Synthetic cholinergic blocking agents – Ethopropazine hydrochloride MCQs With Answer

Synthetic cholinergic blocking agents – Ethopropazine hydrochloride MCQs With Answer
Synthetic cholinergic blocking agents like Ethopropazine hydrochloride are important antimuscarinic drugs studied in B. Pharm. This introduction covers mechanism of action, receptor selectivity (M1–M5), central versus peripheral effects, clinical uses in Parkinsonism and extrapyramidal symptoms, common adverse effects (dry mouth, blurred vision, tachycardia), contraindications (narrow-angle glaucoma, BPH), drug interactions, and antidotes for toxicity. Understanding pharmacodynamics, pharmacokinetics, dosing forms, and exam-focused facts will boost your clinical and exam readiness. Keywords: Synthetic cholinergic blocking agents, Ethopropazine hydrochloride, antimuscarinic, B. Pharm students, MCQs. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which best describes the primary mechanism of action of Ethopropazine hydrochloride?

• Inhibition of acetylcholinesterase
• Agonism at nicotinic receptors
• Competitive antagonism at muscarinic receptors
• Enhancement of dopamine release

Correct Answer: Competitive antagonism at muscarinic receptors

Q2. Ethopropazine hydrochloride is mainly used clinically for which condition?

• Hypertension
• Parkinsonism and drug-induced extrapyramidal symptoms
• Type 2 diabetes mellitus
• Congestive heart failure

Correct Answer: Parkinsonism and drug-induced extrapyramidal symptoms

Q3. Which receptor subtype is most associated with cognitive and central nervous system effects of antimuscarinic drugs?

• M2 receptor
• M3 receptor
• M1 receptor
• Nicotinic receptor

Correct Answer: M1 receptor

Q4. Which adverse effect is most commonly reported with Ethopropazine and other antimuscarinics?

• Hypersalivation
• Excessive lacrimation
• Dry mouth (xerostomia)
• Bradycardia

Correct Answer: Dry mouth (xerostomia)

Q5. Which of the following is a contraindication for using Ethopropazine hydrochloride?

• Open-angle glaucoma
• Acute narrow-angle glaucoma
• Hypothyroidism
• Pulmonary fibrosis

Correct Answer: Acute narrow-angle glaucoma

Q6. The anticholinergic side effects of Ethopropazine are due to blockade of which autonomic pathway?

• Adrenergic sympathetic postganglionic fibers
• Cholinergic parasympathetic muscarinic pathways
• Somatic motor nicotinic pathways
• Presynaptic dopaminergic neurons

Correct Answer: Cholinergic parasympathetic muscarinic pathways

Q7. Which drug is an appropriate antidote for severe anticholinergic toxicity from Ethopropazine?

• Physostigmine
• Atropine
• Propranolol
• Flumazenil

Correct Answer: Physostigmine

Q8. Ethopropazine hydrochloride as a tertiary amine primarily has which of the following pharmacokinetic properties?

• Does not cross blood–brain barrier
• Crosses blood–brain barrier producing central effects
• Is restricted to the urinary tract only
• Is exclusively exhaled unchanged

Correct Answer: Crosses blood–brain barrier producing central effects

Q9. Which clinical use is directly related to the central antimuscarinic action of Ethopropazine?

• Reduction of gastric acid secretion
• Treatment of parkinsonian tremor
• Lowering intraocular pressure
• Management of bacterial infections

Correct Answer: Treatment of parkinsonian tremor

Q10. Which urinary adverse effect may be expected in elderly patients taking Ethopropazine?

• Increased urinary flow
• Urinary retention
• Sterile pyuria
• Nephrotic syndrome

Correct Answer: Urinary retention

Q11. Which effect on the eye is caused by antimuscarinic agents like Ethopropazine?

• Miosis and decreased intraocular pressure
• Mydriasis and blurred vision due to cycloplegia
• Increased lacrimation
• Cataract formation within hours

Correct Answer: Mydriasis and blurred vision due to cycloplegia

Q12. Which patient condition requires caution when prescribing Ethopropazine?

• Benign prostatic hyperplasia (BPH)
• Iron deficiency anemia
• Viral hepatitis
• Hypogonadism

Correct Answer: Benign prostatic hyperplasia (BPH)

Q13. Ethopropazine hydrochloride belongs to which drug class?

• Synthetic cholinergic blocking agents (antimuscarinic)
• Beta-adrenergic agonists
• ACE inhibitors
• Calcium channel blockers

Correct Answer: Synthetic cholinergic blocking agents (antimuscarinic)

Q14. Compared to quaternary ammonium antimuscarinics, tertiary amines like Ethopropazine typically:

• Have no central nervous system effects
• Cross the blood–brain barrier and have central effects
• Are confined to the gastrointestinal lumen
• Are not absorbed orally

Correct Answer: Cross the blood–brain barrier and have central effects

Q15. Which of the following CNS side effects might occur with Ethopropazine?

• Excessive sedation and confusion, especially in elderly
• Improved memory and concentration
• Seizure prevention
• Enhanced motor coordination in all patients

Correct Answer: Excessive sedation and confusion, especially in elderly

Q16. Which drug interaction is important to note when Ethopropazine is prescribed?

• Synergistic anticholinergic effects with tricyclic antidepressants
• Neutral effect with aspirin
• Reduced effect with oral contraceptives
• Antagonism with H2 blockers

Correct Answer: Synergistic anticholinergic effects with tricyclic antidepressants

Q17. How does Ethopropazine affect gastrointestinal motility?

• Increases peristalsis markedly
• Decreases gastrointestinal motility causing constipation
• Specifically treats peptic ulcers by mucosal healing
• Causes profuse diarrhea

Correct Answer: Decreases gastrointestinal motility causing constipation

Q18. In treating drug-induced extrapyramidal symptoms, Ethopropazine primarily counteracts which neurotransmitter imbalance?

• Excess GABA relative to glutamate
• Excess dopamine relative to acetylcholine
• Relative acetylcholine excess compared to dopamine
• Excess serotonin relative to norepinephrine

Correct Answer: Relative acetylcholine excess compared to dopamine

Q19. Which monitoring parameter is most relevant during Ethopropazine therapy in elderly patients?

• Serum potassium levels
• Cognitive function and confusion
• Fasting blood glucose
• Bone mineral density

Correct Answer: Cognitive function and confusion

Q20. The HCl (hydrochloride) salt form of Ethopropazine is used because it:

• Increases lipid solubility drastically
• Improves water solubility and stability for dosing
• Makes the drug inactive until metabolized
• Prevents absorption from the gut

Correct Answer: Improves water solubility and stability for dosing

Q21. During anticholinergic overdose, which sign is most characteristic?

• Salivation and miosis
• Hot, dry skin and hyperthermia
• Profuse sweating and bradycardia
• Excessive lacrimation and rhinorrhea

Correct Answer: Hot, dry skin and hyperthermia

Q22. Which of the following is NOT a typical peripheral antimuscarinic effect?

• Decreased bronchial secretions
• Bronchodilation
• Increased gastrointestinal secretions
• Reduced salivary secretion

Correct Answer: Increased gastrointestinal secretions

Q23. In B. Pharm pharmacology exams, Ethopropazine questions often focus on its role in:

• Anticoagulation therapy
• Management of extrapyramidal side effects and tremor control
• Antiviral therapy optimization
• Insulin sensitization

Correct Answer: Management of extrapyramidal side effects and tremor control

Q24. Which physiological parameter typically increases following antimuscarinic administration?

• Gastric motility
• Heart rate (tachycardia)
• Salivary secretions
• Pupillary constriction

Correct Answer: Heart rate (tachycardia)

Q25. For exam-focused pharmacology, which statement about Ethopropazine metabolism is safest to remember?

• It is excreted unchanged exclusively via lungs
• It undergoes hepatic metabolism and renal elimination of metabolites
• It is stored intact in adipose tissue for years
• It is converted into active atropine in the gut

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

Q26. Which symptom indicates central anticholinergic toxicity rather than peripheral?

• Dry mouth
• Confusion and hallucinations
• Tachycardia
• Decreased sweating

Correct Answer: Confusion and hallucinations

Q27. Ethopropazine should be used with extreme caution in patients with which cardiac condition?

• Bradyarrhythmias and tachyarrhythmia predisposition
• Stable sinus rhythm without symptoms
• Mild mitral valve prolapse only
• Asymptomatic benign PVCs without therapy

Correct Answer: Bradyarrhythmias and tachyarrhythmia predisposition

Q28. Which laboratory or clinical monitoring is most helpful when initiating Ethopropazine in elderly patients?

• Visual acuity and intraocular pressure checks
• Liver enzyme monitoring every day
• Daily blood cultures
• Monthly bone density scans

Correct Answer: Visual acuity and intraocular pressure checks

Q29. Which property makes a drug more likely to produce central anticholinergic effects?

• Low lipid solubility and high ionization
• High lipid solubility and tertiary amine structure
• Being a quaternary ammonium compound
• Exclusive renal excretion without metabolism

Correct Answer: High lipid solubility and tertiary amine structure

Q30. Which class of drugs can potentiate anticholinergic adverse effects when combined with Ethopropazine?

• Cholinesterase inhibitors like neostigmine
• Tricyclic antidepressants and antihistamines
• Beta blockers alone
• Topical antivirals

Correct Answer: Tricyclic antidepressants and antihistamines

Q31. In the context of pharmacology exams, Ethopropazine is best categorized as:

• Direct cholinergic agonist
• Antimuscarinic agent
• Acetylcholinesterase reactivator
• Alpha-adrenergic antagonist

Correct Answer: Antimuscarinic agent

Q32. Which symptom would most likely require immediate discontinuation of Ethopropazine?

• Mild dry mouth
• Acute urinary retention with bladder distension
• Slight constipation for one day
• Transient mild dizziness

Correct Answer: Acute urinary retention with bladder distension

Q33. For B. Pharm practical exams, which formulation detail about Ethopropazine HCl is important?

• HCl salt improves palatability but is not used clinically
• HCl salt increases water solubility making oral dosing feasible
• HCl form is only used for topical ophthalmic injections
• It is always administered via inhalation as dry powder

Correct Answer: HCl salt increases water solubility making oral dosing feasible

Q34. Which of the following best explains why Ethopropazine reduces tremor in Parkinsonism?

• It increases peripheral acetylcholine release
• It reduces central cholinergic activity restoring dopaminergic balance
• It directly stimulates dopamine receptors
• It acts as an MAO-B inhibitor

Correct Answer: It reduces central cholinergic activity restoring dopaminergic balance

Q35. Which of the following is a typical effect of antimuscarinic therapy on respiratory secretions?

• Increased secretions leading to bronchospasm
• Decreased secretions and drier airways
• No change in secretion volume
• Immediate allergic bronchorrhea

Correct Answer: Decreased secretions and drier airways

Q36. Which patient history would make you avoid Ethopropazine?

• History of chronic narrow-angle glaucoma
• History of seasonal allergies managed with antihistamines
• History of healed peptic ulcer years ago
• History of childhood asthma resolved in adolescence

Correct Answer: History of chronic narrow-angle glaucoma

Q37. Which sign differentiates anticholinergic toxicity from sympathomimetic toxicity?

• Presence of diaphoresis (sweating)
• Hot, dry skin suggests anticholinergic toxicity; sweating suggests sympathomimetic
• Both conditions have miosis always
• Hypothermia indicates anticholinergic poisoning

Correct Answer: Hot, dry skin suggests anticholinergic toxicity; sweating suggests sympathomimetic

Q38. In drug interaction terms, Ethopropazine may reduce the effectiveness of which of the following?

• Anticholinesterase drugs used in myasthenia gravis
• Proton pump inhibitors
• Topical antifungals
• Statins for hyperlipidemia

Correct Answer: Anticholinesterase drugs used in myasthenia gravis

Q39. Which dose-related caution is important when prescribing Ethopropazine?

• Start high to ensure efficacy quickly
• Start low and titrate cautiously, especially in elderly
• No titration necessary for any age group
• Administer only as a single lifetime dose

Correct Answer: Start low and titrate cautiously, especially in elderly

Q40. Which of the following is an example of a peripheral quaternary antimuscarinic often contrasted with tertiary agents like Ethopropazine?

• Atropine
• Ipratropium
• Trihexyphenidyl
• Ethopropazine itself

Correct Answer: Ipratropium

Q41. Which neurotransmitter imbalance is targeted indirectly by Ethopropazine in Parkinson’s disease?

• Decrease in norepinephrine causing tremor
• Excess acetylcholine relative to dopamine in basal ganglia
• Excess serotonin causing rigidity
• Deficiency of glutamate in motor cortex

Correct Answer: Excess acetylcholine relative to dopamine in basal ganglia

Q42. For exams, which mnemonic is helpful to remember anticholinergic side effects related to Ethopropazine?

• SLUDGE: Salivation, Lacrimation, Urination, Diarrhea, GI upset, Emesis
• Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter
• ABC: Airway, Breathing, Circulation
• FAST: Face, Arms, Speech, Time

Correct Answer: Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter

Q43. Which strategy reduces anticholinergic burden when multiple meds cause antimuscarinic effects?

• Add a second anticholinergic to offset side effects
• Review medications and deprescribe nonessential anticholinergic agents
• Increase dose of Ethopropazine to overcome interactions
• Avoid monitoring for side effects

Correct Answer: Review medications and deprescribe nonessential anticholinergic agents

Q44. Which sign on clinical examination would prompt immediate assessment for anticholinergic toxicity?

• Excessive sweating and bradycardia
• Hyperthermia, flushed skin, severe agitation
• Clear lungs and calm demeanor
• Hypersalivation and pinpoint pupils

Correct Answer: Hyperthermia, flushed skin, severe agitation

Q45. Which statement about Ethopropazine dosing in pregnancy is most appropriate for B. Pharm knowledge?

• Consider safety profile and use only if benefit outweighs risk; consult guidelines
• Guaranteed safe and recommended in all trimesters
• Contraindicated in all pregnant women without exception
• No data needed; over-the-counter use is ideal

Correct Answer: Consider safety profile and use only if benefit outweighs risk; consult guidelines

Q46. Which exam-focused statement about Ethopropazine’s therapeutic index is accurate?

• It has a wide therapeutic index with no toxicity concerns
• It has a relatively narrow therapeutic window; monitor for toxicity
• It is lethal at any dose
• Therapeutic index is irrelevant for antimuscarinics

Correct Answer: It has a relatively narrow therapeutic window; monitor for toxicity

Q47. Which patient education point is important when dispensing Ethopropazine?

• Expect increased salivation and sweating
• Avoid driving if feeling drowsy or confused due to central effects
• Take with bulky meals to enhance absorption
• Stop other medications without consulting prescriber

Correct Answer: Avoid driving if feeling drowsy or confused due to central effects

Q48. Which diagnostic test is directly used to confirm anticholinergic toxicity?

• Serum acetylcholine level
• Clinical diagnosis based on signs and history
• Complete blood count is diagnostic
• Spirometry exclusively confirms toxicity

Correct Answer: Clinical diagnosis based on signs and history

Q49. In therapeutic comparison, Ethopropazine differs from levodopa in that it primarily:

• Restores dopamine synthesis directly
• Reduces cholinergic overactivity rather than increasing dopamine
• Acts as a monoamine oxidase inhibitor
• Is a dopamine agonist at D2 receptors

Correct Answer: Reduces cholinergic overactivity rather than increasing dopamine

Q50. For exam preparations, which quick contraindication summary is correct for Ethopropazine?

• Safe in narrow-angle glaucoma and obstructive uropathy
• Contraindicated in narrow-angle glaucoma and untreated prostate hypertrophy
• Always preferred in patients with urinary retention
• Has no contraindications and is safe in all populations

Correct Answer: Contraindicated in narrow-angle glaucoma and untreated prostate hypertrophy

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