countries?
- Unscheduled OTC
- Schedule II (high potential for abuse, medical use)
- Schedule IV (low abuse potential)
- Schedule V (very low drug abuse potential)
Correct Answer: Schedule II (high potential for abuse, medical use)
Q14. A pharmacokinetic difference: compared with immediate-release methylphenidate, amphetamine formulations generally have:
- Much shorter half-lives
- Longer duration of action for many formulations
- No oral bioavailability
- Exclusive hepatic excretion unchanged
Correct Answer: Longer duration of action for many formulations
Q15. Which adverse psychiatric effect may be precipitated or worsened by stimulant therapy?
- Depersonalization only
- Psychosis or mania in susceptible individuals
- Persistent cognitive decline indistinguishable from dementia
- Progressive peripheral neuropathy
Correct Answer: Psychosis or mania in susceptible individuals
Q16. The mechanism by which amphetamines increase synaptic monoamines includes interaction with VMAT leading to:
- Enhanced vesicular storage of dopamine
- Displacement of monoamines from vesicles into the cytosol
- Inhibition of tyrosine hydroxylase activity
- Increased MAO-mediated degradation
Correct Answer: Displacement of monoamines from vesicles into the cytosol
Q17. Which drug is a non-stimulant approved for ADHD that acts as a selective norepinephrine reuptake inhibitor?
- Atomoxetine
- Lisdexamfetamine
- Methylphenidate
- Modafinil
Correct Answer: Atomoxetine
Q18. What clinical test or assessment is important before prescribing stimulants to screen for risk factors?
- Baseline ECG and cardiac history assessment
- Bone density scan
- Routine EEG in all patients
- Pulmonary function test
Correct Answer: Baseline ECG and cardiac history assessment
Q19. Which interaction is clinically significant and increases risk of serotonin syndrome when combined with certain stimulants?
- Concurrent use with opioids like morphine
- Concurrent use with MAO inhibitors and some serotonergic antidepressants
- Concurrent use with topical antifungals
- Concurrent use with antihistamines only
Correct Answer: Concurrent use with MAO inhibitors and some serotonergic antidepressants
Q20. Which pharmacological property of lisdexamfetamine reduces its immediate abuse potential compared to immediate-release amphetamines?
- It is hydrophobic and poorly absorbed
- It requires enzymatic conversion to active drug, slowing onset
- It is only active when given intravenously
- It antagonizes dopamine receptors
Correct Answer: It requires enzymatic conversion to active drug, slowing onset
Q21. Chronic high-dose use of stimulants can lead to which long-term neuroadaptive change?
- Upregulation of GABA receptors
- Downregulation of dopamine transporters and receptors leading to tolerance
- Increased cerebrospinal fluid production
- Permanent enhancement of memory
Correct Answer: Downregulation of dopamine transporters and receptors leading to tolerance
Q22. Which side effect is a common cardiovascular manifestation of stimulant therapy?
- Bradycardia and hypotension
- Increased heart rate and elevated blood pressure
- Peripheral edema exclusively
- Mitral valve prolapse development
Correct Answer: Increased heart rate and elevated blood pressure
Q23. Which of the following is an appropriate counseling point when dispensing stimulants?
- They have no potential for misuse or diversion
- Take the medication exactly as prescribed and monitor sleep and appetite
- Double the dose if symptoms persist after one day
- Stop suddenly if appetite decreases
Correct Answer: Take the medication exactly as prescribed and monitor sleep and appetite
Q24. Which laboratory or clinical sign might suggest stimulant-induced sympathomimetic toxicity?
- Bradycardia with hypothermia
- Hyperthermia, mydriasis and tachycardia
- Marked hypoglycemia without other symptoms
- Painless jaundice
Correct Answer: Hyperthermia, mydriasis and tachycardia
Q25. Which agent is considered to have lower abuse potential and is sometimes preferred when abuse is a major concern?
- Immediate-release amphetamine sulfate
- Lisdexamfetamine (prodrug)
- Injectable dextroamphetamine
- Crystalline methylphenidate powder
Correct Answer: Lisdexamfetamine (prodrug)
Q26. An important drug interaction to avoid is combining stimulants with which type of medication due to risk of hypertensive episodes?
- Topical beta-blockers
- Monoamine oxidase inhibitors (MAOIs)
- Oral contraceptives
- H2 receptor antagonists
Correct Answer: Monoamine oxidase inhibitors (MAOIs)
Q27. Which statement about stimulant pharmacokinetics is generally correct?
- All stimulants are renally excreted unchanged and have identical half-lives
- Formulations (IR vs XR) significantly affect onset and duration of action
- Stimulants are not absorbed orally
- Food always prevents stimulant absorption
Correct Answer: Formulations (IR vs XR) significantly affect onset and duration of action
Q28. Which adverse effect may necessitate halting stimulant therapy and specialist referral?
- Persistent insomnia and uncontrolled hypertension
- Mild transient dry mouth resolving in days
- Temporary decrease in appetite for a week
- Short-lived headache after first dose
Correct Answer: Persistent insomnia and uncontrolled hypertension
Q29. During counselling, what should pharmacists warn patients about regarding stimulant use and driving or operating machinery?
- Stimulants always improve reaction time and are safe for driving
- They may cause dizziness, insomnia or agitation; monitor effects before driving
- They cause immediate sleep in all patients
- There are no cognitive effects to consider
Correct Answer: They may cause dizziness, insomnia or agitation; monitor effects before driving
Q30. Which clinical feature favors a diagnosis of stimulant withdrawal rather than intoxication?
- Agitation and elevated blood pressure
- Severe fatigue, increased sleep and depressed mood after cessation
- Hyperthermia and dilated pupils
- Acute psychosis with paranoid delusions
Correct Answer: Severe fatigue, increased sleep and depressed mood after cessation
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.
Mail- Sachin@pharmacyfreak.com