Drug dependence is a core subject in pharmacology and pharmacy practice. This concise set of Drug dependence MCQs With Answer is designed for B. Pharm students to deepen understanding of addiction mechanisms, tolerance, withdrawal, receptor adaptations, pharmacokinetics, and pharmacodynamics. Emphasis is on clinical management and pharmacotherapy for opioids, alcohol, and benzodiazepines, including methadone, buprenorphine, and naltrexone, plus harm reduction, legal and ethical considerations, and patient counseling. Questions target diagnostic criteria, withdrawal syndromes, cross-dependence, dose adjustment, and medication safety to prepare students for real-world dispensing and therapeutic decisions. Answers include brief rationales and focus on real-world pharmacy applications and medication safety. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What best defines pharmacological tolerance in the context of drug dependence?
- A reduced therapeutic effect of a drug due to noncompliance
- An increased response to a drug after repeated use
- A need for higher doses to achieve the original effect
- A permanent loss of drug effect regardless of dose
Correct Answer: A need for higher doses to achieve the original effect
Q2. Which of the following is a core feature distinguishing substance dependence from casual use?
- Intermittent recreational use without cravings
- Persistent use despite harmful consequences
- Single high-dose exposure with no withdrawal
- Strict adherence to prescribed dosing
Correct Answer: Persistent use despite harmful consequences
Q3. Which neurotransmitter pathway is most closely associated with the reward system implicated in addiction?
- Serotonergic projections from raphe nuclei
- Dopaminergic mesolimbic pathway from VTA to nucleus accumbens
- GABAergic projections from the cerebellum
- Cholinergic projections from the basal forebrain
Correct Answer: Dopaminergic mesolimbic pathway from VTA to nucleus accumbens
Q4. What is the primary mechanism of action of methadone in opioid dependence treatment?
- Full opioid agonist at mu receptors with long half-life
- Pure opioid antagonist at mu receptors
- Norepinephrine reuptake inhibition reducing cravings
- Selective serotonin receptor agonism to prevent relapse
Correct Answer: Full opioid agonist at mu receptors with long half-life
Q5. Buprenorphine differs from methadone because it is:
- A full mu-opioid receptor agonist with high overdose risk
- A partial mu-opioid receptor agonist with ceiling effect on respiratory depression
- A pure opioid antagonist used only for overdose reversal
- An NMDA receptor antagonist used for pain only
Correct Answer: A partial mu-opioid receptor agonist with ceiling effect on respiratory depression
Q6. Which medication is an opioid antagonist used to prevent relapse after detoxification?
- Methadone
- Buprenorphine
- Naltrexone
- Clonidine
Correct Answer: Naltrexone
Q7. What is the most appropriate initial pharmacologic treatment for severe alcohol withdrawal with seizures?
- Immediate naloxone administration
- Benzodiazepines such as diazepam or lorazepam
- High-dose antipsychotics alone
- Short course of stimulants to counter sedation
Correct Answer: Benzodiazepines such as diazepam or lorazepam
Q8. Which clinical feature is most characteristic of opioid withdrawal?
- Respiratory depression and miosis
- Intense cravings, piloerection, rhinorrhea, yawning
- Hypotension and hyperkalemia
- Permanent amnesia and confabulation
Correct Answer: Intense cravings, piloerection, rhinorrhea, yawning
Q9. Cross-tolerance means:
- Tolerance to one drug increases sensitivity to another unrelated drug
- Tolerance to one drug reduces tolerance to other drugs in the same class
- Tolerance to one drug produces reduced response to another drug with similar mechanism
- Tolerance resolves immediately after stopping the drug
Correct Answer: Tolerance to one drug produces reduced response to another drug with similar mechanism
Q10. Which property of a drug increases its potential for dependence due to rapid brain penetration?
- High polarity and low lipophilicity
- High plasma protein binding only
- High lipophilicity and fast onset of action
- Large molecular weight and slow absorption
Correct Answer: High lipophilicity and fast onset of action
Q11. In benzodiazepine dependence, the safest tapering strategy is to:
- Stop immediately without substitution
- Switch to a long-acting benzodiazepine then gradually reduce dose
- Increase the dose for one week then stop
- Replace with high-dose opioid therapy
Correct Answer: Switch to a long-acting benzodiazepine then gradually reduce dose
Q12. Which of the following is true regarding naloxone in opioid overdose?
- Naloxone is a long-acting opioid agonist used to treat dependence
- Naloxone reverses opioid-induced respiratory depression but may precipitate withdrawal
- Naloxone is effective orally and has high bioavailability
- Naloxone increases opioid receptor activation to counteract overdose
Correct Answer: Naloxone reverses opioid-induced respiratory depression but may precipitate withdrawal
Q13. Which lab test is most commonly used for screening recent opioid use?
- Serum ethanol concentration
- Urine immunoassay for opiates or opioids
- Blood glucose measurement
- Serum creatinine clearance
Correct Answer: Urine immunoassay for opiates or opioids
Q14. Which medication can be used to reduce autonomic symptoms of opioid withdrawal?
- Clonidine, an alpha-2 adrenergic agonist
- Propranolol, a beta blocker only for cardiac issues
- Flumazenil, a benzodiazepine antagonist
- Levodopa to restore dopamine
Correct Answer: Clonidine, an alpha-2 adrenergic agonist
Q15. What is the significance of “ceiling effect” for buprenorphine?
- It causes unlimited respiratory depression with dose increases
- There is a maximal effect beyond which higher doses do not increase opioid effects
- Buprenorphine has no analgesic properties
- The drug’s half-life shortens at high doses
Correct Answer: There is a maximal effect beyond which higher doses do not increase opioid effects
Q16. Wernicke encephalopathy associated with chronic alcohol use is primarily treated with:
- Intravenous thiamine (vitamin B1)
- High-dose vitamin C
- Immediate naloxone
- Long-term clonazepam therapy
Correct Answer: Intravenous thiamine (vitamin B1)
Q17. Which statement about naltrexone is correct?
- Naltrexone is used to acutely reverse opioid overdose
- Naltrexone is a long-acting opioid antagonist used to prevent relapse after detox
- Naltrexone is a benzodiazepine replacement therapy
- Naltrexone increases opioid receptor signaling
Correct Answer: Naltrexone is a long-acting opioid antagonist used to prevent relapse after detox
Q18. Tolerance develops more rapidly to which opioid effect?
- Constipation
- Analgesia and euphoria
- Miosis (pupil constriction)
- Physical dependence disappears quickly
Correct Answer: Analgesia and euphoria
Q19. Which pharmacokinetic factor most influences the duration of action of a drug used in maintenance therapy?
- Drug taste and color
- Metabolic half-life and active metabolites
- Route of topical application only
- Manufacturer’s patent status
Correct Answer: Metabolic half-life and active metabolites
Q20. In managing opioid dependence, supervised consumption and take-home dosing policies are examples of:
- Diagnostic criteria
- Harm reduction strategies
- Pharmacodynamic testing
- Contraindications to treatment
Correct Answer: Harm reduction strategies
Q21. Which withdrawal sign is most specific for alcohol withdrawal rather than opioid withdrawal?
- Piloerection and lacrimation
- Autonomic hyperactivity, tremor, hallucinations, and seizures
- Yawning and rhinorrhea
- Mydriasis and hyperthermia
Correct Answer: Autonomic hyperactivity, tremor, hallucinations, and seizures
Q22. What is the role of slow-release oral morphine (SROM) in opioid dependence?
- It is used only for acute overdose management
- It may be used as an alternative maintenance therapy for opioid dependence
- It is a benzodiazepine substitute
- It is an opioid antagonist for relapse prevention
Correct Answer: It may be used as an alternative maintenance therapy for opioid dependence
Q23. Which counseling approach is evidence-based for supporting behavior change in substance use disorders?
- Confrontational therapy focused on blame
- Motivational interviewing to enhance readiness to change
- Medication-only approach without psychosocial support
- Ignoring relapse as inevitable
Correct Answer: Motivational interviewing to enhance readiness to change
Q24. Which adverse effect remains common and persistent despite opioid tolerance?
- Analgesic tolerance
- Respiratory depression tolerance
- Constipation
- Euphoria sensitivity
Correct Answer: Constipation
Q25. Which is a pharmacotherapeutic option for nicotine dependence?
- Nicotine replacement therapy, bupropion, and varenicline
- Methadone alone
- High-dose benzodiazepines indefinitely
- Antipsychotics as first-line agents
Correct Answer: Nicotine replacement therapy, bupropion, and varenicline
Q26. Which factor increases risk of dependence in prescribed benzodiazepines?
- Short-term use for 3–5 days
- High potency, long duration, and abrupt discontinuation after prolonged use
- Use only under strict supervision with tapering
- Using non-oral formulations exclusively
Correct Answer: High potency, long duration, and abrupt discontinuation after prolonged use
Q27. Which statement about urine drug screening is correct?
- Immunoassays are definitive and do not require confirmation
- Confirmatory testing by GC-MS or LC-MS is needed for positives to reduce false results
- Urine tests detect exact time of last use to the minute
- All drugs are equally detected by one standard panel
Correct Answer: Confirmatory testing by GC-MS or LC-MS is needed for positives to reduce false results
Q28. For a patient on methadone, which interaction is clinically important and may increase methadone levels?
- Concurrent use of CYP3A4 inhibitors like certain azole antifungals
- Consuming grapefruit juice reduces methadone absorption always
- Concurrent high-fiber diet increases methadone toxicity
- Using topical antibiotic creams increases methadone clearance
Correct Answer: Concurrent use of CYP3A4 inhibitors like certain azole antifungals
Q29. Which describes “psychological dependence”?
- A physical withdrawal syndrome with autonomic signs
- An emotional or cognitive craving and compulsion to use a substance
- An irreversible genetic change after exposure
- Only tolerance without behavioral change
Correct Answer: An emotional or cognitive craving and compulsion to use a substance
Q30. In community pharmacy practice, which action best reduces diversion of opioid medications?
- Refusing all prescriptions from new patients
- Implementing prescription monitoring programs, patient counseling, and secure storage practices
- Dispensing larger quantities without follow-up
- Relying solely on patient verbal assurances
Correct Answer: Implementing prescription monitoring programs, patient counseling, and secure storage practices
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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