Contraceptive pharmacotherapy and reproductive health MCQs With Answer

Contraceptive pharmacotherapy and reproductive health MCQs With Answer

This question set is designed for M.Pharm students studying Pharmacotherapeutics II (MPP 202T). It focuses on the pharmacology, mechanisms, clinical applications, adverse effects, and drug interactions of contraceptives and key reproductive health agents. The questions go beyond basic definitions to test understanding of hormones, emergency contraception, intrauterine devices, long-acting injectables, abortifacients, uterotonics, tocolytics, and fertility agents used in clinical practice. Each MCQ includes plausible alternatives and a clear correct answer to help reinforce therapeutic decision-making, safe prescribing considerations, and mechanistic knowledge necessary for advanced postgraduate competence.

Q1. Which of the following best describes the primary mechanism of action of combined oral contraceptives (estrogen + progestin)?

• Direct spermicidal activity in the female reproductive tract
• Inhibition of ovulation by suppression of gonadotropin release
• Local endometrial toxic effect preventing implantation
• Blocking tubal transport of the ovum

Correct Answer: Inhibition of ovulation by suppression of gonadotropin release

Q2. Which contraceptive method primarily exerts its effect via a local inflammatory and spermicidal environment in the uterine cavity?

• Levonorgestrel-releasing intrauterine device (LNG-IUD)
• Copper intrauterine device (Cu-IUD)
• Combined transdermal patch
• Progestin-only implant

Correct Answer: Copper intrauterine device (Cu-IUD)

Q3. Ulipristal acetate used for emergency contraception functions mainly as:

• A CYP3A4 inducer that accelerates steroid clearance
• A selective progesterone receptor modulator that delays ovulation
• An estrogen receptor agonist that inhibits follicular rupture
• A prostaglandin analogue causing cervical mucus thickening

Correct Answer: A selective progesterone receptor modulator that delays ovulation

Q4. Which of the following is the most appropriate pharmacologic regimen for medical termination of early pregnancy (up to 10 weeks) recommended by WHO?

• Mifepristone followed 24–48 hours later by misoprostol
• High-dose combined oral contraceptive for 7 days
• Levonorgestrel single dose within 72 hours
• Ulipristal acetate followed by oxytocin

Correct Answer: Mifepristone followed 24–48 hours later by misoprostol

Q5. Which adverse effect is classically associated with depot medroxyprogesterone acetate (DMPA) injections?

• Permanent infertility in all users
• Significant irreversible liver toxicity
• Reduction in bone mineral density with prolonged use
• Marked risk of breast cancer within 1 month of initiation

Correct Answer: Reduction in bone mineral density with prolonged use

Q6. A woman on combined oral contraceptives is prescribed rifampicin for tuberculosis. What is the main concern?

• Rifampicin increases estrogen levels causing severe thromboembolism
• Rifampicin induces hepatic enzymes reducing steroid contraceptive efficacy
• Rifampicin competes for albumin binding increasing free estrogen
• Rifampicin inhibits enterohepatic recirculation causing estrogen toxicity

Correct Answer: Rifampicin induces hepatic enzymes reducing steroid contraceptive efficacy

Q7. Which agent is an oxytocin receptor antagonist used as a tocolytic in preterm labor (available in some regions)?

• Terbutaline
• Atosiban
• Ergometrine
• Misoprostol

Correct Answer: Atosiban

Q8. Clomiphene citrate induces ovulation primarily by which mechanism?

• Direct stimulation of ovarian follicle FSH receptors
• Aromatase inhibition leading to decreased estrogen synthesis
• SERM action blocking estrogen receptors in the hypothalamus, increasing GnRH and gonadotropins
• Direct release of stored LH from the pituitary

Correct Answer: SERM action blocking estrogen receptors in the hypothalamus, increasing GnRH and gonadotropins

Q9. Which statement about levonorgestrel emergency contraception is correct?

• It is effective up to 5 days post-unprotected intercourse
• Its primary action is to disrupt implantation of a fertilized egg
• It is most effective when taken as soon as possible, ideally within 72 hours
• It acts as an estrogen receptor antagonist

Correct Answer: It is most effective when taken as soon as possible, ideally within 72 hours

Q10. Which of the following is a recognized contraindication to combined estrogen–progestin oral contraceptives?

• Well-controlled hypothyroidism on levothyroxine
• Current smoker aged 40 years without other risk factors
• History of ischemic stroke or thromboembolic disease
• Migraine without aura in a woman under 35

Correct Answer: History of ischemic stroke or thromboembolic disease

Q11. Misoprostol used after mifepristone in medical abortion is best described pharmacologically as:

• An estrogen receptor agonist that promotes cervical ripening
• A prostaglandin E1 analogue causing uterine contractions
• A dopamine antagonist that induces uterine ischemia
• A beta-2 adrenergic agonist that relaxes the uterus

Correct Answer: A prostaglandin E1 analogue causing uterine contractions

Q12. Which long-acting reversible contraceptive acts mainly by thickening cervical mucus and producing endometrial atrophy?

• Copper IUD
• Levonorgestrel-releasing intrauterine system (LNG-IUS)
• Condom with spermicidal gel
• Combined oral contraceptive

Correct Answer: Levonorgestrel-releasing intrauterine system (LNG-IUS)

Q13. Which drug used for induction of labor is a peptide that stimulates uterine smooth muscle via oxytocin receptors?

• Ergometrine
• Oxytocin
• Misoprostol
• Nifedipine

Correct Answer: Oxytocin

Q14. Which fertility treatment carries the highest risk of ovarian hyperstimulation syndrome (OHSS)?

• Clomiphene citrate oral therapy
• Gonadotropin injections (FSH/hMG) for controlled ovarian stimulation
• Letrozole single-cycle therapy
• Low-dose combined oral contraceptive pretreatment

Correct Answer: Gonadotropin injections (FSH/hMG) for controlled ovarian stimulation

Q15. Which of the following describes a major safety concern with ergometrine when used for postpartum hemorrhage?

• It causes severe hyperglycemia in diabetics
• It is contraindicated in hypertension and can cause severe vasospasm
• It frequently causes permanent infertility
• It is ineffective in uterine atony

Correct Answer: It is contraindicated in hypertension and can cause severe vasospasm

Q16. Which contraceptive is associated with an increased risk of ectopic pregnancy if contraception fails?

• Copper IUD, when in place, increases overall ectopic risk
• Levonorgestrel-only emergency contraception prevents all ectopic pregnancies
• Progestin-only injectable (DMPA) has a relative increase in ectopic proportion among failures
• Barrier methods increase ectopic risk by causing tubal damage

Correct Answer: Progestin-only injectable (DMPA) has a relative increase in ectopic proportion among failures

Q17. Which agent is commonly used as a tocolytic that acts by inhibiting L-type calcium channels?

• Nifedipine
• Ergometrine
• Mifepristone
• Levonorgestrel

Correct Answer: Nifedipine

Q18. Nonoxynol-9, a commonly used spermicide, has which important safety consideration?

• It permanently sterilizes the vaginal epithelium
• Frequent use may increase the risk of HIV transmission by irritating mucosa
• It enhances the protective effect of condoms against STIs
• It is effective as systemic emergency contraception

Correct Answer: Frequent use may increase the risk of HIV transmission by irritating mucosa

Q19. Which statement about male hormonal contraception in current clinical development is most accurate?

• It uses estrogen monotherapy to suppress spermatogenesis
• Combining testosterone with a progestin can suppress gonadotropins and reduce sperm output
• There are widely available oral male contraceptives approved globally
• Vasectomy is a hormonal method under investigation

Correct Answer: Combining testosterone with a progestin can suppress gonadotropins and reduce sperm output

Q20. Which contraceptive option has the additional long-term benefit of reducing the risk of endometrial and ovarian cancer?

• Progestin-only implant without systemic exposure
• Combined oral contraceptives (estrogen–progestin)
• Copper intrauterine device
• Spermicides alone

Correct Answer: Combined oral contraceptives (estrogen–progestin)

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