Steroids – Liquorice MCQs With Answer

Steroids – Liquorice MCQs With Answer

Liquorice (Glycyrrhiza glabra) contains triterpenoid saponins such as glycyrrhizin that affect steroid metabolism and produce mineralocorticoid-like effects. For B.Pharm students, understanding the pharmacognosy, phytochemistry, pharmacology, toxicity and clinical interactions of liquorice is essential: glycyrrhizin inhibits 11β-hydroxysteroid dehydrogenase type 2, elevates cortisol activity, and can cause pseudoaldosteronism, hypokalemia, hypertension and drug interactions with diuretics, antihypertensives and steroids. These MCQs cover mechanism, structure–activity relationships, assay and standardization, therapeutic applications and safety considerations relevant to steroid pharmacology and herbal medicines. You will also encounter questions on laboratory monitoring (serum potassium, renin-aldosterone), dose-response, extraction methods and regulatory considerations for herbal preparations. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which major constituent of liquorice is primarily responsible for mineralocorticoid-like effects?

• Glycyrrhizin
• Glabridin
• Liquiritin
• Isoliquiritigenin

Correct Answer: Glycyrrhizin

Q2. Glycyrrhizin is chemically classified as which of the following?

• Triterpenoid saponin
• Flavonoid glycoside
• Alkaloid
• Steroidal hormone

Correct Answer: Triterpenoid saponin

Q3. In the gut, glycyrrhizin is metabolized to which active aglycone that inhibits 11β-HSD2?

• Glycyrrhetinic acid
• Glycyrrhizic aldehyde
• Glycyrrhizinic ester
• Glycyrrhizin sulfate

Correct Answer: Glycyrrhetinic acid

Q4. Inhibition of 11β-HSD2 by liquorice leads to increased activation of which receptor by cortisol?

• Mineralocorticoid receptor (MR)
• Androgen receptor (AR)
• Glucagon receptor
• Estrogen receptor (ER)

Correct Answer: Mineralocorticoid receptor (MR)

Q5. Which clinical triad best describes liquorice-induced pseudoaldosteronism?

• Hypertension, hypokalemia, suppressed renin
• Hypotension, hyperkalemia, elevated renin
• Bradycardia, hypernatremia, elevated aldosterone
• Fever, rash, eosinophilia

Correct Answer: Hypertension, hypokalemia, suppressed renin

Q6. Which laboratory finding is most characteristic of chronic excessive liquorice ingestion?

• Low plasma renin and low aldosterone
• High renin and high aldosterone
• High cortisol and high ACTH from pituitary adenoma
• Elevated thyroid-stimulating hormone

Correct Answer: Low plasma renin and low aldosterone

Q7. Which pharmacological intervention is most appropriate for severe hypokalemia caused by liquorice?

• Potassium supplementation and stopping liquorice
• Administer high-dose corticosteroids
• Start loop diuretics
• Increase dietary sodium

Correct Answer: Potassium supplementation and stopping liquorice

Q8. Which mineralocorticoid receptor antagonist is commonly used when stopping liquorice is insufficient?

• Spironolactone
• Hydrochlorothiazide
• Amlodipine
• Furosemide

Correct Answer: Spironolactone

Q9. Which of the following drug interactions is most likely with chronic liquorice use?

• Increased toxicity with thiazide diuretics due to hypokalemia
• Reduced effect of insulin leading to hyperglycemia
• Decreased uptake of macrolide antibiotics
• Enhanced anticoagulation with warfarin

Correct Answer: Increased toxicity with thiazide diuretics due to hypokalemia

Q10. Which analytical technique is commonly used for quantification and standardization of glycyrrhizin in herbal formulations?

• High-performance liquid chromatography (HPLC)
• Thin-layer chromatography without standards
• Flame photometry
• Simple UV-visible colorimetry without extraction

Correct Answer: High-performance liquid chromatography (HPLC)

Q11. What is a key difference between glycyrrhizin and glycyrrhetinic acid?

• Glycyrrhizin is a glycoside; glycyrrhetinic acid is its aglycone
• Glycyrrhetinic acid is a flavonoid; glycyrrhizin is an alkaloid
• Both are identical in structure and activity
• Glycyrrhizin is synthetic while glycyrrhetinic acid is natural

Correct Answer: Glycyrrhizin is a glycoside; glycyrrhetinic acid is its aglycone

Q12. Which enzyme family may be involved in herb–drug interactions with liquorice due to modulation of metabolism?

• CYP450 enzymes
• Amylases
• Proteases
• DNA polymerases

Correct Answer: CYP450 enzymes

Q13. Which patient population should be advised to avoid excessive liquorice consumption?

• Patients with uncontrolled hypertension
• Healthy young adults with no comorbidities
• Patients with lactose intolerance
• Individuals vaccinated for influenza

Correct Answer: Patients with uncontrolled hypertension

Q14. Liquorice shows anti-inflammatory effects partly by modulation of which steroid-related pathway?

• Increasing endogenous glucocorticoid activity via 11β-HSD2 inhibition
• Blocking androgen receptors directly
• Acting as a beta-adrenergic agonist
• Inhibiting acetylcholinesterase

Correct Answer: Increasing endogenous glucocorticoid activity via 11β-HSD2 inhibition

Q15. Which structural feature is typical of triterpenoid saponins like glycyrrhizin?

• Triterpene backbone linked to sugar moieties
• Simple phenolic ring without sugars
• Long-chain fatty acid esterified to glycerol
• Polypeptide chain of amino acids

Correct Answer: Triterpene backbone linked to sugar moieties

Q16. What is the expected change in serum aldosterone in liquorice-induced pseudoaldosteronism?

• Decreased aldosterone due to feedback suppression
• Markedly increased aldosterone from adrenal hyperplasia
• Unchanged aldosterone with elevated renin
• Variable increase unrelated to renin

Correct Answer: Decreased aldosterone due to feedback suppression

Q17. Which pharmacognostic test helps identify liquorice root in raw herbal material?

• Presence of characteristic yellowish-brown fracture and sweet taste due to glycyrrhizin
• Strong bitter taste and red latex exudate
• Blue fluorescence under UV only
• Production of froth on vigorous shaking absent sugars

Correct Answer: Presence of characteristic yellowish-brown fracture and sweet taste due to glycyrrhizin

Q18. Which adverse cardiac event can occur secondary to severe hypokalemia from liquorice?

• Arrhythmias, including ventricular tachycardia
• Heart block due to hypercalcemia
• Pericarditis from immune reaction
• Atrial thrombus formation directly caused by liquorice

Correct Answer: Arrhythmias, including ventricular tachycardia

Q19. Which regulatory consideration is important for liquorice-containing OTC products?

• Standardization of glycyrrhizin content and safety labeling
• Mandatory prescription-only status globally
• Prohibition of any herbal combinations
• Universal advertising claiming blood pressure benefits

Correct Answer: Standardization of glycyrrhizin content and safety labeling

Q20. Which analytical sample preparation step is important before HPLC quantification of glycyrrhizin?

• Acidic or enzymatic hydrolysis may be required to release aglycone for some assays
• Direct injection without extraction is always preferred
• Only protein precipitation is needed for solid herbal powders
• Heating to 200°C to volatilize impurities

Correct Answer: Acidic or enzymatic hydrolysis may be required to release aglycone for some assays

Q21. Which clinical manifestation suggests chronic liquorice toxicity rather than acute allergy?

• Gradual development of hypertension and muscle weakness
• Immediate urticarial rash within minutes
• Acute bronchospasm on first exposure
• Immune-mediated thrombocytopenia

Correct Answer: Gradual development of hypertension and muscle weakness

Q22. Which of these natural constituents of liquorice exhibits estrogenic or phytoestrogen-like activity?

• Glabridin
• Glycyrrhizin
• Glycyrrhetinic acid
• Starch

Correct Answer: Glabridin

Q23. Which statement about dose and duration related risk is correct?

• Prolonged ingestion of moderate amounts can produce toxicity due to accumulation
• Single small dose always causes severe pseudoaldosteronism
• Toxicity only occurs with intravenous administration
• Topical use poses equal systemic risk as oral intake

Correct Answer: Prolonged ingestion of moderate amounts can produce toxicity due to accumulation

Q24. In drug design, inhibition of 11β-HSD2 would most likely increase which endogenous hormone action?

• Cortisol acting on mineralocorticoid receptors
• Aldosterone degradation rate
• Thyroxine activation
• Insulin secretion from pancreas

Correct Answer: Cortisol acting on mineralocorticoid receptors

Q25. Which extraction solvent is commonly used to obtain glycyrrhizin-rich extracts from liquorice root?

• Water or hydroalcoholic mixtures
• Pure hexane only
• Supercritical CO2 exclusively
• Petroleum ether for polar saponins

Correct Answer: Water or hydroalcoholic mixtures

Q26. Which contraindication should be included on labels for high-glycyrrhizin products?

• Avoid use in pregnancy and uncontrolled hypertension
• Safe for unlimited use in all ages
• Must be taken with high-dose ACE inhibitors
• Use encourages simultaneous diuretic therapy

Correct Answer: Avoid use in pregnancy and uncontrolled hypertension

Q27. Which experimental model helps demonstrate 11β-HSD2 inhibition by liquorice components?

• Measuring cortisol to cortisone ratio in renal tissue incubations
• Measuring acetylcholine breakdown in muscle tissue
• Platelet aggregation assays exclusively
• Monitoring bile acid synthesis in hepatocytes only

Correct Answer: Measuring cortisol to cortisone ratio in renal tissue incubations

Q28. Which adverse electrolyte disturbance is hallmark of liquorice-induced mineralocorticoid excess?

• Hypokalemia
• Hyperkalemia
• Hyponatremia without potassium change
• Hypocalcemia only

Correct Answer: Hypokalemia

Q29. Which is a plausible reason for interindividual variability in response to oral liquorice?

• Differences in gut microbial conversion of glycyrrhizin to glycyrrhetinic acid
• Uniform absorption in all subjects regardless of microbiome
• Complete first-pass elimination in all individuals
• Identical pharmacodynamics across populations

Correct Answer: Differences in gut microbial conversion of glycyrrhizin to glycyrrhetinic acid

Q30. For pharmacy students, which preventive counseling point is most important when dispensing liquorice-containing products?

• Advise limiting intake and monitoring blood pressure and potassium
• Recommend doubling the dose if no immediate effect
• Encourage combining with other herbal diuretics for synergy
• Tell patients there are no interactions with prescription drugs

Correct Answer: Advise limiting intake and monitoring blood pressure and potassium

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