Synthetic cholinergic blocking agents – Biperidine hydrochloride MCQs With Answer

Synthetic cholinergic blocking agents – Biperidine hydrochloride MCQs With Answer

Synthetic cholinergic blocking agents such as Biperiden hydrochloride are important antimuscarinic drugs studied in B.Pharm for their central and peripheral effects. Biperiden hydrochloride is a tertiary amine anticholinergic that crosses the blood–brain barrier, restores dopamine–acetylcholine balance in Parkinsonism, and treats drug‑induced extrapyramidal symptoms. Key concepts include mechanism of action, pharmacokinetics, therapeutic uses, adverse effects, contraindications, drug interactions, overdose management, and patient counseling. This concise, keyword‑rich introduction prepares you for focused learning and exam practice on anticholinergics, antimuscarinic activity, Parkinson disease therapy and EPS management. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which class best describes biperiden hydrochloride?

• Synthetic cholinergic agonist
• Synthetic cholinergic blocking agent
• Benzodiazepine derivative
• Dopamine agonist

Correct Answer: Synthetic cholinergic blocking agent

Q2. What is the primary mechanism of action of biperiden?

• Inhibition of dopamine receptors
• Activation of nicotinic receptors
• Antagonism of muscarinic acetylcholine receptors
• Stimulation of acetylcholinesterase

Correct Answer: Antagonism of muscarinic acetylcholine receptors

Q3. Biperiden is classified chemically as which type of amine?

• Quaternary ammonium
• Primary amine
• Tertiary amine
• Secondary amine

Correct Answer: Tertiary amine

Q4. A major clinical use of biperiden is:

• Treatment of acute asthma attacks
• Management of hypertension
• Treatment of Parkinsonism and drug‑induced extrapyramidal symptoms
• Antibiotic therapy for infections

Correct Answer: Treatment of Parkinsonism and drug‑induced extrapyramidal symptoms

Q5. Why does biperiden produce central effects?

• It is a quaternary ammonium that stays peripherally
• It inhibits the blood–brain barrier formation
• Being a tertiary amine, it crosses the blood–brain barrier
• It is administered directly into cerebrospinal fluid

Correct Answer: Being a tertiary amine, it crosses the blood–brain barrier

Q6. Which adverse effect is most commonly associated with biperiden?

• Excessive salivation
• Diarrhea
• Dry mouth
• Bradycardia

Correct Answer: Dry mouth

Q7. Which condition is a contraindication for biperiden therapy?

• Parkinson disease
• Closed‑angle glaucoma
• Essential tremor
• Chronic bronchitis

Correct Answer: Closed‑angle glaucoma

Q8. The preferred emergency antidote for severe anticholinergic overdose, including biperiden, is:

• Naloxone
• Flumazenil
• Physostigmine
• Atropine

Correct Answer: Physostigmine

Q9. Biperiden helps in drug‑induced acute dystonia by:

• Increasing acetylcholine release
• Blocking central muscarinic receptors to rebalance cholinergic and dopaminergic activity
• Enhancing monoamine oxidase activity
• Directly stimulating dopamine receptors

Correct Answer: Blocking central muscarinic receptors to rebalance cholinergic and dopaminergic activity

Q10. Which of the following is a likely urinary effect of biperiden?

• Increased urination due to bladder contraction
• Urinary retention due to decreased detrusor tone
• Proteinuria
• Hematuria

Correct Answer: Urinary retention due to decreased detrusor tone

Q11. Compared with quaternary antimuscarinics, tertiary amines like biperiden:

• Have less central activity
• Cannot cross lipid membranes
• Cross the blood–brain barrier more readily
• Are exclusively peripheral in action

Correct Answer: Cross the blood–brain barrier more readily

Q12. Which symptom suggests anticholinergic toxicity in a patient taking biperiden?

• Salivation and lacrimation
• Miosis and bronchospasm
• Hyperthermia, dry skin, and delirium
• Bradycardia and pinpoint pupils

Correct Answer: Hyperthermia, dry skin, and delirium

Q13. Biperiden is often compared with which other anticholinergic used in Parkinsonism?

• Levodopa
• Trihexyphenidyl (benzhexol)
• Ropinirole
• Amantadine

Correct Answer: Trihexyphenidyl (benzhexol)

Q14. A relevant drug interaction to watch for with biperiden is coadministration with:

• Other anticholinergic agents leading to additive effects
• Beta‑blockers causing increased bradycardia
• Antacids reducing its effect
• Insulin causing hypoglycemia

Correct Answer: Other anticholinergic agents leading to additive effects

Q15. Which of the following therapeutic effects is central rather than peripheral for biperiden?

• Reduction of gastrointestinal motility
• Pupil dilation (mydriasis)
• Alleviation of parkinsonian tremor
• Reduced bronchial secretions

Correct Answer: Alleviation of parkinsonian tremor

Q16. In elderly patients, biperiden use requires caution primarily because of:

• Increased risk of anticholinergic cognitive impairment and delirium
• Marked hypoglycemia
• Enhanced renal clearance
• Increased muscle mass

Correct Answer: Increased risk of anticholinergic cognitive impairment and delirium

Q17. Which clinical sign would indicate peripheral antimuscarinic action of biperiden?

• Improved gait stability
• Tachycardia and dry mouth
• Increased salivation
• Bradykinesia

Correct Answer: Tachycardia and dry mouth

Q18. The therapeutic aim of using anticholinergics like biperiden in Parkinsonism is to:

• Increase acetylcholine levels in the striatum
• Enhance GABAergic inhibition
• Reduce excessive cholinergic activity to rebalance with dopamine
• Directly replace dopamine

Correct Answer: Reduce excessive cholinergic activity to rebalance with dopamine

Q19. Which monitoring parameter is most relevant when a patient is started on biperiden?

• Serum potassium concentration
• Mental status and cognitive function
• Bone mineral density
• Thyroid function tests

Correct Answer: Mental status and cognitive function

Q20. Which symptom of Parkinsonism is least responsive to biperiden?

• Resting tremor
• Bradykinesia
• Acute dystonic reactions
• Drug‑induced EPS

Correct Answer: Bradykinesia

Q21. Which route(s) of administration are commonly used for biperiden in clinical practice?

• Oral and parenteral (IM/IV)
• Topical only
• Inhalation only
• Transdermal patch only

Correct Answer: Oral and parenteral (IM/IV)

Q22. Which of the following adverse effects can complicate hot climate exposure in patients taking biperiden?

• Excessive sweating
• Inability to sweat leading to heat intolerance
• Increased tear production
• Cold intolerance

Correct Answer: Inability to sweat leading to heat intolerance

Q23. During preclinical pharmacology, which receptor family is the primary target of biperiden?

• Nicotinic acetylcholine receptors
• Muscarinic acetylcholine receptors
• GABA receptors
• NMDA receptors

Correct Answer: Muscarinic acetylcholine receptors

Q24. A patient on biperiden reports blurry vision and difficulty focusing. This effect is due to:

• Inhibition of accommodation (cycloplegia) from muscarinic blockade
• Increased intraocular pressure by nicotinic stimulation
• Retinal detachment
• Enhanced lacrimation

Correct Answer: Inhibition of accommodation (cycloplegia) from muscarinic blockade

Q25. Which emergency presentation would raise suspicion of severe anticholinergic toxicity from biperiden?

• Coma with pinpoint pupils
• Agitation, hallucinations, hyperthermia and dry flushed skin
• Profuse sweating and bradycardia
• Hypotension with miosis

Correct Answer: Agitation, hallucinations, hyperthermia and dry flushed skin

Q26. Biperiden’s therapeutic effect in EPS is most useful for which antipsychotic‑induced condition?

• Tardive dyskinesia
• Akathisia only
• Acute dystonic reactions
• Metabolic syndrome

Correct Answer: Acute dystonic reactions

Q27. Which patient counseling point is most appropriate for biperiden?

• Increase fluid intake to reduce dry mouth and maintain hydration
• Drive and operate heavy machinery immediately until effects are known
• Expect increased sweating
• Stop medication abruptly if symptoms improve

Correct Answer: Increase fluid intake to reduce dry mouth and maintain hydration

Q28. Co‑administration of biperiden with which class of drugs may increase confusion and anticholinergic burden?

• Anticholinergic antihistamines and tricyclic antidepressants
• ACE inhibitors
• Statins
• Beta‑lactam antibiotics

Correct Answer: Anticholinergic antihistamines and tricyclic antidepressants

Q29. In patients with benign prostatic hyperplasia, biperiden may worsen:

• Urinary incontinence
• Urinary retention and obstructive symptoms
• Renal stone formation
• Urethral infection risk

Correct Answer: Urinary retention and obstructive symptoms

Q30. Which laboratory or diagnostic monitoring is specifically required for routine biperiden therapy?

• Regular ECG monitoring in all patients
• No routine specific laboratory monitoring; monitor clinical status and side effects
• Weekly liver function tests
• Frequent serum biperiden level measurements

Correct Answer: No routine specific laboratory monitoring; monitor clinical status and side effects

Q31. Biperiden’s use in paediatric patients is primarily for:

• Acute extrapyramidal reactions caused by antipsychotics
• Chronic hypertension
• Type 1 diabetes
• Viral infections

Correct Answer: Acute extrapyramidal reactions caused by antipsychotics

Q32. Which feature distinguishes central antimuscarinic effects from peripheral ones?

• Peripheral effects include delirium and confusion
• Central effects include memory impairment and agitation
• Central effects always produce diarrhea
• Peripheral effects cause hallucinations

Correct Answer: Central effects include memory impairment and agitation

Q33. Which of the following is a desirable effect of biperiden in parkinsonian patients?

• Worsening of bradykinesia
• Reduction in tremor and rigidity
• Induction of tardive dyskinesia
• Increase in drooling

Correct Answer: Reduction in tremor and rigidity

Q34. Which statement about biperiden metabolism and excretion is most accurate?

• It is not metabolized and is excreted unchanged solely via feces
• It undergoes hepatic metabolism and renal excretion of metabolites
• It is exclusively metabolized by plasma cholinesterases
• It is excreted only via pulmonary routes

Correct Answer: It undergoes hepatic metabolism and renal excretion of metabolites

Q35. A patient with narrow‑angle glaucoma accidentally receives biperiden. The most likely ocular consequence is:

• Reduction of intraocular pressure
• Precipitation or worsening of angle closure and increased intraocular pressure
• Immediate improvement in visual acuity
• Miosis and increased aqueous outflow

Correct Answer: Precipitation or worsening of angle closure and increased intraocular pressure

Q36. Which pharmacological property explains biperiden’s benefit in tremor more than bradykinesia?

• Selective dopamine receptor agonism
• Antimuscarinic reduction of cholinergic overactivity that contributes to tremor
• Enhancement of GABAergic transmission
• Peripheral sympathetic blockade

Correct Answer: Antimuscarinic reduction of cholinergic overactivity that contributes to tremor

Q37. Which cardiovascular effect is commonly associated with antimuscarinic therapy like biperiden?

• Severe bradycardia in all patients
• Tachycardia due to blockade of vagal tone
• Marked hypotension from vasodilation
• Complete AV block

Correct Answer: Tachycardia due to blockade of vagal tone

Q38. For exam preparation, which keyword combination best helps retrieve relevant resources on biperiden?

• “Beta‑blocker pharmacology biperiden”
• “Synthetic cholinergic blocking agents biperiden hydrochloride antimuscarinic Parkinsonism EPS”
• “Antibiotic resistance biperiden”
• “Insulin interactions with biperiden”

Correct Answer: “Synthetic cholinergic blocking agents biperiden hydrochloride antimuscarinic Parkinsonism EPS”

Q39. Long‑term use of anticholinergics like biperiden in elderly patients has been associated with:

• Improved cognitive function
• Increased risk of cognitive decline and dementia
• Decreased cardiovascular risk
• Enhanced renal function

Correct Answer: Increased risk of cognitive decline and dementia

Q40. Which symptom would you counsel a patient to report immediately while on biperiden?

• Mild dry mouth
• Severe urinary retention or inability to pass urine
• Occasional mild headache
• Normal bowel movements

Correct Answer: Severe urinary retention or inability to pass urine

Q41. In pharmacology exams, biperiden is an example used to illustrate:

• Cholinesterase reactivators
• Central antimuscarinic agents used in movement disorders
• Peripheral nicotinic agonists
• Monoamine oxidase inhibitors

Correct Answer: Central antimuscarinic agents used in movement disorders

Q42. Which formulation consideration is important for biperiden in acute dystonia?

• Only topical forms are effective
• Parenteral (IM/IV) administration allows rapid reversal of dystonia
• Transdermal patch gives immediate effect
• Oral sustained‑release is always preferred in emergencies

Correct Answer: Parenteral (IM/IV) administration allows rapid reversal of dystonia

Q43. Which physiological system is primarily affected by muscarinic blockade of biperiden?

• Renin‑angiotensin system
• Cholinergic parasympathetic nervous system
• Adrenergic sympathetic nervous system only
• Thyroid hormone axis

Correct Answer: Cholinergic parasympathetic nervous system

Q44. Which symptom differentiates anticholinergic delirium from opioid overdose?

• Constricted pupils and respiratory depression
• Dry, flushed skin and hallucinations seen in anticholinergic delirium
• Coma with pinpoint pupils only
• Excessive salivation and miosis

Correct Answer: Dry, flushed skin and hallucinations seen in anticholinergic delirium

Q45. Which patient group requires special caution or dose adjustment when prescribing biperiden?

• Young healthy adults with no comorbidities
• Elderly patients and those with prostatic hypertrophy or glaucoma
• Patients with acute bacterial infections
• Athletes during training

Correct Answer: Elderly patients and those with prostatic hypertrophy or glaucoma

Q46. Which clinical effect of biperiden would improve a patient’s drooling in Parkinsonism?

• Increased salivary secretion
• Reduction of salivary secretion due to muscarinic blockade
• Enhanced swallowing reflex
• Stimulation of salivary glands via nicotinic receptors

Correct Answer: Reduction of salivary secretion due to muscarinic blockade

Q47. When explaining mechanism to peers, which phrase best describes biperiden’s site of action?

• Postsynaptic muscarinic receptor antagonist in central and peripheral neurons
• Presynaptic acetylcholine release enhancer
• Postsynaptic nicotinic receptor agonist
• Direct dopamine receptor blocker

Correct Answer: Postsynaptic muscarinic receptor antagonist in central and peripheral neurons

Q48. Which sign would indicate improved therapeutic response to biperiden in Parkinsonism?

• Worsening rigidity and tremor
• Reduced tremor and decreased drooling
• Increased urinary frequency
• Development of new cognitive impairment

Correct Answer: Reduced tremor and decreased drooling

Q49. Which drug class should be used cautiously with biperiden due to additive anticholinergic effects?

• Anticholinergic antihistamines and tricyclic antidepressants
• SSRIs that have no anticholinergic activity
• Insulin and oral hypoglycemics
• Antifungals only

Correct Answer: Anticholinergic antihistamines and tricyclic antidepressants

Q50. In case studies, biperiden’s benefit in early Parkinsonism is mainly for:

• Improving gait and long‑term functional decline
• Alleviating tremor and reducing antipsychotic‑induced EPS
• Replacing levodopa therapy
• Treating autonomic neuropathy

Correct Answer: Alleviating tremor and reducing antipsychotic‑induced EPS

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