MCQ Quiz: Introduction to Brain Therapeutics

The brain is the most complex organ in the body, and the therapeutics used to treat its disorders are equally intricate. An introduction to brain therapeutics requires a foundational understanding of neurotransmission, receptor pharmacology, and how drugs cross the blood-brain barrier to exert their effects. This quiz will test your knowledge on the fundamental principles that govern the action of medications on the central nervous system (CNS).

1. Which of the following is the primary excitatory neurotransmitter in the central nervous system?

• a. GABA
• b. Glycine
• c. Glutamate
• d. Serotonin

Answer: c. Glutamate

2. The primary inhibitory neurotransmitter in the brain is:

• a. Dopamine
• b. Norepinephrine
• c. Acetylcholine
• d. GABA (Gamma-aminobutyric acid)

Answer: d. GABA (Gamma-aminobutyric acid)

3. The blood-brain barrier (BBB) is a highly selective semipermeable border that separates circulating blood from the brain. Which type of drug is most likely to cross the BBB?

• a. A large, hydrophilic molecule
• b. A highly protein-bound drug
• c. A small, lipophilic molecule
• d. A highly ionized molecule

Answer: c. A small, lipophilic molecule

4. Benzodiazepines, such as lorazepam, exert their anxiolytic and sedative effects by enhancing the action of which neurotransmitter?

• a. Glutamate
• b. Dopamine
• c. GABA
• d. Serotonin

Answer: c. GABA

5. Antipsychotic medications used to treat schizophrenia primarily work by blocking which type of receptor?

• a. Histamine H1 receptors
• b. Dopamine D2 receptors
• c. Alpha-1 adrenergic receptors
• d. Muscarinic M1 receptors

Answer: b. Dopamine D2 receptors

6. The “monoamine hypothesis” of depression suggests that depression is caused by a deficiency of which neurotransmitters?

• a. Glutamate and GABA
• b. Acetylcholine and histamine
• c. Serotonin, norepinephrine, and dopamine
• d. Endorphins and enkephalins

Answer: c. Serotonin, norepinephrine, and dopamine

7. Selective Serotonin Reuptake Inhibitors (SSRIs) like fluoxetine work by:

• a. Blocking the breakdown of serotonin by MAO.
• b. Blocking the reuptake of serotonin from the synapse, increasing its availability.
• c. Directly stimulating serotonin receptors.
• d. Increasing the synthesis of serotonin.

Answer: b. Blocking the reuptake of serotonin from the synapse, increasing its availability.

8. Parkinson’s disease is characterized by a deficiency of which neurotransmitter in the brain?

• a. Serotonin
• b. Acetylcholine
• c. GABA
• d. Dopamine

Answer: d. Dopamine

9. The primary treatment strategy for Parkinson’s disease involves replacing dopamine with its precursor, which can cross the blood-brain barrier. This drug is:

• a. Carbidopa
• b. Levodopa
• c. Selegiline
• d. Ropinirole

Answer: b. Levodopa

10. Why is levodopa almost always given in combination with carbidopa?

• a. Carbidopa is also a dopamine agonist.
• b. Carbidopa prevents the peripheral conversion of levodopa to dopamine, which reduces side effects and increases CNS availability.
• c. Carbidopa helps levodopa cross the blood-brain barrier.
• d. Carbidopa treats the side effects of levodopa.

Answer: b. Carbidopa prevents the peripheral conversion of levodopa to dopamine, which reduces side effects and increases CNS availability.

11. Acetylcholinesterase inhibitors like donepezil are used to treat Alzheimer’s disease. What is their mechanism of action?

• a. They increase the production of acetylcholine.
• b. They block the breakdown of acetylcholine in the synapse.
• c. They directly stimulate acetylcholine receptors.
• d. They block the reuptake of acetylcholine.

Answer: b. They block the breakdown of acetylcholine in the synapse.

12. A “neurotransmitter” is a chemical substance that is released at the end of a nerve fiber and diffuses across the synapse to cause a response in another cell.

• a. True
• b. False

Answer: a. True

13. The space between two communicating neurons is called the:

• a. Axon
• b. Dendrite
• c. Myelin sheath
• d. Synapse

Answer: d. Synapse

14. A drug that binds to a receptor and activates it, producing a biological response, is known as a(n):

• a. Antagonist
• b. Agonist
• c. Inverse agonist
• d. Ligand

Answer: b. Agonist

15. A drug that binds to a receptor but does not activate it and prevents the natural neurotransmitter from binding is a(n):

• a. Antagonist
• b. Agonist
• c. Partial agonist
• d. Substrate

Answer: a. Antagonist

16. Opioid analgesics relieve pain by acting as agonists at which receptors in the CNS?

• a. Dopamine receptors
• b. Serotonin receptors
• c. Mu, kappa, and delta opioid receptors
• d. Adrenergic receptors

Answer: c. Mu, kappa, and delta opioid receptors

17. The primary excitatory ion channel in the brain is the ____ channel, while the primary inhibitory channel is the ____ channel.

• a. chloride, sodium
• b. potassium, calcium
• c. sodium, chloride
• d. calcium, potassium

Answer: c. sodium, chloride

18. Many anticonvulsant drugs work by:

• a. Enhancing excitatory neurotransmission.
• b. Enhancing inhibitory neurotransmission (e.g., GABAergic) or blocking excitatory pathways.
• c. Increasing the firing rate of neurons.
• d. Blocking dopamine receptors.

Answer: b. Enhancing inhibitory neurotransmission (e.g., GABAergic) or blocking excitatory pathways.

19. A “prodrug” that acts on the brain is one that:

• a. Is administered in its active form.
• b. Is administered in an inactive form and must be metabolized to its active form, which can then cross the BBB.
• c. Cannot cross the blood-brain barrier.
• d. Is a natural supplement.

Answer: b. Is administered in an inactive form and must be metabolized to its active form, which can then cross the BBB.

20. The therapeutic effect of many antidepressants is often delayed by several weeks. Why?

• a. The drug takes weeks to reach the brain.
• b. The immediate increase in neurotransmitter levels must lead to downstream adaptive changes in receptor sensitivity and gene expression.
• c. The drugs are very slowly absorbed from the gut.
• d. This is a myth; the effects are immediate.

Answer: b. The immediate increase in neurotransmitter levels must lead to downstream adaptive changes in receptor sensitivity and gene expression.

21. A drug’s “half-life” is the time it takes for:

• a. The drug to reach its maximum effect.
• b. The drug concentration in the plasma to be reduced by half.
• c. The patient to feel the drug’s effects.
• d. The drug to be completely eliminated from the body.

Answer: b. The drug concentration in the plasma to be reduced by half.

22. “Pharmacokinetics” is the study of:

• a. What the drug does to the body.
• b. What the body does to the drug (absorption, distribution, metabolism, excretion).
• c. The chemical structure of the drug.
• d. The adverse effects of the drug.

Answer: b. What the body does to the drug (absorption, distribution, metabolism, excretion).

23. “Pharmacodynamics” is the study of:

• a. What the drug does to the body (mechanism of action).
• b. What the body does to the drug.
• c. The cost of the drug.
• d. The formulation of the drug.

Answer: a. What the drug does to the body (mechanism of action).

24. The cytochrome P450 enzyme system is primarily located in which organ and is responsible for drug metabolism?

• a. Kidneys
• b. Brain
• c. Lungs
• d. Liver

Answer: d. Liver

25. A drug that inhibits a CYP450 enzyme can ____ the concentration of another drug that is a substrate for that enzyme.

• a. decrease
• b. increase
• c. have no effect on
• d. stabilize

Answer: b. increase

26. Stimulant medications like methylphenidate, used for ADHD, primarily increase the synaptic levels of which neurotransmitters?

• a. Serotonin and GABA
• b. Acetylcholine and histamine
• c. Dopamine and norepinephrine
• d. Glutamate and glycine

Answer: c. Dopamine and norepinephrine

27. The term “neurodegeneration” refers to:

• a. The generation of new neurons.
• b. The progressive loss of structure or function of neurons.
• c. The normal process of brain aging.
• d. An infection of the brain.

Answer: b. The progressive loss of structure or function of neurons.

28. An “excitatory postsynaptic potential” (EPSP) makes a neuron:

• a. More likely to fire an action potential.
• b. Less likely to fire an action potential.
• c. Hyperpolarized.
• d. Inactive.

Answer: a. More likely to fire an action potential.

29. An “inhibitory postsynaptic potential” (IPSP) makes a neuron:

• a. More likely to fire an action potential.
• b. Less likely to fire an action potential.
• c. Depolarized.
• d. More excitable.

Answer: b. Less likely to fire an action potential.

30. The process by which a neurotransmitter is taken back up into the presynaptic neuron is called:

• a. Enzymatic degradation
• b. Diffusion
• c. Reuptake
• d. Receptor binding

Answer: c. Reuptake

31. A key challenge in brain therapeutics is designing drugs that can effectively cross the:

• a. Glomerular membrane
• b. Intestinal wall
• c. Blood-brain barrier
• d. Cell membrane

Answer: c. Blood-brain barrier

32. A “therapeutic window” refers to the range of drug concentrations:

• a. That are toxic.
• b. That are ineffective.
• c. That produce a therapeutic effect without significant toxicity.
• d. That are available for purchase.

Answer: c. That produce a therapeutic effect without significant toxicity.

33. Many “atypical” or second-generation antipsychotics have a lower risk of extrapyramidal side effects because they have activity at which other receptor?

• a. Muscarinic receptors
• b. Histamine receptors
• c. Serotonin 5-HT2A receptors
• d. Adrenergic receptors

Answer: c. Serotonin 5-HT2A receptors

34. The term “neuroplasticity” refers to the brain’s ability to:

• a. Remain fixed and unchangeable throughout life.
• b. Reorganize itself by forming new neural connections.
• c. Resist all forms of medication.
• d. Only be affected by surgery.

Answer: b. Reorganize itself by forming new neural connections.

35. A “ligand” is a substance that:

• a. Forms a bond with a biomolecule to serve a biological purpose.
• b. Is always a drug.
• c. Is always an endogenous neurotransmitter.
• d. Is another name for a receptor.

Answer: a. Forms a bond with a biomolecule to serve a biological purpose.

36. Drugs that affect the brain are often referred to as:

• a. Psychoactive or psychotropic medications.
• b. Cardiovascular agents.
• c. Gastrointestinal agents.
• d. Dermatological agents.

Answer: a. Psychoactive or psychotropic medications.

37. Which of the following is NOT a monoamine neurotransmitter?

• a. Serotonin
• b. Dopamine
• c. Norepinephrine
• d. Acetylcholine

Answer: d. Acetylcholine

38. The “lock and key” model is an analogy used to describe the interaction between:

• a. A drug and its metabolizing enzyme.
• b. A drug and its receptor.
• c. A drug and its transporter protein.
• d. Two different drugs.

Answer: b. A drug and its receptor.

39. The primary goal of epilepsy treatment is to:

• a. Enhance neuronal excitation.
• b. Stabilize neuronal membranes and suppress seizure activity.
• c. Increase dopamine levels.
• d. Block GABA receptors.

Answer: b. Stabilize neuronal membranes and suppress seizure activity.

40. A drug with a narrow therapeutic index:

• a. Is very safe, with a large margin between effective and toxic doses.
• b. Is very dangerous, with a small margin between effective and toxic doses.
• c. Has very few side effects.
• d. Is not effective.

Answer: b. Is very dangerous, with a small margin between effective and toxic doses.

41. The part of the neuron that receives signals from other neurons is the:

• a. Axon
• b. Soma (cell body)
• c. Dendrite
• d. Axon terminal

Answer: c. Dendrite

42. The part of the neuron that sends signals to other neurons is the:

• a. Axon
• b. Soma (cell body)
• c. Dendrite
• d. Nucleus

Answer: a. Axon

43. A “receptor” is a protein molecule that:

• a. Receives chemical signals from outside a cell.
• b. Is only located on the cell surface.
• c. Has no function in the body.
• d. Is only found in the brain.

Answer: a. Receives chemical signals from outside a cell.

44. A key concept in treating brain disorders is targeting a specific:

• a. Organ system.
• b. Neurotransmitter system.
• c. Type of cell.
• d. Blood vessel.

Answer: b. Neurotransmitter system.

45. Which of the following is NOT a primary target for brain therapeutics?

• a. Receptors
• b. Enzymes
• c. Ion channels
• d. Bones

Answer: d. Bones

46. A drug’s “potency” refers to:

• a. The maximum effect the drug can produce.
• b. The amount of drug needed to produce a given effect.
• c. The half-life of the drug.
• d. The safety of the drug.

Answer: b. The amount of drug needed to produce a given effect.

47. A drug’s “efficacy” refers to:

• a. The maximum effect the drug can produce.
• b. The amount of drug needed to produce a given effect.
• c. The side effect profile of the drug.
• d. The cost of the drug.

Answer: a. The maximum effect the drug can produce.

48. An “action potential” is:

• a. A slow, graded potential.
• b. A rapid, all-or-none electrical signal that travels down an axon.
• c. A chemical signal.
• d. The resting state of a neuron.

Answer: b. A rapid, all-or-none electrical signal that travels down an axon.

49. The overall goal of brain therapeutics is to:

• a. Correct an imbalance in neurotransmission to alleviate symptoms of a disorder.
• b. Change a person’s personality.
• c. Make people happier.
• d. Enhance cognitive function in all individuals.

Answer: a. Correct an imbalance in neurotransmission to alleviate symptoms of a disorder.

50. The ultimate reason for a pharmacist to have a strong introduction to brain therapeutics is to:

• a. Be able to safely and effectively manage medications that have complex mechanisms and significant effects on patients.
• b. Diagnose psychiatric disorders.
• c. Prescribe all CNS medications.
• d. Memorize all the neurotransmitters.

Answer: a. Be able to safely and effectively manage medications that have complex mechanisms and significant effects on patients.