Analgesics and Anti-inflammatory Drugs Practice Questions

Q: A patient presents with an acute gout attack. Which medication is contraindicated in the acute setting due to the risk of exacerbating the attack?

Allopurinol. ***Allopurinol*** - Initiating or increasing the dose of **allopurinol** during an acute gout attack can precipitate or worsen the attack. - Allopurinol is a **urate-lowering therapy** that mobilizes uric acid from tissues, potentially leading to a transient increase in serum uric acid during initiation. *Colchicine* - **Colchicine** is a first-line treatment for acute gout attacks, especially when started within 24-36 hours of symptom onset. - It works by inhibiting neutrophil migration and activation, reducing the inflammatory response to uric acid crystals. *Indomethacin* - **Indomethacin** is a non-steroidal anti-inflammatory drug (NSAID) commonly used to treat the acute pain and inflammation of a gout attack. - It rapidly reduces inflammation by inhibiting prostaglandin synthesis, providing symptomatic relief. *Prednisone* - **Prednisone**, a corticosteroid, is effective in treating acute gout attacks, particularly when NSAIDs or colchicine are contraindicated or ineffective. - It powerfully suppresses the inflammatory response, quickly resolving the pain and swelling associated with gout flares.

Q: A patient presents with gouty arthritis. Which drug inhibits the enzyme xanthine oxidase to lower uric acid levels?

Allopurinol. ***Allopurinol*** - **Allopurinol** is a **xanthine oxidase inhibitor** that blocks the conversion of hypoxanthine and xanthine to uric acid [1, 2]. - It is used for the **long-term management** of hyperuricemia in patients with gout [1, 2]. *Colchicine* - **Colchicine** is an **anti-inflammatory agent** that inhibits neutrophil chemotaxis and activation. - It is primarily used for the **acute treatment** of gout flares and **prophylaxis** against recurrent attacks [2, 3], but it does not lower uric acid levels. *Indomethacin* - **Indomethacin** is a **nonsteroidal anti-inflammatory drug (NSAID)** that inhibits prostaglandin synthesis. - It is commonly used for **acute pain relief and inflammation** during a gout attack [2] but does not affect uric acid production. *Probenecid* - **Probenecid** is a **uricosuric agent** that inhibits the reabsorption of uric acid in the renal tubules. - It increases the **excretion of uric acid** and is used in patients who underexcrete uric acid [2], but it does not inhibit xanthine oxidase.

Q: What is the best antagonist of morphine?

Naloxone. ***Naloxone*** - **Naloxone** is a pure opioid antagonist with a high affinity for **mu-opioid receptors**, making it the most effective antidote for morphine overdose. - It rapidly reverses the effects of opioid agonists like morphine, including **respiratory depression** and sedation. *Pentazocine* - **Pentazocine** is an opioid agonist-antagonist, meaning it can produce both opioid effects and opioid reversal, but it is not a pure antagonist. - It has a risk of precipitating **opioid withdrawal** in opioid-dependent individuals and is not the first-line choice for reversing overdose. *Buprenorphine* - **Buprenorphine** is a partial mu-opioid agonist and kappa-opioid antagonist, also known as an agonist-antagonist. - While it has some antagonistic properties, its partial agonistic activity means it can still produce opioid effects and is not ideal for rapid reversal of full opioid agonists. *Nalorphine* - **Nalorphine** is an older opioid antagonist with mixed agonist-antagonist properties, similar to pentazocine. - It is less potent and has fallen out of favor compared to naloxone for reversing opioid overdose due to its own potential for **respiratory depression** and psychotomimetic effects.

Q: Which class of drugs inhibits the cyclooxygenase (COX) enzyme, thereby reducing prostaglandin synthesis and inflammation in conditions such as arthritis?

Nonsteroidal anti-inflammatory drugs. ***Nonsteroidal anti-inflammatory drugs*** - **NSAIDs** inhibit the **cyclooxygenase (COX) enzyme**, which is responsible for synthesizing **prostaglandins** from arachidonic acid. - By reducing prostaglandin synthesis, NSAIDs decrease **inflammation**, pain, and fever, making them effective in conditions like arthritis. *Corticosteroids* - **Corticosteroids** are potent anti-inflammatory drugs that act by inhibiting **phospholipase A2**, blocking the entire cascade of arachidonic acid metabolism, including both prostaglandins and leukotrienes. - They have broader immunosuppressive effects than NSAIDs but also carry a wider range of potential side effects with long-term use. *Opioids* - **Opioids** are powerful analgesics that work by binding to **opioid receptors** in the central nervous system, altering the perception of pain. - They do not directly inhibit **cyclooxygenase** or reduce **inflammation**, but rather provide symptomatic pain relief. *Antiepileptics* - **Antiepileptic drugs (AEDs)** primarily act on the central nervous system to reduce neuronal excitability and prevent seizures. - Some AEDs, like gabapentin or pregabalin, are also used for **neuropathic pain**, but they do not inhibit **COX enzymes** or reduce inflammation.

Q: A patient with rheumatoid arthritis is prescribed a disease-modifying antirheumatic drug (DMARD) that inhibits dihydroorotate dehydrogenase. Which drug is being used?

Leflunomide. ***Leflunomide*** - **Leflunomide** is an immunosuppressive DMARD that inhibits mitochondrial enzyme **dihydroorotate dehydrogenase**, an enzyme crucial for *de novo* pyrimidine synthesis. - This inhibition leads to a reduction in T-cell proliferation and cytokine production, making it effective in treating **rheumatoid arthritis**. *Methotrexate* - **Methotrexate** is a DMARD that primarily works by inhibiting **dihydrofolate reductase**, thus interfering with folate metabolism and purine synthesis. - Its mechanism is distinct from inhibiting dihydroorotate dehydrogenase and involves effects on various inflammatory pathways. *Sulfasalazine* - **Sulfasalazine** is an anti-inflammatory and immunomodulatory drug. Its mechanism of action in rheumatoid arthritis is not fully understood but involves metabolizing into **sulfapyridine** and **5-aminosalicylic acid**. - It does not directly inhibit dihydroorotate dehydrogenase; instead, it may modulate immune cell function and cytokine production. *Hydroxychloroquine* - **Hydroxychloroquine** is an antimalarial drug used in rheumatoid arthritis that inhibits **lysosomal activity** and antigen presentation, and modulates immune responses. - It does not target dihydroorotate dehydrogenase but rather interferes with intracellular signaling and cytokine release.

Q: Which of the following is the most potent opioid?

Sufentanil. ***Sufentanil*** - **Sufentanil** is a very potent synthetic opioid, estimated to be 5 to 10 times more potent than fentanyl and 500 to 1000 times more potent than morphine. - Its high potency is due to its strong binding affinity for **mu-opioid receptors** and rapid onset of action. *Butorphanol* - **Butorphanol** is a mixed opioid agonist-antagonist, acting as a partial agonist or antagonist at mu-opioid receptors and an agonist at kappa-opioid receptors. - While it provides analgesia, its efficacy is limited compared to full agonists due to its mixed receptor profile. *Pentazocine* - **Pentazocine** is another mixed opioid agonist-antagonist, primarily a kappa-opioid receptor agonist and a weak mu-opioid receptor antagonist or partial agonist. - It has a lower analgesic ceiling and can precipitate withdrawal in patients dependent on full mu-opioid agonists. *Hydrocodone* - **Hydrocodone** is an opioid agonist primarily used for moderate to severe pain, typically found in combination with acetaminophen. - Its potency is comparable to morphine, making it significantly less potent than ultra-potent synthetic opioids like sufentanil.

Q: Which of the following is a naturally occurring opioid?

Morphine. ***Morphine*** - **Morphine** is a naturally occurring **opioid alkaloid** found in the **opium poppy** (Papaver somniferum). - It is one of the most potent **analgesics** and is widely used for severe pain. *Ethylmorphine* - **Ethylmorphine** is a **semisynthetic opioid** derived from morphine by **ethylation**. - It is currently used primarily as an **antitussive** (cough suppressant). *Pholcodeine* - **Pholcodeine** is a **semisynthetic opioid** that acts as a **cough suppressant**. - It works by depressing the **cough reflex** in the brainstem. *Diacetylmorphine* - **Diacetylmorphine**, commonly known as **heroin**, is a **semisynthetic opioid** synthesized from morphine. - It is highly potent and rapidly crosses the **blood-brain barrier**, producing intense effects.

Q: Which of the following statements about local anesthetics is FALSE?

Prilocaine is less toxic than lignocaine. ***Prilocaine is less toxic than lignocaine*** - This statement is **false**. While prilocaine has a lower incidence of central nervous system (CNS) toxicity compared to lidocaine, it is associated with a higher risk of **methemoglobinemia**, especially at higher doses, which makes it potentially more toxic in specific scenarios. - Overall, the safety profile of prilocaine, particularly regarding its potential for methemoglobinemia, does not necessarily make it "less toxic" than lignocaine; they have different toxicity profiles. *Lidocaine is shorter acting than bupivacaine* - This statement is **true**. **Lidocaine** is an intermediate-acting local anesthetic, with a duration of action typically ranging from 30 minutes to 3 hours, depending on the dose and presence of a vasoconstrictor. - **Bupivacaine** is a long-acting local anesthetic, with effects lasting 4-8 hours due to its high lipid solubility and protein binding. *Mixture of lignocaine and prilocaine is known as eutectic* - This statement is **true**. A mixture of lidocaine (lignocaine) and prilocaine is known as an **Eutectic Mixture of Local Anesthetics (EMLA)**. - The word "eutectic" refers to the specific proportion of these two substances that results in a lower melting point than either drug individually, allowing them to exist as a liquid at room temperature. This formulation is used for topical anesthesia. *Lignocaine is used as an antiarrhythmic* - This statement is **true**. **Lidocaine (lignocaine)** is a **Class IB antiarrhythmic** drug. - It works by blocking cardiac sodium channels, thereby stabilizing the myocardial cell membrane and decreasing automaticity, making it effective in treating ventricular arrhythmias, especially after myocardial infarction.

Question 1

A patient presents with an acute gout attack. Which medication is contraindicated in the acute setting due to the risk of exacerbating the attack?

Accepted Answer

Allopurinol

Answer

Colchicine

Answer

Indomethacin

Answer

Prednisone

Question 2

A patient presents with gouty arthritis. Which drug inhibits the enzyme xanthine oxidase to lower uric acid levels?

Accepted Answer

Allopurinol

Answer

Colchicine

Answer

Indomethacin

Answer

Probenecid

Question 3

What is the best antagonist of morphine?

Accepted Answer

Naloxone

Answer

Buprenorphine

Answer

Pentazocine

Answer

Nalorphine

Question 4

Which class of drugs inhibits the cyclooxygenase (COX) enzyme, thereby reducing prostaglandin synthesis and inflammation in conditions such as arthritis?

Accepted Answer

Nonsteroidal anti-inflammatory drugs

Answer

Corticosteroids

Answer

Opioids

Answer

Antiepileptics

Question 5

A patient with rheumatoid arthritis is prescribed a disease-modifying antirheumatic drug (DMARD) that inhibits dihydroorotate dehydrogenase. Which drug is being used?

Accepted Answer

Leflunomide

Answer

Methotrexate

Answer

Sulfasalazine

Answer

Hydroxychloroquine

Question 6

A patient with severe cancer pain is on high-dose morphine but is experiencing uncontrolled pain and side effects. What is the best next step?

Accepted Answer

Switch to methadone for its NMDA receptor antagonism

Answer

Add a non-steroidal anti-inflammatory drug (NSAID)

Answer

Increase the morphine dose and monitor side effects

Answer

Discontinue morphine and switch to fentanyl

Question 7

Which of the following is the most potent opioid?

Accepted Answer

Sufentanil

Answer

Butorphanol

Answer

Pentazocine

Answer

Hydrocodone

Question 8

Which of the following is a naturally occurring opioid?

Accepted Answer

Morphine

Answer

Pholcodeine

Answer

Ethylmorphine

Answer

Diacetylmorphine

Question 9

Anti-inflammatory actions of corticosteroids are mediated by?

Accepted Answer

By inhibiting the production of inflammatory mediators derived from phospholipids

Answer

By inhibiting angiogenesis and reducing inflammation

Answer

By promoting vascular stability

Answer

By enhancing tissue repair mechanisms

Question 10

Which of the following statements about local anesthetics is FALSE?

Accepted Answer

Prilocaine is less toxic than lignocaine

Answer

Lidocaine is shorter acting than bupivacaine

Answer

Mixture of lignocaine and prilocaine is known as eutectic

Answer

Lignocaine is used as an antiarrhythmic

Analgesics and Anti-inflammatory Drugs — MCQs

Analgesics and Anti-inflammatory Drugs — MCQs

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