Mitotane MCQs With Answer

Mitotane MCQs With Answer
Mitotane is an adrenolytic drug used primarily in advanced adrenal cortical carcinoma; understanding its pharmacology, mechanism of action, pharmacokinetics, dosing, adverse effects, and monitoring is essential for B.Pharm students. This collection emphasizes drug interactions, therapeutic drug monitoring, endocrine consequences, toxicity management, and patient counseling—key topics in clinical pharmacy and oncology therapeutics. Questions range from molecular action and metabolite formation to clinical indications, contraindications, dose adjustments, and laboratory monitoring (e.g., cortisol, liver enzymes). These targeted MCQs will deepen your grasp of mitotane’s clinical use, safety profile, and formulation considerations for competent pharmaceutical care. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which of the following best describes the primary mechanism of action of mitotane?

• Selective inhibition of 11β-hydroxylase
• Adrenocortical cell necrosis and inhibition of steroidogenesis
• Competitive antagonism at glucocorticoid receptors
• Inhibition of adrenal ACTH release from the pituitary

Correct Answer: Adrenocortical cell necrosis and inhibition of steroidogenesis

Q2. Mitotane is mainly indicated for which clinical condition?

• Primary hypothyroidism
• Adrenal cortical carcinoma
• Cushing’s disease due to pituitary adenoma
• Pheochromocytoma

Correct Answer: Adrenal cortical carcinoma

Q3. Which pharmacokinetic property of mitotane necessitates prolonged therapeutic monitoring?

• Extensive renal excretion of unchanged drug
• Short half-life requiring frequent dosing
• High lipophilicity and long tissue half-life
• Poor oral bioavailability due to acid degradation

Correct Answer: High lipophilicity and long tissue half-life

Q4. Mitotane is classified chemically as which type of compound?

• An imidazole derivative
• An organochlorine related to DDT
• A steroid analog
• A peptide antibiotic

Correct Answer: An organochlorine related to DDT

Q5. Which adverse effect is particularly associated with mitotane therapy?

• Severe hypoglycemia
• Neurotoxicity including dizziness and ataxia
• Cardiac arrhythmias due to QT prolongation
• Marked hyperkalemia

Correct Answer: Neurotoxicity including dizziness and ataxia

Q6. How does mitotane affect cortisol levels in patients with adrenal carcinoma?

• It increases cortisol synthesis
• It reduces cortisol production by adrenal cortical destruction
• It blocks cortisol receptors without changing levels
• It converts cortisol to inactive metabolites via liver induction only

Correct Answer: It reduces cortisol production by adrenal cortical destruction

Q7. Which monitoring test is most important during mitotane therapy?

• Serum potassium only
• Plasma mitotane concentration and cortisol levels
• Serum insulin levels
• Urinary catecholamines

Correct Answer: Plasma mitotane concentration and cortisol levels

Q8. Therapeutic plasma mitotane concentrations are generally targeted at:

• 0.1–1 mg/L
• 5–20 mg/L
• 14–20 mg/L
• 30–50 mg/L

Correct Answer: 14–20 mg/L

Q9. Which enzyme system does mitotane induce, affecting metabolism of other drugs?

• CYP3A4 (and other hepatic CYPs)
• Monoamine oxidase (MAO)
• Cyclooxygenase-2 (COX-2)
• Thromboxane synthetase

Correct Answer: CYP3A4 (and other hepatic CYPs)

Q10. Mitotane’s lipophilicity primarily leads to which clinical consequence?

• Rapid renal clearance
• Extensive accumulation in adipose tissue and prolonged effects
• High aqueous solubility and intravenous use
• Limited crossing of the blood-brain barrier

Correct Answer: Extensive accumulation in adipose tissue and prolonged effects

Q11. Which endocrine deficiency commonly requires replacement when using mitotane?

• Thyroid hormone deficiency
• Aldosterone and glucocorticoid deficiency (adrenal insufficiency)
• Growth hormone deficiency
• Insulin deficiency

Correct Answer: Aldosterone and glucocorticoid deficiency (adrenal insufficiency)

Q12. The preferred route of administration for mitotane is:

• Intravenous infusion
• Oral tablets/capsules
• Intramuscular injection
• Topical application

Correct Answer: Oral tablets/capsules

Q13. Which patient counseling point is important for mitotane therapy?

• Mitotane causes immediate symptom relief within 24 hours
• Avoid pregnancy and use effective contraception due to teratogenicity
• No need for steroid replacement even if fatigue occurs
• Mitotane enhances oral contraceptive efficacy

Correct Answer: Avoid pregnancy and use effective contraception due to teratogenicity

Q14. Which laboratory abnormality is commonly seen with mitotane use?

• Marked leukopenia in all patients
• Elevated liver enzymes (transaminases)
• Low serum calcium consistently
• Persistent hypomagnesemia

Correct Answer: Elevated liver enzymes (transaminases)

Q15. Mitotane’s effect on sex hormone-binding globulin (SHBG) and thyroid tests can cause:

• No change in binding proteins
• Alteration of total hormone levels, complicating interpretation of thyroid and sex hormones
• Direct stimulation of TSH release
• Marked increase in free T4 without symptoms

Correct Answer: Alteration of total hormone levels, complicating interpretation of thyroid and sex hormones

Q16. Which of the following is a serious toxicity requiring immediate discontinuation of mitotane?

• Mild nausea that resolves in days
• Severe neurotoxicity with coma or seizures
• Transient alopecia
• Temporary taste disturbance

Correct Answer: Severe neurotoxicity with coma or seizures

Q17. Which drug interaction is likely with mitotane due to CYP induction?

• Increased warfarin effect due to CYP inhibition
• Decreased efficacy of oral contraceptives due to increased metabolism
• Reduced clearance of carbamazepine
• Enhanced digoxin bioavailability

Correct Answer: Decreased efficacy of oral contraceptives due to increased metabolism

Q18. When initiating mitotane therapy, dose escalation is typically used to:

• Achieve rapid peak plasma levels in 24 hours
• Reduce gastrointestinal and neurological adverse effects while reaching target concentrations
• Avoid any need for monitoring
• Ensure renal accumulation for efficacy

Correct Answer: Reduce gastrointestinal and neurological adverse effects while reaching target concentrations

Q19. Which statement about mitotane in pregnancy is correct?

• It is safe and recommended during pregnancy
• It is teratogenic and contraindicated; pregnancy must be avoided
• It has no effect on fetal development
• It should be given at double dose in pregnancy

Correct Answer: It is teratogenic and contraindicated; pregnancy must be avoided

Q20. Mitotane-induced adrenal insufficiency is managed primarily by:

• Immediate dialysis
• Glucocorticoid and mineralocorticoid replacement therapy
• High-dose vitamin D only
• Stopping all endocrine drugs permanently

Correct Answer: Glucocorticoid and mineralocorticoid replacement therapy

Q21. Which population parameter may prolong mitotane half-life further?

• Low body fat percentage
• High adipose tissue stores (obesity)
• Young age under 18
• High renal clearance

Correct Answer: High adipose tissue stores (obesity)

Q22. What is a common gastrointestinal adverse effect of mitotane?

• Constipation only
• Nausea, vomiting, and diarrhea
• Painless rectal bleeding
• Increased appetite without other symptoms

Correct Answer: Nausea, vomiting, and diarrhea

Q23. Which monitoring frequency is appropriate for plasma mitotane levels after dose changes?

• No monitoring needed ever
• Regular measurement every 2–4 weeks until stable, then less frequently
• Check only once annually
• Daily monitoring for life

Correct Answer: Regular measurement every 2–4 weeks until stable, then less frequently

Q24. Mitotane’s structural relation to DDT suggests which environmental/chemical property?

• High water solubility and low persistence
• Persistence in lipid tissues and environmental stability
• Rapid biodegradation in soil
• Strong acidic reactivity

Correct Answer: Persistence in lipid tissues and environmental stability

Q25. Which formulation consideration affects mitotane absorption?

• Taking with a high-fat meal increases absorption
• Drug must be given intravenously to be absorbed
• Acidic beverages inactivate the drug completely
• Absorption is independent of food

Correct Answer: Taking with a high-fat meal increases absorption

Q26. Which laboratory parameter may be suppressed secondary to mitotane therapy and require assessment?

• Prolactin only
• Cortisol and ACTH with dynamic testing as indicated
• Serum amylase exclusively
• Fasting insulin levels only

Correct Answer: Cortisol and ACTH with dynamic testing as indicated

Q27. Which management strategy is recommended if mitotane toxicity occurs?

• Continue drug and add symptomatic therapy only
• Reduce or stop mitotane, provide supportive care, and treat endocrine deficits
• Switch immediately to high-dose ketoconazole without evaluation
• No action; toxicity resolves without intervention

Correct Answer: Reduce or stop mitotane, provide supportive care, and treat endocrine deficits

Q28. Mitotane can increase clearance of which class of drugs, potentially reducing their plasma levels?

• Antibiotics cleared renally only
• Medications metabolized by hepatic CYP enzymes (e.g., corticosteroids, oral contraceptives)
• Drugs exclusively excreted unchanged in bile
• Intravenous monoclonal antibodies

Correct Answer: Medications metabolized by hepatic CYP enzymes (e.g., corticosteroids, oral contraceptives)

Q29. Which statement about mitotane dose adjustment in hepatic impairment is most appropriate?

• No adjustment needed; drug is unaffected by liver function
• Caution and possible dose reduction because hepatic metabolism and toxicity risk may change
• Always double the dose in hepatic impairment
• Switch to topical therapy in hepatic disease

Correct Answer: Caution and possible dose reduction because hepatic metabolism and toxicity risk may change

Q30. Which is an appropriate counseling point regarding the timeline of clinical response to mitotane in adrenal carcinoma?

• Clinical response is immediate within 48 hours
• Therapeutic effects may take weeks to months due to slow accumulation and delayed tumor response
• Effectiveness can be judged after a single dose
• Mitotane cures adrenal carcinoma in most cases within a week

Correct Answer: Therapeutic effects may take weeks to months due to slow accumulation and delayed tumor response

Download