Analgesics and Anti-inflammatory Drugs — MCQs
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Which of the following statements about colchicine is/are true?
What is the primary mechanism of action of opioids in pain management?
Which of the following drugs is useful in acute attack of gout ?
Which of the following medications is not typically used for the acute treatment of severe pain during a gout attack?
Which drug is commonly used for outpatient department (OPD) analgesia?
Which enzyme is irreversibly inhibited by aspirin?
Which drug is known to inhibit both cyclooxygenase and lipoxygenase enzymes?
Which of the following is not an amide local anesthetic?
Which of the following substances is not classified as an opioid?
What is the drug of choice for the treatment of acute gout in patients in whom NSAIDs are contraindicated?
Analgesics and Anti-inflammatory Drugs Indian Medical PG Practice Questions and MCQs
Question 401: Which of the following statements about colchicine is/are true?
- A. Inhibits neutrophil migration
- B. Used in the treatment of gout
- C. All of the options are true (Correct Answer)
- D. Causes metaphase arrest during cell division
Explanation: ***All of the options are true***- All three statements accurately describe different properties and clinical uses of colchicine, making this the correct answer. Causes metaphase arrest during cell division- Colchicine binds to **tubulin dimers**, preventing their polymerization into **microtubules** [2]- This disrupts the mitotic spindle, causing cells to arrest in **metaphase** [2]- This property is utilized in **cytogenetic studies** for karyotyping- It forms the basis of colchicine's **anti-proliferative effects** [2] Inhibits neutrophil migration- Colchicine's disruption of **microtubules** impairs neutrophil **chemotaxis** and migration to sites of inflammation [2]- It reduces neutrophil adhesion to endothelium and decreases **phagocytosis** [2]- Inhibits release of **inflammatory mediators** (leukotrienes, cytokines) [1, 2]- This anti-inflammatory mechanism is crucial for its therapeutic effect in **gout** [1, 2] Used in the treatment of gout- FDA-approved for **acute gout attacks** and **prophylaxis** [2, 3]- Effective in **familial Mediterranean fever** [2]- Used in **pericarditis** and other inflammatory conditions [2]- Works by reducing the inflammatory response to **urate crystals** in joints [1] *Individual options alone*- While each statement is true, selecting only one would be incomplete, as colchicine possesses all these properties simultaneously
Question 402: What is the primary mechanism of action of opioids in pain management?
- A. Inhibition of cyclooxygenase (COX) enzymes
- B. Activation of opioid receptors in the spinal cord only
- C. Activation of opioid receptors in the brain only
- D. Activation of opioid receptors at both spinal and supraspinal levels (Correct Answer)
Explanation: ***Activation of opioid receptors at both spinal and supraspinal levels*** - Opioids primarily exert their analgesic effects by binding to and activating **mu (μ), delta (δ), and kappa (κ) opioid receptors** located throughout the central nervous system, including the brain and spinal cord. - Activation of these receptors modulates **pain perception**, emotional responses to pain, and descending pain inhibitory pathways. *Inhibition of cyclooxygenase (COX) enzymes* - This is the primary mechanism of action for **Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)**, not opioids. - NSAIDs reduce pain, inflammation, and fever by blocking the synthesis of **prostaglandins**. *Activation of opioid receptors in the spinal cord only* - While opioids do activate receptors in the spinal cord to inhibit **pain transmission**, their action is not confined to this area. - Significant **supraspinal analgesic effects** contribute to their overall pain-relieving properties, affecting higher brain centers involved in pain processing. *Activation of opioid receptors in the brain only* - Opioids act on opioid receptors in the brain to modulate pain perception and emotional aspects of pain, but they also have crucial effects at the **spinal cord level**. - Their action at the spinal cord level helps to prevent pain signals from reaching the brain, making **both levels crucial** for their comprehensive pain management.
Question 403: Which of the following drugs is useful in acute attack of gout ?
- A. Furosemide
- B. Sulfinpyrazone
- C. Allopurinol
- D. Piroxicam (Correct Answer)
Explanation: ***Piroxicam*** - **Piroxicam** is a **non-steroidal anti-inflammatory drug (NSAID)**, which are the first-line treatment for acute gout attacks. - NSAIDs work by inhibiting **prostaglandin synthesis**, thereby reducing inflammation and pain associated with the acute crystal-induced arthritis. *Furosemide* - **Furosemide** is a loop diuretic that can **raise uric acid levels** by increasing reabsorption in the renal tubules. - Therefore, it would exacerbate **gout** and is contraindicated during an acute attack. *Sulfinpyrazone* - **Sulfinpyrazone** is a **uricosuric agent** used for chronic gout management to increase uric acid excretion. - It is **not used for acute attacks** as it can precipitate or worsen an attack by mobilizing uric acid crystals. *Allopurinol* - **Allopurinol** is a **xanthine oxidase inhibitor** used for long-term management of hyperuricemia and chronic gout. - Starting allopurinol during an **acute attack** can worsen or prolong the attack by causing rapid changes in serum uric acid levels.
Question 404: Which of the following medications is not typically used for the acute treatment of severe pain during a gout attack?
- A. Indomethacin
- B. Colchicine
- C. Corticosteroids
- D. Febuxostat (Correct Answer)
Explanation: ***Febuxostat*** - **Febuxostat** is a **xanthine oxidase inhibitor** used for long-term management of chronic gout by lowering uric acid levels, not for acute pain relief. - Initiating febuxostat during an acute attack can paradoxically **worsen the attack** by mobilizing urate crystals, so it's typically withheld until the acute phase resolves. *Indomethacin* - **Indomethacin** is a **non-steroidal anti-inflammatory drug (NSAID)** commonly used as a first-line treatment for acute gout attacks due to its potent anti-inflammatory effects. - It works by inhibiting prostaglandin synthesis, thereby reducing pain and inflammation associated with crystal deposition. *Colchicine* - **Colchicine** is an effective anti-inflammatory agent specifically used for acute gout attacks, particularly when initiated within **24-36 hours** of symptom onset. - It works by interfering with neutrophil migration and activity, preventing the inflammatory cascade triggered by uric acid crystals. *Corticosteroids* - **Corticosteroids**, such as prednisone or methylprednisolone, are potent anti-inflammatory agents frequently used for acute gout attacks, especially when NSAIDs or colchicine are contraindicated or ineffective. - They can be administered orally, intravenously, or via intra-articular injection to rapidly reduce pain and inflammation.
Question 405: Which drug is commonly used for outpatient department (OPD) analgesia?
- A. Diclofenac
- B. Ibuprofen
- C. Paracetamol (Correct Answer)
- D. Tramadol
Explanation: ***Paracetamol*** - It is a widely used and generally **safe analgesic** and antipyretic often prescribed for mild to moderate pain in an outpatient setting. - Its favorable side effect profile and availability as an **over-the-counter (OTC)** medication make it a first-choice drug for many common pain conditions. *Diclofenac* - While it is an effective NSAID used for pain and inflammation, its use can be associated with **gastrointestinal side effects** like ulcers and bleeding, as well as cardiovascular risks. - It is often reserved for more significant inflammatory pain or when other analgesics are insufficient, and may require more careful monitoring in an outpatient setting. *Ibuprofen* - Similar to diclofenac, Ibuprofen is an **NSAID** which is effective for pain and inflammation. However, it also carries risks of **gastrointestinal irritation** and renal side effects, especially with prolonged use or in certain patient populations. - While available OTC, its use for routine outpatient analgesia may be less preferred than paracetamol in some cases due to its GI and renal side effect profile. *Tramadol* - Tramadol is a **central acting opioid analgesic** with a higher potential for side effects such as nausea, dizziness, constipation, and the risk of dependence or abuse. - It is typically reserved for moderate to severe pain that is not adequately managed by non-opioid analgesics, and its prescription often involves more stringent monitoring than paracetamol.
Question 406: Which enzyme is irreversibly inhibited by aspirin?
- A. Lipooxygenase
- B. Cyclooxygenase (Correct Answer)
- C. Thromboxane synthase
- D. Phospholipase
Explanation: ***Cyclooxygenase*** - **Aspirin** irreversibly inhibits **cyclooxygenase (COX-1 and COX-2)** by acetylating a serine residue in the enzyme's active site. - This irreversible inhibition prevents the production of **prostaglandins, thromboxane**, and **prostacyclin**, thereby reducing inflammation, pain, fever, and platelet aggregation. *Lipooxygenase* - **Lipooxygenase** is involved in the synthesis of **leukotrienes**, which are mediators of inflammation and allergic responses. - Aspirin does not directly inhibit lipooxygenase; rather, it primarily targets the COX pathway. *Thromboxane synthase* - **Thromboxane synthase** is an enzyme downstream of COX, responsible for converting prostaglandin H2 into **thromboxane A2**. - While aspirin's effect on platelet aggregation is due to reduced thromboxane A2 synthesis via COX inhibition, it does not directly inhibit thromboxane synthase itself. *Phospholipase* - **Phospholipase A2** is responsible for releasing **arachidonic acid** from cell membrane phospholipids, which is the initial step in both the cyclooxygenase and lipooxygenase pathways. - Aspirin does not directly inhibit phospholipase A2; its action occurs later in the cascade.
Question 407: Which drug is known to inhibit both cyclooxygenase and lipoxygenase enzymes?
- A. Aspirin
- B. Indomethacin
- C. BW755 (Correct Answer)
- D. Zileuton
Explanation: ***BW755*** - **BW755** is an experimental drug that has been shown to inhibit both the **cyclooxygenase (COX)** and **lipoxygenase (LOX)** pathways. - This dual inhibition prevents the synthesis of both **prostaglandins** and **leukotrienes**, offering a broader anti-inflammatory effect. - Due to dual pathway inhibition, it has theoretical advantages over conventional NSAIDs but is not in clinical use. *Aspirin* - **Aspirin** primarily inhibits **cyclooxygenase (COX) enzymes**, leading to reduced production of **prostaglandins** and **thromboxanes**. - It does not significantly inhibit **lipoxygenase (LOX)** enzymes. - Irreversibly acetylates COX-1 and COX-2. *Indomethacin* - **Indomethacin** is a potent **non-selective COX inhibitor**, reducing the synthesis of **prostaglandins**. - Similar to aspirin, it does not exert significant inhibitory effects on the **lipoxygenase** pathway. - One of the most potent NSAIDs available. *Zileuton* - **Zileuton** is a selective **5-lipoxygenase (5-LOX) inhibitor** used in the management of **asthma**. - It reduces the synthesis of **leukotrienes** (LTC4, LTD4, LTE4) which are mediators of bronchoconstriction and inflammation. - It does **not** inhibit cyclooxygenase enzymes, making it distinct from NSAIDs.
Question 408: Which of the following is not an amide local anesthetic?
- A. Prilocaine
- B. Bupivacaine
- C. Lignocaine
- D. Cocaine (Correct Answer)
Explanation: ***Cocaine*** - **Cocaine** is an **ester-type** local anesthetic, not an amide. Ester local anesthetics are characterized by an **ester bond** in their chemical structure. - It works by blocking nerve impulse transmission and also by **inhibiting norepinephrine reuptake**, contributing to its vasoconstrictive and stimulatory effects. *Lignocaine* - **Lignocaine** (also known as **lidocaine**) is an **amide-type** local anesthetic, characterized by an **amide bond** in its chemical structure. - Amide local anesthetics are generally more stable and have a longer duration of action compared to ester types. *Prilocaine* - **Prilocaine** is an **amide-type** local anesthetic, commonly used in dentistry and for regional anesthesia. - Its amide structure contributes to its stability and intermediate duration of action. *Bupivacaine* - **Bupivacaine** is an **amide-type** local anesthetic known for its relatively long duration of action and potency. - It is often used for epidural anesthesia and nerve blocks due to its prolonged effect.
Question 409: Which of the following substances is not classified as an opioid?
- A. Heroin
- B. Ketamine (Correct Answer)
- C. Methadone
- D. Fentanyl
Explanation: ***Ketamine*** - **Ketamine** is classified as a **dissociative anesthetic** and does not act on opioid receptors. - Its primary mechanism of action involves **N-methyl-D-aspartate (NMDA) receptor antagonism**. *Heroin* - **Heroin** (diacetylmorphine) is a **semisynthetic opioid** derived from morphine [1, 3]. - It rapidly crosses the **blood-brain barrier** and is metabolized to morphine, where it acts as a potent **mu-opioid receptor agonist** [3]. *Methadone* - **Methadone** is a **synthetic opioid** used in the treatment of opioid dependence and chronic pain [1, 2]. - It acts primarily as a **mu-opioid receptor agonist** with a long duration of action [1, 2]. *Fentanyl* - **Fentanyl** is a powerful **synthetic opioid** analgesic, much more potent than morphine [2]. - It selectively binds to and activates **mu-opioid receptors**, producing strong analgesic and sedative effects [2].
Question 410: What is the drug of choice for the treatment of acute gout in patients in whom NSAIDs are contraindicated?
- A. Colchicine (Correct Answer)
- B. Allopurinol
- C. Paracetamol
- D. Febuxostat
Explanation: ***Colchicine*** * **Colchicine** is a highly effective anti-inflammatory agent for acute gout flares, particularly when initiated early in the attack. * It is often the drug of choice when **NSAIDs are contraindicated** due to renal, gastrointestinal, or cardiovascular issues. *Allopurinol* * **Allopurinol** is a **xanthine oxidase inhibitor** used for long-term **gout prophylaxis** by reducing uric acid levels, not for acute attacks. * Initiating allopurinol during an acute flare can sometimes *exacerbate* the attack by transiently shifting uric acid levels. *Febuxostat* * **Febuxostat** is another **xanthine oxidase inhibitor** used for **chronic management of hyperuricemia** in gout patients, similar to allopurinol. * It is not indicated for the **acute treatment of gout** due to its mechanism of action, which focuses on reducing uric acid production over time. *Paracetamol* * **Paracetamol (acetaminophen)** is an **analgesic** and **antipyretic** but possesses very limited anti-inflammatory properties. * It is generally **ineffective** for the intense inflammatory pain and swelling characteristic of an acute gout attack.
Practice by Chapter
NSAIDs: Classification and Mechanism
Practice Questions
COX-2 Selective Inhibitors
Practice Questions
Acetaminophen (Paracetamol)
Practice Questions
Opioid Analgesics and Antagonists
Practice Questions
Drugs Used in Gout and Hyperuricemia
Practice Questions
Drugs Used in Rheumatoid Arthritis
Practice Questions
Disease-Modifying Antirheumatic Drugs
Practice Questions
Glucocorticoids as Anti-inflammatory Agents
Practice Questions
Migraine Therapeutics
Practice Questions
Neuropathic Pain Management
Practice Questions
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