Analgesics and Anti-inflammatory Drugs Practice Questions

Q: Naloxone is the physiological antidote of which substance?

Opium. **Explanation:** **Correct Answer: D. Opium** Naloxone is a **pure opioid antagonist** that acts by competitively binding to all three opioid receptors (μ, κ, and δ), with the highest affinity for the **mu (μ) receptor**. Opium and its derivatives (morphine, heroin, codeine) exert their effects by stimulating these receptors. Naloxone rapidly displaces opioids from the receptor sites, reversing life-threatening symptoms such as respiratory depression, sedation, and miosis. It is the drug of choice for acute opioid overdose. **Analysis of Incorrect Options:** * **A. Alcohol:** While Naltrexone (a long-acting antagonist) is used to reduce cravings in chronic alcoholism, Naloxone does not reverse acute ethanol toxicity, as alcohol acts primarily on GABA receptors. * **B. Cocaine:** Cocaine is a CNS stimulant that inhibits the reuptake of dopamine and norepinephrine. There is no specific pharmacological antagonist for cocaine; management is primarily supportive (e.g., benzodiazepines). * **C. Barbiturates:** These are GABA-A receptor modulators. There is no specific antidote for barbiturate poisoning; management involves gastric lavage and urinary alkalinization. (Note: Flumazenil is the antidote for Benzodiazepines, not Barbiturates). **High-Yield Clinical Pearls for NEET-PG:** * **Route & Duration:** Naloxone has a very short half-life (approx. 60–90 mins). Since many opioids (like Methadone) last longer, **repeated dosing or IV infusion** is often required to prevent "re-narcotization." * **Diagnostic Use:** It can be used in the "Naloxone Challenge Test" to identify opioid physical dependence. * **Acute Withdrawal:** Administration in a dependent individual will precipitate an immediate and severe **withdrawal syndrome** (rhinorrhea, lacrimation, pupillary dilation, and agitation).

Q: Morphine is used in the treatment of which of the following conditions?

Acute left ventricular failure. **Explanation:** Morphine is a cornerstone in the management of **Acute Left Ventricular Failure (LVF)** and Acute Pulmonary Edema. Its therapeutic benefit is derived from its unique hemodynamic and central effects: 1. **Venodilation:** Morphine increases venous capacitance (peripheral pooling of blood), which reduces **preload**. This decreases the workload on the failing left ventricle. 2. **Arteriodilation:** It causes mild arterial dilation, reducing **afterload** and improving cardiac output. 3. **Anxiolysis:** By relieving the intense anxiety and "air hunger" (dyspnea) associated with pulmonary edema, it reduces sympathetic overactivity, further lowering myocardial oxygen demand. **Analysis of Incorrect Options:** * **A. Hypertension:** Morphine is not an antihypertensive. While it may cause a transient drop in BP due to histamine release and vasodilation, it is never used to treat chronic or acute hypertension. * **B. Cardiac Arrhythmias:** Morphine has no anti-arrhythmic properties. In fact, it can occasionally trigger bradycardia via vagal stimulation. * **D. A-V Block:** Morphine increases vagal tone, which can potentially worsen an atrioventricular (A-V) block. Atropine is the drug of choice for symptomatic bradycardia/A-V blocks. **NEET-PG High-Yield Pearls:** * **Mnemonic for LVF Management:** **LMNOP** (L-Loop diuretics, M-Morphine, N-Nitrates, O-Oxygen, P-Positioning/Pressors). * **Specific Antidote:** Naloxone is the competitive antagonist used for morphine overdose. * **Contraindications:** Avoid morphine in Head Injury (masks pupillary signs, increases ICP), Bronchial Asthma (histamine release), and Biliary Colic (causes spasm of the Sphincter of Oddi).

Q: What is the best drug for acute gout in a patient with renal impairment?

Naproxen. **Explanation:** The management of acute gout focuses on rapid pain relief and inflammation control. The first-line agents are **NSAIDs**, Colchicine, or Glucocorticoids. **Why Naproxen is correct:** Among the options provided, **Naproxen** (an NSAID) is the drug of choice for an acute attack. While all NSAIDs must be used with caution in renal impairment, they remain the standard for acute symptom control. However, in clinical practice, if renal impairment is severe (CrCl <30 ml/min), NSAIDs are generally avoided in favor of systemic or intra-articular corticosteroids. In the context of this specific MCQ, Naproxen is the only agent listed that treats the *acute* inflammatory phase. **Why the other options are incorrect:** * **Probenecid & Sulfinpyrazone:** These are **uricosuric drugs**. They are used for *chronic* gout (intercritical period) to lower uric acid levels. They are ineffective during an acute attack and are actually contraindicated in patients with renal impairment/urolithiasis as they increase the risk of uric acid stones. * **Allopurinol:** This is a **Xanthine Oxidase Inhibitor** used for *chronic* prophylaxis. Starting Allopurinol during an acute attack is contraindicated as it can fluctuate serum urate levels, potentially worsening or prolonging the acute episode. **High-Yield NEET-PG Pearls:** 1. **Drug of Choice (DOC) for Acute Gout:** NSAIDs (e.g., Indomethacin, Naproxen). 2. **DOC for Acute Gout with Renal Failure:** Corticosteroids (Prednisolone) are preferred over NSAIDs and Colchicine. 3. **Colchicine Toxicity:** Limited by GI side effects (diarrhea). It inhibits microtubule polymerization by binding to tubulin. 4. **Allopurinol Caution:** Always co-administer with low-dose NSAIDs or Colchicine when starting Allopurinol to prevent "mobilization flares."

Q: Abatacept is:

Inhibitor of co-stimulation of T cells. **Explanation:** **Mechanism of Action (Why B is correct):** Abatacept is a soluble fusion protein consisting of the extracellular domain of human **CTLA-4** linked to the modified Fc portion of human IgG1. It acts as a **selective co-stimulation modulator**. For a T-cell to become fully activated, it requires two signals: 1. The binding of the T-cell receptor to the Antigen-MHC complex. 2. A **co-stimulatory signal** involving the binding of **CD80/CD86** on antigen-presenting cells (APCs) to **CD28** on T-cells. Abatacept binds to CD80 and CD86 with high affinity, preventing them from binding to CD28, thereby inhibiting T-cell activation and the subsequent inflammatory cascade in Rheumatoid Arthritis. **Analysis of Incorrect Options:** * **Option A (TNF-α inhibitors):** These include drugs like **Etanercept** (soluble receptor), **Infliximab**, and **Adalimumab** (monoclonal antibodies). They target the cytokine TNF-α directly. * **Option C (IL-1 receptor antagonist):** This refers to **Anakinra**, which competitively inhibits the binding of IL-1 to its receptor. * **Option D (Anti-IL-6 receptor antibody):** This refers to **Tocilizumab** and **Sarilumab**, which block IL-6 signaling. **High-Yield Clinical Pearls for NEET-PG:** * **Belatacept:** A related drug (modified version of Abatacept) used primarily in **renal transplantation** to prevent graft rejection. * **Indication:** Abatacept is used in patients with moderate-to-severe Rheumatoid Arthritis who have had an inadequate response to DMARDs (like Methotrexate) or TNF inhibitors. * **Contraindication:** It should **not** be used concurrently with TNF-α inhibitors due to an increased risk of serious infections.

Q: Which of the following drugs is a selective COX-2 inhibitor?

Etoricoxib. **Explanation:** The correct answer is **Etoricoxib**. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are classified based on their selectivity for the Cyclooxygenase (COX) enzymes. COX-1 is constitutive (protective for gastric mucosa and platelets), while COX-2 is inducible (mediated by inflammation). **Etoricoxib** belongs to the "coxib" class, which are **highly selective COX-2 inhibitors**. These drugs provide potent anti-inflammatory and analgesic effects with a significantly lower risk of gastrointestinal ulcers and bleeding compared to non-selective agents. **Analysis of Incorrect Options:** * **A. Ketorolac:** A potent non-selective NSAID with a high affinity for **COX-1**. It is primarily used for short-term management of severe acute pain but carries a high risk of GI toxicity. * **C. Piroxicam:** An oxicam derivative that is a **non-selective** COX inhibitor with a long half-life. It is associated with a higher incidence of gastric side effects. * **D. Nimesulide:** Classified as a **preferential** COX-2 inhibitor (not highly selective). While it favors COX-2, it still inhibits COX-1 to some degree. **High-Yield Clinical Pearls for NEET-PG:** * **Selectivity Ratio:** Etoricoxib has the highest COX-2 selectivity among the available coxibs (Etoricoxib > Valdecoxib > Celecoxib). * **Cardiovascular Risk:** Selective COX-2 inhibitors lack anti-platelet activity (as they don't inhibit TXA2) and may shift the balance toward pro-thrombotic states, increasing the risk of myocardial infarction and stroke. * **Sulfonamide Allergy:** Celecoxib contains a sulfonamide moiety; use with caution in patients with sulfa allergies. * **Aspirin-Exacerbated Respiratory Disease (AERD):** Selective COX-2 inhibitors are generally safe in patients with "Aspirin Triad" (asthma, nasal polyps, and NSAID sensitivity).

Question 1

Naloxone is the physiological antidote of which substance?

Accepted Answer

Opium

Answer

Alcohol

Answer

Cocaine

Answer

Barbiturates

Question 2

Colchicine is:

Accepted Answer

None of the above

Answer

Analgesic

Answer

Anti-inflammatory

Answer

Uricosuric

Question 3

Less gastrointestinal bleed is seen in the following NSAID.

Accepted Answer

COX2 specific inhibitors

Answer

Meloxicam

Answer

Naproxen

Answer

Ibuprofen

Question 4

What is the DOC for acute attack of Hereditary angioneurotic edema?

Accepted Answer

C1 inhibitor concentrate

Answer

Danazol

Answer

Icatibant

Answer

Methylprednisolone

Question 5

Morphine is used in the treatment of which of the following conditions?

Accepted Answer

Acute left ventricular failure

Answer

Hypertension

Answer

Cardiac arrhythmias

Answer

A-V block

Question 6

Which drug is indicated for pain related to acute renal calculi?

Accepted Answer

Narcotic analgesics

Answer

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Answer

Muscle relaxants

Answer

Salicylates

Question 7

What is the best drug for acute gout in a patient with renal impairment?

Accepted Answer

Naproxen

Answer

Probenecid

Answer

Allopurinol

Answer

Sulfinpyrazone

Question 8

Abatacept is:

Accepted Answer

Inhibitor of co-stimulation of T cells

Answer

TNF alpha inhibitor

Answer

IL-1 receptor antagonist

Answer

Monoclonal antibody against IL-6 receptor

Question 9

Which of the following drugs is a selective COX-2 inhibitor?

Accepted Answer

Etoricoxib

Answer

Ketorolac

Answer

Piroxicam

Answer

Nimesulide

Question 10

Which of the following is a disease-modifying antirheumatic drug (DMARD)?

Accepted Answer

Penicillamine

Answer

Desferrioxamine

Answer

Succimer

Answer

Dimercaprol

Analgesics and Anti-inflammatory Drugs — MCQs

Analgesics and Anti-inflammatory Drugs — MCQs

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