Over-the-counter (OTC) medications – sale and rational use MCQs With Answer

Introduction

Over-the-counter (OTC) medications are drugs available without a prescription for self-care and symptom relief. For B.Pharm students, understanding OTC sale, OTC classification, regulatory requirements, patient counseling, drug interactions, adverse effects and rational use is essential for safe community pharmacy practice. This concise guide emphasizes pharmacist responsibilities in OTC supply, labeling, dosing, vulnerable populations (pediatrics, pregnancy, elderly), pharmacovigilance and strategies to minimize misuse and self-medication risks. Key keywords include Over-the-counter (OTC) medications, sale, rational use, self-medication, regulatory authority, patient counseling, drug interactions and adverse effects. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. What best defines an over-the-counter (OTC) medication?

• Drugs that can be bought without a prescription for self-care and symptomatic relief
• Drugs that require a specialist prescription only
• Only herbal supplements sold in pharmacies
• Medications restricted to hospital supply

Correct Answer: Drugs that can be bought without a prescription for self-care and symptomatic relief

Q2. What is the primary objective of promoting rational use of OTC medicines?

• Maximize sales volume in the pharmacy
• Ensure safe, effective and appropriate self-medication with minimal harm
• Replace prescription medicines entirely with OTC drugs
• Limit patient access to any medications

Correct Answer: Ensure safe, effective and appropriate self-medication with minimal harm

Q3. Which body typically regulates the classification and sale of OTC medications?

• National drug regulatory authority or equivalent government agency
• Local retail associations only
• Manufacturer marketing departments
• Independent community groups

Correct Answer: National drug regulatory authority or equivalent government agency

Q4. What is a key role of the pharmacist when dispensing OTC products?

• Provide patient counseling on indications, dosing, interactions and when to refer
• Prescribe antibiotics without investigation
• Recommend maximum possible doses to ensure quick relief
• Discourage reporting of adverse effects to avoid alarm

Correct Answer: Provide patient counseling on indications, dosing, interactions and when to refer

Q5. OTC classification is commonly based on what primary factor?

• Risk profile and need for professional supervision
• Color and packaging type
• Manufacturer’s stock availability
• Marketing budget for the product

Correct Answer: Risk profile and need for professional supervision

Q6. What is the widely accepted maximum daily dose of paracetamol for a healthy adult?

• 4 grams per day
• 10 grams per day
• 500 mg per day
• 8 grams per day

Correct Answer: 4 grams per day

Q7. Which commonly used analgesic has been associated with increased cardiovascular risk when used long-term?

• Diclofenac
• Paracetamol
• Aspirin low dose
• Pseudoephedrine

Correct Answer: Diclofenac

Q8. Loperamide relieves diarrhea primarily by which mechanism?

• Agonism at intestinal mu-opioid receptors to reduce gut motility
• Neutralizing gastric acid
• Stimulating intestinal secretion of fluids
• Increasing intestinal peristalsis

Correct Answer: Agonism at intestinal mu-opioid receptors to reduce gut motility

Q9. Which antihistamine is most likely to cause sedation?

• Chlorpheniramine
• Loratadine
• Fexofenadine
• Cetirizine (non-sedating at typical doses)

Correct Answer: Chlorpheniramine

Q10. Which oral decongestant is generally contraindicated in uncontrolled hypertension?

• Pseudoephedrine
• Guaifenesin
• Oxymetazoline nasal spray (systemic effects less but caution still advised)
• Saline nasal spray

Correct Answer: Pseudoephedrine

Q11. Antacids can reduce absorption of which class of antibiotics by chelation?

• Fluoroquinolones (e.g., ciprofloxacin)
• Penicillins (e.g., amoxicillin)
• Macrolides (e.g., azithromycin)
• Cephalosporins (e.g., cefixime)

Correct Answer: Fluoroquinolones (e.g., ciprofloxacin)

Q12. The primary pharmacologic action of pseudoephedrine is:

• Alpha-adrenergic agonism producing vasoconstriction of nasal mucosa
• Anticholinergic bronchodilation
• Direct antihistamine blockade
• Topical mucolysis

Correct Answer: Alpha-adrenergic agonism producing vasoconstriction of nasal mucosa

Q13. Sun Protection Factor (SPF) primarily indicates protection against which type of radiation?

• UVB rays
• UVA rays exclusively
• Visible light only
• Infrared radiation

Correct Answer: UVB rays

Q14. Which topical agent is contraindicated or likely to worsen acne?

• Potent topical corticosteroids
• Benzoyl peroxide
• Topical retinoids
• Topical benzyl peroxide with appropriate formulation

Correct Answer: Potent topical corticosteroids

Q15. Which OTC antihistamine is commonly used for motion sickness?

• Dimenhydrinate
• Fexofenadine
• Loratadine
• Famotidine

Correct Answer: Dimenhydrinate

Q16. Which statement about herbal OTC supplements is most accurate?

• They may vary in active content and can interact with prescription medicines
• They are always safe and interaction-free because they are natural
• They never require labeling of active constituents
• They are regulated identically to prescription drugs in all countries

Correct Answer: They may vary in active content and can interact with prescription medicines

Q17. Recommended single-dose paracetamol in children is typically:

• 15 mg per kg of body weight
• 50 mg per kg
• 1 g fixed dose for all children
• 5 mg per kg

Correct Answer: 15 mg per kg of body weight

Q18. Loperamide is contraindicated in which clinical situation?

• Acute bloody diarrhea or high fever suggesting invasive infection
• Mild traveler’s diarrhea without fever
• Chronic irritable bowel syndrome with diarrhea-predominance
• Non-infective chronic diarrhea under medical supervision

Correct Answer: Acute bloody diarrhea or high fever suggesting invasive infection

Q19. Rebound nasal congestion (rhinitis medicamentosa) is most commonly caused by overuse of which OTC product?

• Topical alpha-adrenergic nasal decongestants like oxymetazoline
• Saline nasal rinses
• Topical steroid sprays when used short-term
• Antihistamine tablets

Correct Answer: Topical alpha-adrenergic nasal decongestants like oxymetazoline

Q20. Which OTC medication class should generally be avoided in the third trimester of pregnancy?

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Paracetamol for short-term pain relief
• Bulk-forming laxatives like psyllium
• Topical emollients

Correct Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)

Q21. Which analgesic is generally considered the preferred first-line OTC choice in pregnancy for pain and fever?

• Paracetamol
• Ibuprofen throughout pregnancy
• Aspirin at high doses
• Diclofenac

Correct Answer: Paracetamol

Q22. Which H2-receptor antagonist is notable for many drug interactions due to CYP450 inhibition?

• Cimetidine
• Famotidine
• Ranitidine (withdrawn in many markets)
• Nizatidine

Correct Answer: Cimetidine

Q23. Which type of laxative is recommended as first-line OTC therapy for occasional constipation?

• Bulk-forming laxatives (e.g., psyllium)
• Stimulant laxatives as daily first-line
• Osmotic laxatives for children under 2 without advice
• Oil retention enemas for routine use

Correct Answer: Bulk-forming laxatives (e.g., psyllium)

Q24. Which OTC cough preparation has notable abuse potential at high doses due to NMDA receptor effects?

• Dextromethorphan
• Benzonatate
• Guaifenesin
• Saline nebulizers

Correct Answer: Dextromethorphan

Q25. Child-resistant packaging is particularly important for which OTC product due to toxicity risk?

• Iron-containing supplements
• Vitamin C chewables only
• Plain glycerin suppositories
• Saline nasal drops

Correct Answer: Iron-containing supplements

Q26. Which OTC analgesic is primarily associated with hepatotoxicity in overdose?

• Paracetamol (acetaminophen)
• Ibuprofen at therapeutic doses
• Aspirin in low-dose cardio formulations
• Naproxen at normal OTC doses

Correct Answer: Paracetamol (acetaminophen)

Q27. Where should consumers report suspected adverse drug reactions from OTC medicines?

• To the national pharmacovigilance programme or local ADR monitoring centre
• Only to the product manufacturer’s marketing team
• Never report; assume OTC drugs are safe
• Post only on social media without informing authorities

Correct Answer: To the national pharmacovigilance programme or local ADR monitoring centre

Q28. Which OTC medication should be avoided in children with viral febrile illness due to risk of Reye’s syndrome?

• Aspirin
• Paracetamol
• Oral rehydration salts
• Antihistamines like cetirizine

Correct Answer: Aspirin

Q29. A patient using OTC therapy should be referred to a physician if which of the following occurs?

• Symptoms persist or worsen after 48–72 hours of appropriate OTC use
• Minor cold symptoms improving within 24 hours
• Mild occasional heartburn relieved by antacid once
• Symptom resolution after a single dose

Correct Answer: Symptoms persist or worsen after 48–72 hours of appropriate OTC use

Q30. Which labeling element is mandatory on OTC medication packaging to ensure rational use?

• Active ingredients and their strengths
• Manufacturer’s marketing slogans only
• Unverified home remedy claims
• Only the product barcode without contents

Correct Answer: Active ingredients and their strengths

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com