Norgestrel MCQs With Answer

Norgestrel MCQs With Answer

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Norgestrel MCQs With Answer: This set of focused multiple-choice questions on norgestrel is designed for B.Pharm students to reinforce understanding of norgestrel pharmacology, mechanism of action, stereochemistry, pharmacokinetics, clinical uses, adverse effects and drug interactions. Emphasis is placed on differences between norgestrel and levonorgestrel, progestin receptor binding, contraceptive efficacy, emergency contraception, metabolic pathways (CYP3A4), protein binding, and formulation considerations. Questions probe clinical scenarios, dosing, contraindications, and monitoring to build applied knowledge for pharmacy practice. These MCQs include pharmacodynamics, adverse reaction management, laboratory considerations, and patient counseling points relevant to pharmacist roles. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. What is the pharmacological classification of norgestrel?

  • Synthetic estrogen
  • Synthetic progestin (19-nortestosterone derivative)
  • Selective estrogen receptor modulator

Correct Answer: Synthetic progestin (19-nortestosterone derivative)

Q2. Norgestrel is best described as:

  • A pure estrogenic compound
  • A racemic mixture containing an active enantiomer
  • A peptide hormone
  • A progestin that is inactive in humans

Correct Answer: A racemic mixture containing an active enantiomer

Q3. Which enantiomer of norgestrel is primarily responsible for progestogenic activity?

  • Dextra-norgestrel
  • Levonorgestrel
  • Racemic norgestrel itself is fully active
  • Ethynyl estradiol

Correct Answer: Levonorgestrel

Q4. The main contraceptive mechanisms of norgestrel include:

  • Increased estrogen production and follicular rupture
  • Inhibition of ovulation, thickening of cervical mucus, and endometrial changes
  • Direct spermicidal action in the vagina
  • Stimulation of FSH and LH release

Correct Answer: Inhibition of ovulation, thickening of cervical mucus, and endometrial changes

Q5. Norgestrel is metabolized predominantly by which pathway?

  • Renal excretion unchanged
  • CYP3A4-mediated hepatic metabolism
  • Monoamine oxidase
  • Gut bacterial deconjugation only

Correct Answer: CYP3A4-mediated hepatic metabolism

Q6. Which protein-binding profile applies to levonorgestrel (active enantiomer of norgestrel)?

  • Free in plasma, minimal protein binding
  • Extensively bound to albumin and sex hormone–binding globulin (SHBG)
  • Bound exclusively to globulins other than SHBG
  • Irreversibly bound to red blood cells

Correct Answer: Extensively bound to albumin and sex hormone–binding globulin (SHBG)

Q7. The elimination half-life of levonorgestrel is approximately:

  • 1–2 hours
  • 4–6 hours
  • 13–20 hours
  • 72–96 hours

Correct Answer: 13–20 hours

Q8. Which clinical use is norgestrel commonly associated with?

  • Primary therapy for hypothyroidism
  • Component of combined oral contraceptives and progestin-only pills
  • First-line therapy for bacterial infections
  • Monoclonal antibody therapy adjunct

Correct Answer: Component of combined oral contraceptives and progestin-only pills

Q9. Compared with older progestins, levonorgestrel demonstrates which additional activity?

  • Strong anti-androgenic activity
  • Moderate androgenic activity
  • No interaction with androgen receptors
  • Potent estrogen receptor agonism

Correct Answer: Moderate androgenic activity

Q10. Which adverse effect is commonly associated with norgestrel-containing contraceptives?

  • Hyperthyroidism
  • Nausea, breast tenderness, and menstrual irregularities
  • Acute pancreatitis in all users
  • Immediate renal failure

Correct Answer: Nausea, breast tenderness, and menstrual irregularities

Q11. In emergency contraception, the effective active ingredient related to norgestrel is:

  • Desogestrel
  • Levonorgestrel
  • Medroxyprogesterone acetate
  • Estradiol valerate

Correct Answer: Levonorgestrel

Q12. Which statement about norgestrel and thrombotic risk is most accurate?

  • Progestins like norgestrel eliminate any thrombosis risk from contraception
  • Combined estrogen–progestin products contribute more to venous thromboembolism risk than progestin-only products
  • Progestin-only pills have the highest VTE risk of all contraceptives
  • Norgestrel directly activates clotting factor VII

Correct Answer: Combined estrogen–progestin products contribute more to venous thromboembolism risk than progestin-only products

Q13. Which laboratory parameter may be affected by long-term progestin therapy like norgestrel?

  • Markedly decreased serum sodium in all patients
  • Possible modest changes in lipid profile (HDL, LDL)
  • Total bilirubin consistently triples
  • Immediate increase in serum creatinine

Correct Answer: Possible modest changes in lipid profile (HDL, LDL)

Q14. Which is a contraindication to using combined oral contraceptives containing norgestrel?

  • Well-controlled hypertension with no vascular disease
  • History of ischemic stroke or myocardial infarction
  • Age under 20 with no risk factors
  • Current controlled hypothyroidism on replacement therapy

Correct Answer: History of ischemic stroke or myocardial infarction

Q15. Norgestrel’s action on the endometrium typically leads to:

  • Proliferative endometrium with increased bleeding risk
  • Secretory changes and endometrial atrophy that reduce implantation likelihood
  • Cancerous transformation within days
  • Complete regeneration of endometrial glands

Correct Answer: Secretory changes and endometrial atrophy that reduce implantation likelihood

Q16. A pharmacy student counseling a patient about missed progestin-only (norgestrel-like) pills should emphasize:

  • There is no consequence; continue as usual
  • If a pill is missed by more than 3 hours, additional contraceptive precautions or emergency contraception may be needed
  • Stop taking all medications immediately
  • Double the next dose and continue without precautions

Correct Answer: If a pill is missed by more than 3 hours, additional contraceptive precautions or emergency contraception may be needed

Q17. Which drug interaction can reduce the efficacy of norgestrel by inducing its metabolism?

  • Ketoconazole (CYP3A4 inhibitor)
  • Rifampicin (CYP3A4 inducer)
  • Erythromycin (CYP3A4 inhibitor)
  • Warfarin (CYP inhibitor of different pathway)

Correct Answer: Rifampicin (CYP3A4 inducer)

Q18. In comparison to levonorgestrel, norgestrel as a racemate contains:

  • Only the inactive isomer
  • Both active (levonorgestrel) and inactive enantiomer
  • Only estrogenic components
  • Two identical active stereoisomers

Correct Answer: Both active (levonorgestrel) and inactive enantiomer

Q19. Which monitoring consideration is most relevant when a patient starts long-term norgestrel therapy?

  • Frequent measurement of serum calcium every month
  • Baseline and periodic blood pressure checks and evaluation of menstrual pattern and side effects
  • Daily renal ultrasound
  • Mandatory liver biopsy after 1 month

Correct Answer: Baseline and periodic blood pressure checks and evaluation of menstrual pattern and side effects

Q20. Which statement about norgestrel and bone health is supported by evidence?

  • All progestins cause immediate bone demineralization
  • Progestin-only contraceptives generally have minimal adverse effects on bone mineral density in adults
  • Norgestrel permanently increases bone density in all users
  • Bone effects are independent of estrogen status

Correct Answer: Progestin-only contraceptives generally have minimal adverse effects on bone mineral density in adults

Q21. Which pharmacodynamic property explains norgestrel’s ability to suppress ovulation?

  • Stimulation of GnRH secretion from hypothalamus
  • Negative feedback on hypothalamic–pituitary axis lowering LH surge
  • Direct toxic effect on ovarian follicles
  • Activation of prolactin release only

Correct Answer: Negative feedback on hypothalamic–pituitary axis lowering LH surge

Q22. Which formulation does NOT typically contain norgestrel or its active enantiomer?

  • Combined oral contraceptive pills
  • Progestin-only emergency contraceptive using levonorgestrel
  • Depot medroxyprogesterone acetate injection
  • Levonorgestrel-releasing intrauterine device (IUD)

Correct Answer: Depot medroxyprogesterone acetate injection

Q23. A pharmacist explains that levonorgestrel’s androgenic effects may contribute to which side effect?

  • Reduced facial hair growth
  • Acne and possible hirsutism in susceptible individuals
  • Profound estrogenic breast enlargement only
  • Immediate loss of libido in all users

Correct Answer: Acne and possible hirsutism in susceptible individuals

Q24. Which pregnancy classification historically applied to progestins like norgestrel?

  • Category X for all uses
  • Often considered category C for some formulations historically; clinical context matters
  • Category A for safety in pregnancy
  • Automatically teratogenic in first trimester

Correct Answer: Often considered category C for some formulations historically; clinical context matters

Q25. When counseling about emergency contraception using levonorgestrel related to norgestrel, the student should state:

  • It must be taken within 72 hours, and earlier use is more effective
  • It is equally effective up to 2 weeks after unprotected intercourse
  • It acts by causing immediate abortion of an established pregnancy
  • It permanently prevents future fertility

Correct Answer: It must be taken within 72 hours, and earlier use is more effective

Q26. Which adverse metabolic effect is most likely with androgenic progestins like levonorgestrel?

  • Marked hyperinsulinemia in all users
  • Potential unfavorable changes in lipid profile such as reduced HDL
  • Immediate correction of diabetes mellitus
  • Severe hypoglycemia within hours

Correct Answer: Potential unfavorable changes in lipid profile such as reduced HDL

Q27. For pharmacokinetic interactions, which class of drugs can increase plasma levels of levonorgestrel by inhibiting metabolism?

  • CYP3A4 inducers like carbamazepine
  • CYP3A4 inhibitors like ritonavir (some protease inhibitors) and ketoconazole
  • P-glycoprotein inducers without CYP effect
  • High-dose vitamin C supplements

Correct Answer: CYP3A4 inhibitors like ritonavir (some protease inhibitors) and ketoconazole

Q28. Which clinical scenario indicates a need to avoid starting combined contraceptives containing norgestrel?

  • Healthy non-smoking 22-year-old woman
  • Woman with known inherited thrombophilia or active thromboembolic disease
  • Peri-menopausal woman seeking HRT without estrogen
  • Woman with well-controlled acne where androgenic progestin could help

Correct Answer: Woman with known inherited thrombophilia or active thromboembolic disease

Q29. In terms of receptor binding, progestins like levonorgestrel primarily act on:

  • Estrogen receptors alpha and beta only
  • Progesterone receptors (nuclear) to alter gene transcription
  • Membrane ion channels exclusively
  • Glucagon receptors in the liver

Correct Answer: Progesterone receptors (nuclear) to alter gene transcription

Q30. A final-year B.Pharm student should recognize that switching a patient from a norgestrel-containing combined pill to a progestin-only method may be appropriate when:

  • The patient desires higher estrogen exposure
  • The patient is breastfeeding or has contraindications to estrogen
  • The patient has no contraindications and prefers combined therapy
  • The patient requires immediate surgical contraception

Correct Answer: The patient is breastfeeding or has contraindications to estrogen

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