Oral contraceptives – Mifepristone MCQs With Answer

Oral contraceptives – Mifepristone MCQs With Answer

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Oral contraceptives – Mifepristone MCQs With Answer

This focused set of questions is designed for B. Pharm students to deepen understanding of oral contraceptives and mifepristone, emphasizing pharmacology, mechanism of action, dosing regimens, pharmacokinetics, adverse effects, contraindications, drug interactions and clinical use. Topics include combined and progestin‑only pills, emergency contraception, enzyme‑mediated interactions (CYP3A4), thromboembolic risk with estrogens, and the evidence‑based use of mifepristone with misoprostol for medical termination. Questions are practical and clinically relevant to pharmacy practice and patient counselling. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which is the principal mechanism by which combined oral contraceptives (estrogen + progestin) prevent pregnancy?

  • Thickening of cervical mucus only
  • Inhibition of ovulation by suppressing LH and FSH surge
  • Direct toxic effect on sperm
  • Inducing immediate endometrial atrophy

Correct Answer: Inhibition of ovulation by suppressing LH and FSH surge

Q2. What is the main contraceptive action of progestin-only pills (mini‑pills)?

  • Consistent ovulation induction
  • Thickening of cervical mucus and alteration of endometrium
  • Increasing uterine contractility to expel fertilized ovum
  • Enhancing tubal motility to prevent implantation

Correct Answer: Thickening of cervical mucus and alteration of endometrium

Q3. Which serious adverse event is most strongly linked to estrogen-containing oral contraceptives?

  • Hepatic failure
  • Venous thromboembolism (deep vein thrombosis, pulmonary embolism)
  • Renal tubular acidosis
  • Acute pancreatitis

Correct Answer: Venous thromboembolism (deep vein thrombosis, pulmonary embolism)

Q4. How do strong hepatic enzyme inducers (e.g., rifampin, carbamazepine) affect combined oral contraceptives?

  • Increase estrogen levels and risk of toxicity
  • Decrease steroid hormone levels and reduce contraceptive efficacy
  • No clinically relevant effect on steroid hormones
  • Convert estrogens to inactive metabolites that enhance efficacy

Correct Answer: Decrease steroid hormone levels and reduce contraceptive efficacy

Q5. Which condition is an absolute contraindication to prescribing combined estrogen–progestin oral contraceptives?

  • Well‑controlled hypothyroidism
  • History of deep vein thrombosis or pulmonary embolism
  • Intermittent migraine without aura in a young nonsmoker
  • Polycystic ovary syndrome when contraception is required

Correct Answer: History of deep vein thrombosis or pulmonary embolism

Q6. Which agent is most commonly used as over‑the‑counter emergency contraception within 72 hours after unprotected intercourse?

  • Mifepristone single dose 200 mg
  • Levonorgestrel 1.5 mg single dose
  • Combined estrogen‑progestin high dose tablet
  • Misoprostol 400 mcg

Correct Answer: Levonorgestrel 1.5 mg single dose

Q7. Mifepristone is classified pharmacologically as which of the following?

  • A selective estrogen receptor modulator (SERM)
  • An antiprogestin (progesterone receptor antagonist)
  • A pure progestin agonist
  • A gonadotropin‑releasing hormone agonist

Correct Answer: An antiprogestin (progesterone receptor antagonist)

Q8. The primary clinical indication of mifepristone in reproductive health is:

  • Long‑term contraception via implant
  • Medical termination of intrauterine pregnancy (in combination with misoprostol)
  • Treatment of menopausal symptoms
  • First‑line emergency contraception for all cases

Correct Answer: Medical termination of intrauterine pregnancy (in combination with misoprostol)

Q9. What is the recommended regimen for medical abortion using mifepristone in early pregnancy (up to 70 days)?

  • Mifepristone 200 mg orally, then misoprostol 800 mcg buccal/vaginal 24–48 hours later
  • Mifepristone 50 mg daily for 7 days with no prostaglandin
  • Misoprostol alone 400 mcg orally once
  • Mifepristone 600 mg single dose with no follow-up

Correct Answer: Mifepristone 200 mg orally, then misoprostol 800 mcg buccal/vaginal 24–48 hours later

Q10. Besides antagonism at progesterone receptors, mifepristone also has clinically relevant activity at which receptor?

  • Thyroid hormone receptor
  • Glucocorticoid receptor (antagonist activity)
  • Beta‑adrenergic receptor (agonist)
  • Vitamin D receptor

Correct Answer: Glucocorticoid receptor (antagonist activity)

Q11. Which are the most common adverse effects experienced after mifepristone‑assisted medical abortion?

  • Severe hypertension and glucose intolerance
  • Vaginal bleeding and abdominal cramping
  • Nephrotoxicity and ototoxicity
  • Thyrotoxicosis and palpitations

Correct Answer: Vaginal bleeding and abdominal cramping

Q12. Before administering mifepristone for medical abortion, which important condition must be excluded?

  • Intrauterine device in situ without pregnancy
  • Ectopic (tubal) pregnancy
  • History of prior normal vaginal delivery
  • Current use of combined oral contraceptives

Correct Answer: Ectopic (tubal) pregnancy

Q13. Which cytochrome P450 isoenzyme primarily metabolizes mifepristone, creating potential for drug interactions?

  • CYP2D6
  • CYP1A2
  • CYP3A4
  • CYP2C9

Correct Answer: CYP3A4

Q14. A patient taking a strong CYP3A4 inducer (e.g., rifampin) while on mifepristone is expected to have which effect?

  • Increased mifepristone plasma concentrations and toxicity
  • Decreased mifepristone plasma concentrations and reduced effectiveness
  • No change in mifepristone pharmacokinetics
  • Conversion of mifepristone to an active metabolite that increases efficacy

Correct Answer: Decreased mifepristone plasma concentrations and reduced effectiveness

Q15. Up to what gestational age is the commonly accepted mifepristone + misoprostol medical abortion regimen effective and recommended?

  • Up to 42 days (6 weeks)
  • Up to 70 days (10 weeks)
  • Up to 140 days (20 weeks)
  • Any gestational age with no restrictions

Correct Answer: Up to 70 days (10 weeks)

Q16. Which contraceptive method is generally preferred and considered safe during breastfeeding?

  • Combined estrogen–progestin oral contraceptives immediately postpartum
  • Progestin‑only pills or levonorgestrel intrauterine device
  • High‑dose estrogen therapy
  • Systemic mifepristone for lactation suppression

Correct Answer: Progestin‑only pills or levonorgestrel intrauterine device

Q17. How does estrogen in combined oral contraceptives contribute to increased thrombotic risk?

  • By directly injuring vascular endothelium
  • By increasing hepatic synthesis of clotting factors and decreasing antithrombin III
  • By elevating platelet destruction
  • By promoting erythrocytosis and hyperviscosity

Correct Answer: By increasing hepatic synthesis of clotting factors and decreasing antithrombin III

Q18. Which effect on blood pressure is most commonly associated with estrogen‑containing oral contraceptives?

  • They have no effect on blood pressure
  • A modest increase in blood pressure in some users
  • Consistent severe hypotension
  • Immediate hypertensive emergency in all users

Correct Answer: A modest increase in blood pressure in some users

Q19. Combined oral contraceptives typically affect lipid profile by which change?

  • Lowering triglycerides significantly
  • Increasing HDL and triglycerides, with variable effects on LDL
  • Causing profound reduction in LDL only
  • No measurable effect on lipid parameters

Correct Answer: Increasing HDL and triglycerides, with variable effects on LDL

Q20. Which of the following drugs is well documented to reduce the effectiveness of oral contraceptives through enzyme induction?

  • Rifampin
  • Amoxicillin (short course)
  • Metformin
  • Omeprazole

Correct Answer: Rifampin

Q21. The primary mechanism by which mifepristone facilitates termination of early pregnancy is:

  • Stimulating estrogen receptors to cause uterine hypertonus
  • Blocking progesterone receptors leading to decidual breakdown and detachment of the embryo
  • Directly lysing chorionic villi through cytotoxicity
  • Inhibiting prostaglandin synthesis to induce uterine relaxation

Correct Answer: Blocking progesterone receptors leading to decidual breakdown and detachment of the embryo

Q22. The elimination half‑life of mifepristone in humans is approximately:

  • 1–3 hours
  • 18–30 hours (prolonged due to strong protein binding)
  • 100–200 hours
  • Minutes; it is rapidly cleared

Correct Answer: 18–30 hours (prolonged due to strong protein binding)

Q23. After a patient undergoes a medical abortion with mifepristone and misoprostol, the appropriate follow‑up to confirm completion is:

  • No follow‑up is necessary unless symptoms occur
  • Clinical assessment and either ultrasound or serial serum β‑hCG decline measurement within 1–2 weeks
  • Immediate repeat dose of mifepristone the next day as routine
  • Initiate combined oral contraceptives the same hour without assessment

Correct Answer: Clinical assessment and either ultrasound or serial serum β‑hCG decline measurement within 1–2 weeks

Q24. Which of the following is generally NOT considered a contraindication to combined oral contraceptive use?

  • Active breast cancer
  • Uncontrolled severe hypertension with end‑organ damage
  • Well‑controlled hypothyroidism on stable therapy
  • History of cerebrovascular accident

Correct Answer: Well‑controlled hypothyroidism on stable therapy

Q25. Which progestin commonly used in contraceptives has among the highest androgenic activity and may worsen acne?

  • Drospirenone
  • Desogestrel
  • Levonorgestrel
  • Cyproterone acetate

Correct Answer: Levonorgestrel

Q26. Ulipristal acetate differs from mifepristone in that ulipristal is best described as:

  • A pure glucocorticoid antagonist used for abortion
  • A selective progesterone receptor modulator (SPRM) used for emergency contraception by delaying ovulation
  • An estrogen agonist used for contraception
  • An antibiotic used to prevent infection post‑abortion

Correct Answer: A selective progesterone receptor modulator (SPRM) used for emergency contraception by delaying ovulation

Q27. Which of the following is a recognized contraindication to the use of mifepristone for medical abortion?

  • Known or suspected ectopic pregnancy
  • History of prior uncomplicated first‑trimester abortion
  • Allergy to penicillin
  • Use of combined oral contraceptives within the past month

Correct Answer: Known or suspected ectopic pregnancy

Q28. Regarding routine antibiotics and combined oral contraceptive effectiveness, which statement is most accurate?

  • All antibiotics cause significant contraceptive failure
  • Most common short‑course antibiotics do not significantly reduce combined OCP efficacy; rifampin is a notable exception
  • Antibiotics universally increase estrogen levels and cause toxicity
  • Antibiotics render progestin‑only pills inactive but not combined pills

Correct Answer: Most common short‑course antibiotics do not significantly reduce combined OCP efficacy; rifampin is a notable exception

Q29. For a woman over 35 years who smokes heavily, which contraceptive choice is generally safest?

  • Combined estrogen–progestin oral contraceptive
  • Progestin-only method or a long‑acting reversible contraceptive (e.g., IUD)
  • High-dose estrogen patch
  • Mifepristone as a contraceptive implant

Correct Answer: Progestin-only method or a long‑acting reversible contraceptive (e.g., IUD)

Q30. In combined oral contraceptives, which component primarily suppresses the LH surge to prevent ovulation?

  • Estrogen component
  • Progestin component
  • Both components have no effect on LH
  • Only nonhormonal excipients contribute

Correct Answer: Progestin component

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