Oral contraceptives MCQs With Answer

Oral contraceptives MCQs With Answer

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Oral contraceptives MCQs With Answer

Oral contraceptives are cornerstone therapeutics in reproductive health; B.Pharm students must master their pharmacology, mechanisms, formulations, adverse effects, contraindications, and drug interactions. This focused MCQ set covers combined oral contraceptives (COCs), progestin-only pills, emergency contraceptives, pharmacokinetics, metabolism, clinical uses, monitoring, and counseling points. Questions emphasize mechanism of action (ovulation suppression, endometrial changes), important adverse reactions (thromboembolism, hypertension), enzyme induction interactions, contraceptive failure causes, and special population considerations. Detailed clinical and pharmaceutical perspectives will strengthen exam readiness and dispensing competence. Practical knowledge of dosing, synthetic progestins, ethinylestradiol alternatives, and drug–drug interactions is integrated. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which primary mechanism explains how combined oral contraceptives (COCs) prevent pregnancy?

  • Increase tubal motility to expel ova
  • Suppress ovulation by inhibiting LH and FSH surge
  • Neutralize sperm in the uterine cavity
  • Thicken cervical mucus only

Correct Answer: Suppress ovulation by inhibiting LH and FSH surge

Q2. Which component of most COCs is primarily responsible for stabilizing the endometrium and cycle control?

  • Ethinylestradiol
  • Norethindrone acetate
  • Levonorgestrel
  • Medroxyprogesterone acetate

Correct Answer: Ethinylestradiol

Q3. A progestin-only pill (POP) mainly prevents pregnancy by which action?

  • Complete inhibition of follicular development
  • Thickening cervical mucus and altering endometrium
  • Increasing estrogen production
  • Blocking implantation chemically

Correct Answer: Thickening cervical mucus and altering endometrium

Q4. Which enzyme system primarily metabolizes ethinylestradiol and many progestins?

  • Monoamine oxidase
  • CYP3A4
  • UDP-glucuronosyltransferase only
  • Cholinesterase

Correct Answer: CYP3A4

Q5. Which drug interaction is most likely to reduce the effectiveness of oral contraceptives?

  • Concomitant use of selective serotonin reuptake inhibitors (SSRIs)
  • Concurrent use of rifampicin or rifabutin
  • Co-administration with metformin
  • Use with proton pump inhibitors

Correct Answer: Concurrent use of rifampicin or rifabutin

Q6. The most serious rare cardiovascular risk associated with combined oral contraceptives is:

  • Myocarditis
  • Deep vein thrombosis and pulmonary embolism
  • Peripheral neuropathy
  • Mitral valve prolapse

Correct Answer: Deep vein thrombosis and pulmonary embolism

Q7. Which patient characteristic is an absolute contraindication to prescribing combined oral contraceptives?

  • History of migraine with aura
  • History of tubal ligation
  • Iron-deficiency anemia
  • Age over 40 without comorbidities

Correct Answer: History of migraine with aura

Q8. Emergency contraceptive pills containing levonorgestrel are most effective when taken within:

  • 120 hours after unprotected intercourse for maximum efficacy
  • 72 hours, with efficacy decreasing after 72 hours
  • 24 hours only
  • Any time before next ovulation equally

Correct Answer: 72 hours, with efficacy decreasing after 72 hours

Q9. Which progestin has higher androgenic activity and may worsen acne or hirsutism?

  • Desogestrel
  • Drospirenone
  • Norethindrone
  • Levonorgestrel

Correct Answer: Levonorgestrel

Q10. Which formulation change can reduce estrogen-related adverse events while maintaining contraceptive efficacy?

  • Switching to a higher dose ethinylestradiol
  • Using a progestin-only formulation or lower-dose estrogen COC
  • Doubling the daily dose intermittently
  • Replacing oral with subcutaneous insulin

Correct Answer: Using a progestin-only formulation or lower-dose estrogen COC

Q11. Which monitoring parameter is most important before initiating COCs in a new adult patient?

  • Baseline complete blood count only
  • Blood pressure measurement
  • Baseline liver ultrasound
  • Spirometry

Correct Answer: Blood pressure measurement

Q12. Which adverse effect is more associated with progestin-only pills compared to combined pills?

  • Increased risk of venous thromboembolism
  • Irregular bleeding and spotting
  • Marked elevation of blood pressure
  • Severe nausea and vomiting

Correct Answer: Irregular bleeding and spotting

Q13. How does obesity (high BMI) affect oral contraceptive pharmacokinetics and effectiveness?

  • No effect on pharmacokinetics or effectiveness
  • Increased clearance and possible reduced efficacy, especially for lower-dose pills
  • Guaranteed failure of all hormonal contraceptives
  • Improved absorption and higher efficacy

Correct Answer: Increased clearance and possible reduced efficacy, especially for lower-dose pills

Q14. Which synthetic estrogen is most commonly used in combined oral contraceptives?

  • Estradiol valerate
  • Ethinylestradiol
  • Conjugated equine estrogens
  • 17-beta estradiol

Correct Answer: Ethinylestradiol

Q15. A patient on COCs begins rifampicin; what counseling is most appropriate?

  • No change needed; continue pills as usual
  • Use additional non-hormonal contraception while on rifampicin and for 28 days after
  • Stop rifampicin immediately and continue COC
  • Increase COC dose automatically

Correct Answer: Use additional non-hormonal contraception while on rifampicin and for 28 days after

Q16. Which laboratory test is commonly altered by oral contraceptive use and should be interpreted cautiously?

  • Serum TSH markedly decreased
  • Elevated sex hormone-binding globulin (SHBG)
  • Marked leukopenia
  • Reduced serum creatinine clearance

Correct Answer: Elevated sex hormone-binding globulin (SHBG)

Q17. The advantage of newer progestins like drospirenone includes:

  • Strong androgenic activity
  • Antimineralocorticoid effects reducing bloating and water retention
  • Guaranteed absence of thrombotic risk
  • Complete protection against STIs

Correct Answer: Antimineralocorticoid effects reducing bloating and water retention

Q18. Which oral contraceptive strategy is recommended for managing heavy menstrual bleeding due to anovulatory cycles?

  • Intermittent high-dose estrogen bursts only
  • Combined oral contraceptives or levonorgestrel intrauterine system
  • Immediate hysterectomy
  • Antibiotic therapy for one month

Correct Answer: Combined oral contraceptives or levonorgestrel intrauterine system

Q19. Which side effect is more directly linked to estrogen component in COCs?

  • Acne flare
  • Nausea and breast tenderness
  • Menstrual spotting only
  • Hypoglycemia

Correct Answer: Nausea and breast tenderness

Q20. If a woman misses two active combined oral contraceptive tablets in the third week, the best pharmacist advice is:

  • Skip the rest of the cycle and start a new pack immediately
  • Continue taking the remaining tablets and use backup contraception for 7 days
  • Double the dose the next day to catch up
  • Stop the pill permanently

Correct Answer: Continue taking the remaining tablets and use backup contraception for 7 days

Q21. Which progestin-only method provides long-acting contraception via intramuscular injection?

  • Levonorgestrel daily pill
  • Medroxyprogesterone acetate depot injection (DMPA)
  • Ethinylestradiol transdermal patch
  • Combined oral contraceptive pill

Correct Answer: Medroxyprogesterone acetate depot injection (DMPA)

Q22. Which of the following is a common metabolic effect of COCs to be aware of in diabetic patients?

  • Marked hypoglycemia risk
  • Possible slight impairment of glucose tolerance and insulin sensitivity
  • Complete protection from diabetic complications
  • Elimination of need for diabetic monitoring

Correct Answer: Possible slight impairment of glucose tolerance and insulin sensitivity

Q23. For women taking antiepileptic enzyme-inducing drugs, what contraceptive adjustment is recommended?

  • No adjustment; standard COC is fine
  • Consider higher-dose estrogen pills, alternate methods, or IUDs due to reduced effectiveness
  • Stop antiepileptic drugs to preserve contraception
  • Switch to topical estrogen cream

Correct Answer: Consider higher-dose estrogen pills, alternate methods, or IUDs due to reduced effectiveness

Q24. Which formulation is least likely to cause thrombotic risk: progestin-only pill, combined low-dose COC, or high-dose estrogen COC?

  • High-dose estrogen COC
  • Combined low-dose COC
  • Progestin-only pill
  • All have equal high risk

Correct Answer: Progestin-only pill

Q25. Which contraceptive mechanism is NOT a primary action of oral hormonal contraceptives?

  • Inhibition of ovulation
  • Thickening of cervical mucus
  • Direct sterilization of the uterus
  • Endometrial alteration preventing implantation

Correct Answer: Direct sterilization of the uterus

Q26. What counseling point is important when starting combined oral contraceptives immediately postpartum in breastfeeding women?

  • Start ethinylestradiol-containing COCs immediately to improve milk supply
  • Delay estrogen-containing COCs until at least 6 weeks postpartum to protect lactation and reduce VTE risk
  • No need to consider breastfeeding status
  • Replace breastfeeding with formula when starting any contraception

Correct Answer: Delay estrogen-containing COCs until at least 6 weeks postpartum to protect lactation and reduce VTE risk

Q27. Which adverse effect requires immediate discontinuation and urgent evaluation in a woman on COCs?

  • Mild nausea on starting therapy
  • Severe unilateral leg pain and swelling suggestive of DVT
  • Spotting during initial cycles
  • Decreased acne over months

Correct Answer: Severe unilateral leg pain and swelling suggestive of DVT

Q28. Which statement about ethinylestradiol pharmacokinetics is correct?

  • It is not metabolized and is excreted unchanged
  • It undergoes first-pass hepatic metabolism and influences hepatic protein synthesis
  • It bypasses the liver entirely
  • It has no interaction with liver enzyme inducers

Correct Answer: It undergoes first-pass hepatic metabolism and influences hepatic protein synthesis

Q29. In selecting an oral contraceptive for a woman with acne and hirsutism, which is preferable?

  • COC with drospirenone or anti-androgenic progestin
  • High-androgenic levonorgestrel COC
  • Progestin-only pill with norethindrone
  • No hormonal method is acceptable

Correct Answer: COC with drospirenone or anti-androgenic progestin

Q30. Which counseling point reduces the risk of missed-pill contraceptive failure for combined oral contraceptives?

  • Take the pill at varying times each day to remember
  • Use a daily reminder, take at the same time each day, and use backup if pills are missed
  • Skip placebo week whenever convenient
  • Double-dose only on weekends

Correct Answer: Use a daily reminder, take at the same time each day, and use backup if pills are missed

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