Thiotepa MCQs With Answer

Thiotepa MCQs With Answer

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Thiotepa MCQs With Answer

Thiotepa is an important alkylating antineoplastic agent studied in B. Pharm pharmacology and clinical pharmacy. This concise introduction covers Thiotepa’s mechanism of action (aziridine-mediated DNA alkylation and crosslinking), key indications (ovarian, bladder, conditioning for bone marrow transplant), metabolism to active TEPA, major toxicities (dose-limiting myelosuppression, mucositis, neurotoxicity with intrathecal use), dosing principles, and handling precautions for cytotoxic drugs. These focused MCQs emphasize pharmacology, pharmacokinetics, adverse effects, monitoring, and safe handling—essential topics for B. Pharm students. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which pharmacologic class does thiotepa belong to?

  • Antimetabolite
  • Topoisomerase inhibitor
  • Aziridine alkylating agent
  • Antimicrotubule agent

Correct Answer: Aziridine alkylating agent

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

  • Inhibition of thymidylate synthase
  • Formation of aziridinium ions leading to DNA alkylation and cross-linking
  • Stabilization of microtubules preventing mitosis
  • Topoisomerase II inhibition causing DNA strand breaks

Correct Answer: Formation of aziridinium ions leading to DNA alkylation and cross-linking

Q3. Which active metabolite is mainly produced from thiotepa metabolism?

  • Carboplatin
  • TEPA (triethylenephosphoramide)
  • Cyclophosphamide
  • 4-hydroxythiotepa

Correct Answer: TEPA (triethylenephosphoramide)

Q4. What is the dose-limiting toxicity most commonly associated with thiotepa?

  • Cardiotoxicity
  • Myelosuppression
  • Severe peripheral neuropathy
  • Pulmonary fibrosis

Correct Answer: Myelosuppression

Q5. For which local therapy is thiotepa commonly used?

  • Topical for melanoma
  • Intravesical therapy for superficial bladder cancer
  • Inhalational therapy for lung cancer
  • Intra-arterial therapy for liver metastases

Correct Answer: Intravesical therapy for superficial bladder cancer

Q6. Thiotepa is frequently used as part of conditioning regimens prior to which procedure?

  • Hemodialysis
  • Bone marrow or hematopoietic stem cell transplantation
  • Cardiac transplantation
  • Orthopedic joint replacement

Correct Answer: Bone marrow or hematopoietic stem cell transplantation

Q7. Which route of administration of thiotepa is associated with a high risk of neurotoxicity?

  • Oral
  • Intramuscular
  • Intrathecal
  • Topical

Correct Answer: Intrathecal

Q8. Which laboratory test is essential to monitor before each thiotepa dose?

  • Serum amylase
  • Complete blood count (CBC)
  • Thyroid function tests
  • Fasting blood glucose

Correct Answer: Complete blood count (CBC)

Q9. Thiotepa is contraindicated in which patient population due to teratogenicity?

  • Children under 2 years
  • Pregnant women
  • Elderly over 70 years
  • Patients with controlled diabetes

Correct Answer: Pregnant women

Q10. A common molecular mechanism of tumor resistance to thiotepa is:

  • Increased drug influx into tumor cells
  • Upregulation of DNA repair pathways and glutathione-mediated detoxification
  • Enhanced activation to TEPA
  • Mutations in tubulin genes

Correct Answer: Upregulation of DNA repair pathways and glutathione-mediated detoxification

Q11. During preparation and administration of thiotepa, pharmacists should follow which precaution?

  • No special precautions are needed
  • Use cytotoxic handling precautions with appropriate PPE
  • Only wear sterile gloves without gowns
  • Prepare in open-air to ensure ventilation

Correct Answer: Use cytotoxic handling precautions with appropriate PPE

Q12. What is the primary route of elimination for thiotepa and its metabolites?

  • Renal excretion
  • Fecal excretion only
  • Exhalation via lungs
  • Sequestration in adipose tissue

Correct Answer: Renal excretion

Q13. Thiotepa is best described chemically as:

  • A platinum coordination complex
  • An anthracycline antibiotic
  • A polyfunctional aziridine alkylating agent
  • A folate antagonist

Correct Answer: A polyfunctional aziridine alkylating agent

Q14. How is thiotepa dosing typically calculated in adults?

  • Fixed dose for all patients
  • Based on body surface area (mg/m2)
  • Based on creatinine clearance only
  • By age alone

Correct Answer: Based on body surface area (mg/m2)

Q15. Which mucosal adverse effect is commonly associated with thiotepa therapy?

  • Gingival hyperplasia
  • Mucositis (oral and gastrointestinal)
  • Increased salivation
  • Taste hypersensitivity only

Correct Answer: Mucositis (oral and gastrointestinal)

Q16. Long-term survivors treated with alkylating agents like thiotepa are at increased risk of:

  • Secondary malignancies such as leukemia
  • Primary immunodeficiency syndromes
  • Genetic inheritance of cancer to offspring
  • Immediate hypersensitivity reactions only

Correct Answer: Secondary malignancies such as leukemia

Q17. Because thiotepa is metabolized hepatically, clinicians should exercise caution in patients with:

  • Severe hepatic impairment
  • Mild seasonal allergies
  • Controlled hypertension only
  • Recent history of gout

Correct Answer: Severe hepatic impairment

Q18. Which enzyme system is primarily involved in thiotepa biotransformation to active metabolites?

  • Monoamine oxidase (MAO)
  • Cytochrome P450 hepatic oxidases
  • Renal dehydrogenases
  • Pancreatic lipases

Correct Answer: Cytochrome P450 hepatic oxidases

Q19. The metabolite TEPA is pharmacologically significant because it:

  • Is an inactive detoxified product
  • Retains alkylating activity and contributes to cytotoxicity
  • Antagonizes thiotepa action
  • Is exclusively exhaled unchanged

Correct Answer: Retains alkylating activity and contributes to cytotoxicity

Q20. Thiotepa’s cytotoxic effect is considered:

  • Cell cycle phase-specific (S phase only)
  • Cell cycle phase-nonspecific
  • Specific to G2/M phase only
  • Active only during mitosis

Correct Answer: Cell cycle phase-nonspecific

Q21. Which type of DNA damage is most characteristic of thiotepa activity?

  • Singe-strand nicks without crosslinking
  • Interstrand and intrastrand DNA cross-links
  • RNA chain termination only
  • Protein-DNA crosslinks exclusively

Correct Answer: Interstrand and intrastrand DNA cross-links

Q22. Thiotepa has been used historically in the treatment of which gynecologic malignancy?

  • Cervical carcinoma only
  • Ovarian carcinoma
  • Gestational trophoblastic disease exclusively
  • Endometrial polyps

Correct Answer: Ovarian carcinoma

Q23. In case of thiotepa overdose, the most appropriate immediate management is:

  • Administration of a specific chemical antidote
  • Supportive care and symptomatic management with hematologic support as needed
  • Forced diuresis with mannitol exclusively
  • Exchange transfusion in all cases

Correct Answer: Supportive care and symptomatic management with hematologic support as needed

Q24. Thiotepa therapy can adversely affect reproductive function by causing:

  • Permanent improvement in fertility
  • Gonadal toxicity leading to infertility or reduced fertility
  • Only temporary hair loss with no effect on fertility
  • Enhanced spermatogenesis

Correct Answer: Gonadal toxicity leading to infertility or reduced fertility

Q25. Which hematologic abnormality is commonly observed during thiotepa treatment?

  • Eosinophilia only
  • Neutropenia and thrombocytopenia
  • Polycythemia
  • Isolated lymphocytosis

Correct Answer: Neutropenia and thrombocytopenia

Q26. Which administration routes are used clinically for thiotepa?

  • Topical and inhalational only
  • Intravenous and intravesical (and in select cases intrathecal/intraperitoneal)
  • Oral tablet only
  • Transdermal patch only

Correct Answer: Intravenous and intravesical (and in select cases intrathecal/intraperitoneal)

Q27. Which supportive therapy is often employed to manage thiotepa-induced neutropenia?

  • Systemic corticosteroids only
  • Colony-stimulating factors such as G-CSF
  • High-dose vitamin C infusion
  • Prophylactic antifungals as sole therapy

Correct Answer: Colony-stimulating factors such as G-CSF

Q28. At the molecular level, thiotepa most frequently alkylates which nucleophilic site on DNA?

  • 5-methylcytosine exclusively
  • N7 position of guanine
  • Ribose 2’-OH group only
  • Phosphate backbone without base modification

Correct Answer: N7 position of guanine

Q29. Besides CBC, which laboratory parameter should be monitored because thiotepa undergoes hepatic metabolism?

  • Liver function tests (LFTs)
  • Serum amylase only
  • Fasting lipid profile
  • Serum calcium exclusively

Correct Answer: Liver function tests (LFTs)

Q30. Which common nonhematologic adverse effect may patients receiving thiotepa experience?

  • Alopecia (hair loss)
  • Improved skin turgor
  • Increased appetite leading to weight gain
  • Permanent hyperpigmentation only

Correct Answer: Alopecia (hair loss)

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