Block 10 Antiinflammatory Drugs MCQ's
Questions and Answers
- 1.
A 42-year-old woman has been recovering from the surgical removal of a breast cancer. Since postoperative pain is severe the physician prescribed an IV injection of Ketorolac. Which of the following statements best explains the reason of the analgesic effect of the drug in this patient?
- A.
Binding of the drug to prostaglandin receptors in the surgical area
- B.
Decreased concentration of prostaglandins in the surgical area
- C.
Decreased oxygen radical production in the surgical area
- D.
Inhibition of prostaglandins biosynthesis in the hypothalamus
- E.
Lowering of anxiety, fear and suffering evoked by pain
Correct Answer
B. Decreased concentration of prostaglandins in the surgical areaExplanation
The analgesic effect of Ketorolac in this patient can be explained by the decreased concentration of prostaglandins in the surgical area. Prostaglandins are known to be involved in the inflammatory response and sensitization of pain receptors. By decreasing the concentration of prostaglandins, Ketorolac reduces inflammation and pain at the surgical site, providing relief for the patient.Rate this question:
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- 2.
A 2-year-old boy was brought to the emergency room by his parents who stated that the boy had ingested some aspirin tablets. The parents were sure that the number of tablets taken by their son was no more than 6. The boy was drowsy, was complaining of stomach ache and exhibited a pronounced hyperpnea. Laboratory exams were ordered. Most likely the data would show which of the following results?
- A.
Increased pH, decreased PC02, and decreased bicarbonate
- B.
Decreased pH, increased PC02, and increased bicarbonate
- C.
Increased pH, increased PC02, and increased bicarbonate
- D.
Decreased pH, decreased PC02, and decreased bicarbonate
- E.
Decreased pH, increased PC02, and decreased bicarbonate
Correct Answer
A. Increased pH, decreased PC02, and decreased bicarbonateExplanation
The symptoms described, including drowsiness, stomach ache, and pronounced hyperpnea, suggest that the boy may be experiencing respiratory alkalosis. This is characterized by increased pH, decreased PCO2 (partial pressure of carbon dioxide), and decreased bicarbonate levels in the blood. Aspirin overdose can lead to metabolic acidosis, which is characterized by decreased pH, increased PCO2, and increased bicarbonate levels. Therefore, the most likely result of the laboratory exams would be increased pH, decreased PCO2, and decreased bicarbonate levels.Rate this question:
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- 3.
A 68-year-old man suffering from chronic urticaria presented with fever (103 F) and syrnptorns.suqqestive of influenza. Past history of the patient included an episode of angioedema at the age of 63, apparently due to a hypersensitivity reaction to aspirin, and a myocardial infarction at the age of 65. Which of the following would be an appropriate antipyretic drug for this patient?
- A.
Indomethacin
- B.
Ibuprofen
- C.
Acetaminophen
- D.
Piroxicam
- E.
Ketorolac
Correct Answer
C. AcetaminopHenExplanation
Acetaminophen would be an appropriate antipyretic drug for this patient because it is a non-steroidal anti-inflammatory drug (NSAID) that does not inhibit cyclooxygenase-1 (COX-1) or cyclooxygenase-2 (COX-2). This is important for this patient because he has a history of angioedema due to a hypersensitivity reaction to aspirin, which is an NSAID that inhibits both COX-1 and COX-2. Acetaminophen does not have the same inhibitory effects on COX enzymes and is therefore a safer choice for this patient.Rate this question:
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- 4.
Which of the following statements best explains the mechanism of the antipyretic effect of NSAIDs?
- A.
Inhibition of prostaglandin biosynthesis in peripheral tissues
- B.
Decreased interleukin concentration in the hypothalamus
- C.
Blockade of oxidative phosphorylation in skeletal muscle
- D.
Inhibition of prostaglandin biosynthesis in the hypothalamus
- E.
Blockade of prostaglandin receptors in the hypothalamus
Correct Answer
D. Inhibition of prostaglandin biosynthesis in the hypothalamus -
- 5.
A 45-year-old woman was found to have a plasma urate levels of 13 mg/dl and 800 mg/24 hrs of uric acid in her urine, during a routine checkup. She started an appropriate treatment and three weeks later her plasma urate levels were 7.2 mg/dL and the urinary uric acid level 530 mg/24 hrs. Which of the following drugs was most likely prescribed?
- A.
Probenecid
- B.
Aspirin
- C.
Furosem ide
- D.
Allopurinol
- E.
Indomethacin
- F.
Naproxen
Correct Answer
D. AllopurinolExplanation
Allopurinol is the most likely drug prescribed in this case. Allopurinol is a medication used to treat high levels of uric acid in the blood, which can lead to gout or kidney stones. It works by inhibiting the production of uric acid in the body. The decrease in plasma urate levels and urinary uric acid levels after three weeks of treatment suggests that the medication is effectively reducing uric acid levels in the patient.Rate this question:
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- 6.
A 42 year old woman developed severe arthritic pain in her knees. Which one of the followinq drugs would likely be the most effective in the relief of her pain?
- A.
Ketorolac
- B.
Indomethacin
- C.
Aspirin
- D.
Ibuprofen
Correct Answer
A. KetorolacExplanation
Ketorolac would likely be the most effective in the relief of her pain because it is a nonsteroidal anti-inflammatory drug (NSAID) that is known for its strong analgesic properties. It is often used for short-term management of moderate to severe pain, such as postoperative pain or pain due to musculoskeletal conditions. Ketorolac works by inhibiting the production of prostaglandins, which are substances in the body that cause pain and inflammation. By reducing the levels of prostaglandins, ketorolac can effectively alleviate pain in conditions such as severe arthritic pain in the knees.Rate this question:
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- 7.
A 32 year old man is given a short course of prednisone for asthma. What is the primary mechanism of action of prednisone?
- A.
Alteration of gene expression
- B.
Direct inhibition of the COX enzymes
- C.
Direct inhibition of phospholipase A2
- D.
Blockade of LT release
Correct Answer
A. Alteration of gene expressionExplanation
Prednisone is a corticosteroid that acts by altering gene expression. It enters the cells and binds to glucocorticoid receptors, leading to the activation or repression of specific genes. This modulation of gene expression results in various anti-inflammatory and immunosuppressive effects, which are beneficial in the treatment of asthma. Prednisone does not directly inhibit COX enzymes or phospholipase A2, nor does it block LT release.Rate this question:
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- 8.
A 44 -year-old woman complains of severe pain and swelling of both the knee joints. History reveals she also had similar swelling of small joints in both hand and feet. She is also suffering from gastric ulcer. Which of the following anti-inflammatory drug is ideal to treat her symptoms?
- A.
Colchicine
- B.
Ibuprofen
- C.
Ketorolac
- D.
Celecoxib
Correct Answer
D. CelecoxibExplanation
Celecoxib is the ideal anti-inflammatory drug to treat the symptoms of the 44-year-old woman. This is because she is also suffering from gastric ulcer, and celecoxib is a selective COX-2 inhibitor that is less likely to cause gastrointestinal side effects compared to other nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and ketorolac. Colchicine is primarily used to treat gout and does not specifically target inflammation in the joints.Rate this question:
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- 9.
62-year-old woman with a history of past myocardial infarction is taking 81 mg of aspirin daily. She complains of passing black colored stools. She isnot on any other drugs. On examination she was found to have petechia, hemorrhage and anemia. These signs and symptoms can be attributed to:
- A.
Inhibition of Platelet synthesis
- B.
Prolonged inh ibition of COX-l
- C.
Irreversible inhibition of COX-2
- D.
Reversible inhibition of COX-l
Correct Answer
B. Prolonged inh ibition of COX-lExplanation
The signs and symptoms described, such as petechia, hemorrhage, and anemia, suggest that the patient is experiencing gastrointestinal bleeding. This is a known side effect of prolonged inhibition of COX-1, which is the enzyme responsible for the production of prostaglandins that protect the stomach lining. Aspirin, at a low dose of 81 mg, acts as an irreversible inhibitor of COX-1, leading to a decreased production of prostaglandins and an increased risk of gastric bleeding.Rate this question:
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- 10.
A 67 -year-old woman is brought to the emergency room in a mentally confused state. The patient displays a respiratory rate of 32/min, profuse sweating, and intermittent vomiting. Her daughter tells the attending physician that her mother was complaining about dizziness and ringing ears earlier that day. The patient's history reveals that she has been heavily self-medicating for the past several days with an over-the-counter analgesic; (which she has used for years) in order to reduce the pain associated with her rheumatoid arthritis. Which of the following drug adverse effects is the woman most likely suffering from?
- A.
Salicylate-related GI toxicity
- B.
Reye's Syndrome
- C.
Analgesic Nephropathy
- D.
SaIicylate Hypersensitivity
- E.
Salicylism
Correct Answer
E. SalicylismExplanation
The patient is experiencing symptoms of salicylism, which is an adverse effect of salicylates. Salicylates are found in over-the-counter analgesics, such as aspirin, which the patient has been heavily self-medicating with. The symptoms of salicylism include mental confusion, respiratory rate changes, sweating, vomiting, dizziness, and tinnitus (ringing ears). Salicylism occurs due to the accumulation of salicylates in the body, leading to toxic levels. This is the most likely explanation for the patient's symptoms in this case.Rate this question:
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- 11.
A 37-year-old woman is scheduled to have an impacted wisdom tooth removed. On the day of the surgery, the patient tells the dentist that she has been taking an analgesic agent for the past 3 days to relieve the pain resulting from a recent sprained ankle. The dentist promptly reschedules the surgery 8 days later and tells the patient to stop taking that particular agent. Which drug was the patient most likely taking?
- A.
Ibuprofen
- B.
Acetaminophen
- C.
Aspirin
- D.
Meloxicam
- E.
Naproxen
Correct Answer
C. AspirinExplanation
Aspirin is the most likely drug that the patient was taking. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that is commonly used as an analgesic and anti-inflammatory agent. However, it can increase the risk of bleeding due to its antiplatelet effects. Since the patient is scheduled to have a tooth extraction surgery, which can cause bleeding, the dentist reschedules the surgery and advises the patient to stop taking aspirin to minimize the risk of excessive bleeding during the procedure.Rate this question:
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- 12.
An 8-year-old boy presented with fever (103°F), general malaise and the characteristic rash of measles infection. Past medical history of the patient included an episode of hemolytic anemia, most probably related to his congenital deficiency of RBC glutathione synthase. Which of the following drugs would be a suitable antipyretic for this boy?
- A.
Aspirin
- B.
Indomethacin
- C.
Acetaminophen
- D.
Ibuprofen
- E.
Prednisone
Correct Answer
D. IbuprofenExplanation
Ibuprofen has been approved for use as an antipyretic in children and is currently available over the counter. All NSAIDs have antipyretic activity and therefore the initial choice is often based on specific patient related contraindications. Aspirin is contraindicated because of the risk of Reye’s syndrome. Indomethacin is not indicated for general use as an antipyretic because of its toxicity. Normally, acetaminophen would be an appropriate choice, but it is contraindicated in this patient because of his congenital deficiency of RBC glutathione synthase. Acetaminophen is partially metabolized to NAPQI which is rapidly conjugated with glutathione. If glutathione stores are deficient, the metabolite reacts with hepatic bio-macromolecules, resulting in hepatotoxicity. Patients with a congenital deficiency of glutathione synthase are therefore at increased risk of acetaminophen toxicity. Prednisone is not used as an antipyretic.Rate this question:
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- 13.
A 75-year-old man complains of a dull, continuous bone pain which has been increasing during the past few days. The patient has been suffering from a prostatic carcinoma for two years. Past history of the patient is significant for an episode of hemolytic anemia, which was ascribed to his congenital G6PD deficiency, and erythema multiforme, apparently due to an allergic reaction to naproxen. Which of the following would be an appropriate analgesic drug for this patient?
- A.
Aspirin
- B.
Acetaminophen
- C.
Piroxicam
- D.
Ibuprofen
- E.
Oxaprozin
Correct Answer
C. PiroxicamExplanation
The symptoms and the history of the patient suggest that the pain is caused by bone metastases that are the most frequent metastases in cases of prostatic carcinoma. Osseous metastases induce an inflammatory reaction with the production of prostaglandins that may cause osteolysis and sensitize free nerve endings, thereby augmenting pain perception. The NSAIDs effectively decrease prostaglandin and endoperoxide production and therefore can be useful for an initial treatment of metastatic bone pain. Piroxicam is a long-acting, nonselective competitive inhibitor of COX enzymes that also inhibits polymorphonuclear cell migration and decreases oxygen radical production. Likely all NSAIDs would be useful, and the superiority of any particular drug for a particular patient cannot be predicted. Therefore the initial choice is often based on specific patient related contraindications. Aspirin is contraindicated because of his congenital G6PD deficiency (salicylates can cause hemolytic anemia in patients with this deficiency). Acetaminophen is a very weak inhibitor of COX enzymes in the periphery and in the presence of a high concentration of peroxide which is often found in inflammatory lesions. All propionic acid derivatives (including ibuprofen and oxaprozin) are contraindicated because of the serious allergic reaction to naproxen.Rate this question:
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- 14.
A 44-year-old woman suffering from Crohn’s’ disease had been receiving high doses of oral prednisone to treat an acute stage of the disease. Which of the following actions most likely contributed to the therapeutic effect of the drug in this patient?
- A.
Increased catabolism of prostaglandins
- B.
Decreased number of circulating neutrophils
- C.
Increased proliferation of T-cells
- D.
Increased activation of complement system
- E.
Inhibition of lymphocyte-mediated production of interleukin-2
Correct Answer
E. Inhibition of lympHocyte-mediated production of interleukin-2Explanation
Crohn’s disease is a chronic inflammatory bowel disease of unknown origin. The anti-inflammatory effect of glucocorticoids, which may dramatically reduce fever, diarrhea, and abdominal pain in the acute stage of the disease, is due to many actions, including inhibition of lymphocyte-mediated production of interleukin-2. This cytokine induces proliferation of B- and T-cells (including cytotoxic T-cells) and activation of natural killer cells and lymphokine-activated killer cells, and therefore it plays a main role in inflammatory processes. A is incorrect because glucocorticoids have no effect on the metabolism of prostaglandins. B, C, and D are incorrect because glucocorticoids have the opposite effect to those listed.Rate this question:
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- 15.
A 62-year-old man who was being treated chronically for polyarteritis nodosa (inflammatory condition of blood vessels), complained of epigastric distress, muscle weakness, hypertension, and oral candidiasis. Laboratory values showed fasting blood glucose of 155 mg/dL and blood urea nitrogen of 40 mg/dL. Which of the following drugs most likely caused the patient’s symptoms and signs?
- A.
Prednisone
- B.
Ketoconazole
- C.
Naproxen
- D.
Acetaminophen
- E.
Indomethacin
- F.
Ibuprofen
Correct Answer
A. PrednisoneExplanation
The symptoms and signs of the patient indicate that he is suffering from many adverse effects due to chronic treatment with a glucocorticoid, like prednisone. Polyarteritis nodosa is a connective tissue disorder of unknown cause which is usually treated with high doses of glucocorticoids. Chronic treatment with these drugs can cause epigastric distress (because of increased peptic acid secretions and inhibition of prostaglandin synthesis), muscle weakness (because of potassium wasting), hypertension (mechanisms still uncertain), and candidiasis (because of the anti-inflammatory effect that increase the probability of opportunistic infections). These drugs can cause hyperglycemia (due to increased gluconeogenesis, decreased glucose utilization, and increased glucagon secretion), and increased blood urea nitrogen (due to protein wasting). These other drugs do not cause the syndrome presented by the patient and are not currently used in the therapy of polyarteritis nodosa.Rate this question:
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- 16.
A 49-year-old alcoholic woman, brought to the emergency room by her husband, was disoriented, combative and complained of headache, vertigo, and "ringing in my ears". The husband stated that she recently said she wanted to commit suicide. Vital signs were: Temperature 104°F Pulse 108 bpm Respirations 6/min Blood pressure 85/60 mm Hg Pertinent lab data on admission were: Arterial blood pH 7.25 Creatinine 2.2 mg/dL Bicarbonate 18 mEq/L Glucose 170 mg/dL Arterial blood gases on room air were: Pco2 48 mm Hg Po2 70 mm Hg Which of the following drugs most likely caused this poisoning?
- A.
Ethanol
- B.
Aspirin
- C.
Ketorolac
- D.
Ibuprofen
- E.
Celecoxib
Correct Answer
B. AspirinExplanation
The patient’s marked hyperthermia and respiratory depression suggest severe poisoning by salicylates. This is supported by the lab results indicating mixed respiratory and metabolic acidosis (low pH, increased Pco2 and decreased plasma bicarbonate content). This acid-base disturbance is typical of high salicylate content in the blood. In salicylate poisoning, the initial event (when salicylate concentration in blood is not yet high) is respiratory alkalosis caused by salicylate-induced stimulation of the respiratory center. Partial compensation is achieved, as usual, by increased renal excretion of bicarbonate. Therefore the initial phase of poisoning (or when the poisoning is mild) is characterized by high pH, and decreased plasma levels of CO2 and bicarbonate. In a later phase, when salicylate blood levels become quite high, the respiratory center becomes depressed and respiratory acidosis supervenes. This acidosis is uncompensated since a significant amount of bicarbonate has been already eliminated. Moreover, salicylates cause uncoupling of mitochondrial oxidative phosphorylation (which leads to hyperthermia) and inhibits the enzymes of Krebs cycle, resulting in increased pyruvic and lactic acids. Lipolysis, gluconeogenesis, and glycolysis are also stimulated, leading to hyperglycemia and the production of keto acids. Therefore the final picture is the one of mixed respiratory and metabolic acidosis. Acute alcohol poisoning can cause combative behavior, but hypothermia and hypoglycemia are typical signs of alcohol poisoning and tinnitus is usually absent. Poisoning by NSAIDs other than salicylates does not usually cause profound impairment of acid-base balance.Rate this question:
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- 17.
A 50-year-old man with a history of past myocardial infarction (MI) on aspirin, atenolol, and atorvastatin presents with pain in the knee joints. He is a diabetic controlled by diet and exercise. He is diagnosed with osteoarthritis and prescribed ibuprofen. What is a cause for concern with regard to ibuprofen prescription in this patient?
- A.
Ibuprofen increases the risk of hyperglycemia.
- B.
His age is inappropriate to prescribe ibuprofen
- C.
Ibuprofen reduces aspirin's cardioprotective benefits
- D.
Ibuprofen decreases atorvastatin's hypocholesterolemic effects.
- E.
Ibuprofen is ineffective in treating osteoarthrits.
Correct Answer
C. Ibuprofen reduces aspirin's cardioprotective benefitsExplanation
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which when used concomitantly with aspirin, may reduce the latter's cardioprotective effect. Ibuprofen has been shown to inhibit the irreversible platelet inhibition brought about by aspirin. A clinically and statistically significant increase in the risk of mortality in persons using ibuprofen and aspirin compared to those using ibuprofen alone has been noted.
It is recommended that ibuprofen not be prescribed for the long term in patients on aspirin. Another strategy is to ingest aspirin 2 hours before ibuprofen.
Ibuprofen has not been shown to cause hyperglycemia or interact with atorvastatin.
The greater risk of gastrointestinal complications should be borne in mind Mille prescribing NSAIDS in persons aged 65 years or more.
Ibuprofen is one of the NSAIDs effective in osteoarthritis.Rate this question:
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Mar 22, 2023Quiz Edited by
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Jun 15, 2012Quiz Created by
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