NSAIDS(PT)

Acetyl salicylic acid is soluble in (a) An aqueous base (b) Water (c) An aqueous acid

(a) An aqueous base

Which of the following is an irreversible inhibitor of cyclooxygenase ? (a) Aspirin (b) Phenylbutazone (c) Indomethacin (d) Piroxicam

(a) Aspirin

What is the true of nimesulide (a) It exerts anti-inflammatory action by several mechanisms in addition to cyclooxygenase inhibition (b) It is preferred for long-term use in rheumatoid arthritis (c) It is contraindicated in aspirin intolerant asthma patients (d) All of the above

(a) It exerts anti-inflammatory action by several mechanisms in addition to cyclooxygenase inhibition

. Patients taking chronic doses of nonselective nonsteroidal antiinflammatory drugs (NSAIDs) should periodically be screened for which of the following toxicities? (a) Nephrotoxicity (b) Peripheral neuropathy (c) Cardiotoxicity (d) All of the above (e) None of the above

(a) Nephrotoxicity

Nonsteroidal anti-inflammatory drugs reduce the diuretic action of furosemide by (a) Preventing prostaglandin mediated intrarenal haemodynamic actions (b) Blocking the action in ascending limb of loop of Henle (c) Enhancing salt and water reabsorption in distal tubule (d) Increasing aldosterone secretion

(a) Preventing prostaglandin mediated intrarenal haemodynamic actions

The constellation of adverse effects associated with non-steroidal antiinflammatory drugs does not include the following (a) Sedation (b) Gastric irritation (c) Fluid retention (d) Rashes

(a) Sedation

Cyclooxygenase-1 and -2 are responsible for (a) The synthesis of prostaglandins from Arachidonate (b) The synthesis of leukotrienes from arachidonate (c) The conversion of ATP to cAMP (d) The metabolic degradation of cAMP (e) The conversion of GTP to cGMP

(a) The synthesis of prostaglandins from Arachidonate

Earliest sign of aspirin toxicity is (a) Tinnitus (b) Metabolic acidosis (c) Reye syndrome (d) Respiratory depression

(a) Tinnitus

A 45-year-old surgeon has developed symmetric early morning stiffness in her hands. She wishes to take a nonsteroidal anti-inflammatory drug to relieve these symptoms and wants to avoid gastrointestinal side effects. Which one of the following drugs is most appropriate? (a) Aspirin (b) Celecoxib (c) Ibuprofen (d) Indomethacin (e) Piroxicam

(b) Celecoxib

Which one of the following drugs is not useful in dysmenorrhea? (a) Aspirin (b) Colchicine (c) Ibuprofen (d) Rofecoxib (e) Naproxen

(b) Colchicine

Which one of the following effects does not occur in salicylate intoxication ? (a) Hyperventilation (b) Hypothermia (c) Metabolic acidosis (d) Respiratory alkalosis (e) Tinnitus

(b) Hypothermia

The non-steroidal anti-inflammatory drug which is contraindicated in drivers and machine operators is (a) Phenylbutazone (b) Indomethacin (c) Naproxen (d) Diclofenac sodium

(b) Indomethacin

Phenylbutazone should be used only in patients not responding to other nonsteroidal anti-inflammatory drugs (NSAIDs)because (a) It has lower anti-inflammatory efficacy than other NSAIDs (b) It has potential to cause agranulocytosis (c) It has weak analgesic action (d) It alters the protein binding and metabolism of many drugs

(b) It has potential to cause agranulocytosis

The following nonsteroidal anti-inflammatory drug is a relatively selective cycloodygenase2 inhibitor (a) Tenoxicam (b) Meloxicam (c) Diclofenac sod (d) Ketoprofen

(b) Meloxicam

Aspirin in low doses produces longlasting inhibition (a) Platelets contain low quantity of COX (b) Platelets cannot synthesize fresh COX molecules (c) Platelets bind aspirin with high affinity (d) Platelet COX is inducible

(b) Platelets cannot synthesize fresh COX molecules

Potential adverse effects associated with aspirin include all of the following except (a) Gastrointestinal ulceration (b) Renal dysfunction (c) Enhanced methotrexate toxicity (d) Cardiac arrhythmias (e) Hypersensitivity asthma

(c) Enhanced methotrexate toxicity

In the treatment of chronic inflammatory diseases, the most important limitation of aspirin is (a) Acid - base and electrolytc disturbances (b) Hypersensitivity and idiosyncratic reactions (c) Gastric mucosal damage (d) Salicylism

(c) Gastric mucosal damage

Decomposition of the acetyl salicylic acid at room temperature most likely would occur by (a) Oxidation of the ester (b) Reduction of the carboxylic acid (c) Hydrolysis of the ester

(c) Hydrolysis of the ester

The toxicity spectrum of aspirin does not include (a) Increased risk of encephalopathy in children with viral infections (b) Increased risk of peptic ulcers (c) Hyperprothrombinemia (d) Metabolic acidosis (e) Respiratory alkalosis

(c) Hyperprothrombinemia

In overall assessment, which non-steroidal anti-inflammatory drug has been considered to be the safest (a) Aspirin (b) Naproxen (c) Ibuprofen (d) Piroxicam

(c) Ibuprofen

Which of the following is a reversible inhibitor of platelet cyclooxygenase? (a) Alprostadil (b) Aspirin (c) Ibuprofen (d) LTC4 (e) Misoprostol

(c) Ibuprofen

The distinctive feature of nimesulide is (a) It does not inhibit prostaglandin synthesis (b) It does not cause gastric irritation (c) It is well tolerated by aspirin intolerant asthma patients (d) It is not bound to plasma proteins

(c) It is well tolerated by aspirin intolerant asthma patients

The primary objective for designing drugs that selectively inhibit COX - 2 is to (a) Decrease the risk of nephrotoxicity (b) Improve anti-inflammatory effectiveness (c) Lower the risk of gastrointestinal toxicity (d) Reduce the cost of treatment of rheumatoid arthritis (e) Selectively decrease thromboxane A2 without effects on other eicosanoids

(c) Lower the risk of gastrointestinal toxicity

Accidental poisonings are common with both aspirin and ibuprofen, two OC drugs available in tasty chewable tablets. In cases of overdose, aspirin is more likely than ibuprofen to cause (a) Autonomic Instability (b) Hepatic necrosis (c) Metabolic acidosis (d) Thrombocytopenia (e) Ventricular arrhythmias

(c) Metabolic acidosis

For a patient of peptic ulcer, the safest nonopioid analgesic is (a) Ketorolac (b) Diclofenac sodium (c) Paracetamol (d) Ibuprofen

(c) Paracetamol

Cylcoocygenase-II specific inhibitors block the following (a) Production of cytoprotective prostaglandins (b) Tumor necrosis factor - α (c) Production of prostaglandins responsible for pain and inflammation

(c) Production of prostaglandins responsible for pain and inflammation

All of the following facts are true about non-steroidal anti-inflammatory drugs (NSAIDs) except (a) They are antipyretic (b) There is a celling effect to their analgesia (c) They can cause tolerance (d) They do not cause dependence (e) They are anti-inflammatory

(c) They can cause tolerance

Aspirin produces analgesia by (a) Preventing sensitization of peripheral pain receptors (b) Affecting gating of pain impulses at spinal level (c) Raising pain threshold at subcortical level (d) Both (a) and (b)

(d) Both (a) and (b)

. Aspirin reduces fever by (a) Decreasing heat production in the body (b) Enhancing cutaneous blood flow (c) Inducing sweating (d) Both (b) and (c)

(d) Both (b) and (c)

The cyclooxygenase isoenzymes COX-1 and COX-2 differ from each other in that (a) They catalyse different pathways in prostanoid biosynthesis (b) COX-1 is inhibited by aspirin but not COX-2 (c) COX-2 is inhibited by ibuprofen but not COX-1 (d) COX-1 is constitutive while COX-2 is inducible

(d) COX-1 is constitutive while COX-2 is inducible

Which of the following enzymes is ultimately responsible for the production of prostaglandins associated with inflammatory reactions? (a) Phospholipase (b) Lipoxygenase (c) Cyclooxygenase-I (d) Cyclooxygenase II (e) Xanthine oxidase

(d) Cyclooxygenase II

The main advantage of ketorolac over aspirin is that ketorolac (a) Can be combined more safely with an opioid such as codeine (b) Can be obtained as an over-the-counter agent (c) Does not prolong the bleeding time (d) Is available in a parenteral formulation that can be injected intramuscularly or intravenously (e) Is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment

(d) Is available in a parenteral formulation that can be injected intramuscularly or intravenously

A newborn was diagnosed as having a congenital abnormality that resulted in transposition of her great arteries. While preparing the infant for surgery, the medical team needed to keep the ductus arteriosus open. They did this by infusing (a) Cortisol (b) Indomethacin (c) Ketorolac (d) Misoprostol (e) Tacrolimus

(d) Misoprostol

Which of the following anti-inflammatoryanalgesics has been cleared for pediatric use (a) Indomethacin (b) Ibuprofen (c) Ketorolac (d) Piroxicam

(d) Piroxicam

Aspirin is contraindicated in children suffering from influenza or similar viral infection because of increased risk of (a) Gastric bleeding (b) Thrombocytopenia (c) Fancony syndrome (d) Reye's syndrome

(d) Reye's syndrome

Generally the earliest manifestation of salicylism is (a) Visual disturbance (b) Excitement (c) Hyperventillation (d) Tinnitus

(d) Tinnitus

The action of aspirin that results in its greater efficacy as an antithrombotic (anti-platelet) drug is its ability to (a) Inhibit lipoxygenase as well as cyclooxygenase (b) Selectively inhibit cyclooxygenase I (c) Inhibit leukocyte migration (d) Promote uric acid excretion (e) Acetylate cyclooxygenase

(e) Acetylate cyclooxygenase

Which of the following is a side effect of NSAID ? (a) GI ulceration (b) Blockade of platelet agregation (c) Inhibition of uterine motility (d) Renal vasoconstriction (e) All of the above

(e) All of the above

In addition to their ability to decrease inflammatory prostaglandin synthesis, some non steroidal anti-inflammatory drugs (NSAIDs) may owe part of their effects to their ability to (a) Inhibit leukocyte migration (b) Inhibit leukotriene synthesis (c) Stabilize lysosmal membranes (d) All of the above (e) None of the above

(e) None of the above

Which of the following medications would represent arthritis therapy that is least likely to cause gastric ulceration? (a) Aspirin (b) Acetaminophen (c) Piroxicam (d) Meclofenamate (e) Rofecoxib

(e) Rofecoxib

Aspirin: bleeding time A) increases bleeding time B) decreases bleeding time

A) increases bleeding time

Which of the following is an analgesic and antipyretic drug that lacks an antiinflammatory action? A Acetaminophen B Celecoxib C Colchicine D Indomethacin E Probenecid

A. Acetaminophen

Which of the following two cyclooxygenase isoenzymes is constitutively expressed? A. COX-1 B. COX-2

A. COX-1

Which of the following NSAIDs has greater inhibitory selectivity for COX-1 than COX-2? A.Flurbiprofen B. Indomethacin C. Diclofenac D. Celecoxib

A. Flurbiprofen

Among NSAIDs, aspirin is unique because it A Irreversibly inhibits its target enzyme B Prevents episodes of gouty arthritis with long-term use C Reduces fever D Increases the risk of colon cancer E Selectively inhibits the COX-2 enzyme

A. Irreversibly inhibits its target enzyme

NSAIDs combat fever by inhibiting which prostaglandin? A. Prostaglandin E2 B. Prostaglandin I2 C. Prostaglandin D2 D. Prostaglandin F2

A. Prostaglandin E2

A patient takes a drug that has analgesic & antipyretic effects, but is not antiinflammatory. It can cause potentially fatal hepatotoxicity when large doses (e.g. 15 grams) are consumed over a short time period, especially in alcoholic patients, or those with pre-existing liver disease. Which drug best fits this description? A. acetaminophen B. aspirin C. colchicine D. ibuprofen E. methylprednisolone

A. acetaminophen

John is a 63 year old alcoholic with a 5 year history of ulcers. Recently when self-medicating for a back condition John consumed 5 times the recommended daily dose of an over-the-counter pain reliever. Soon afterwards John developed a severe episode of nausea and vomiting. Twleve hours later his wife brings him to the local Emergency Department. After quizzing John about the identity of his analgesic, the ER physician draws blood samples for drug analysis and administers N-acetyl cysteine (Mucomyst) 140 mg/kg orally to prevent further toxicity. What analgesic did John most likely take to cause this problem? A. acetaminophen B. aspirin C. ibuprofen D. naproxen E. prednisone

A. acetaminophen

A premature newborn suffering from cyanosis is found to have a heart murmur upon auscultation. A 2D doppler echocardiogram indicates the presence of a patent ductus arteriosis. A drug is prescribed, and during the next follow up exam, the murmur is gone. A new echocardiogram indicates a normal pattern of blood flow inside the heart. The drug prescribed was most likely: A. ibuprofen B. montelukast C. PGE2 D. propranolol

A. ibuprofen

Isozyme primarily responsible for prostaglandin production by cells involve an inflammation: A) COX-I B) COX-II

B) COX-II

Aspirin is a drug commonly used for the primary prevention of cardiovascular disease in patients with elevated risk factors (e.g. advanced age, diabetes, smoking, high blood pressure, and/or coronary artery disease). While aspirin has been found to be effective in reducing cardiovascular risk in such patients, it has also been found that other drugs can significantly interfere with aspirin's beneficial effects if taken concomitantly. An example of the type of drug to be avoided in such patients is: A. Colchicine B. Ibuprofen C. Methotrexate D. Montelukast E. Prednisone

B. Ibuprofen

Which of the following statements about NSAIDs is false? A. NSAIDs are not recommended during pregnancy B. NSAIDs increase renal blood flow C. NSAIDs reduce the therapeutic effect of SSRIs D. NSAIDs have a hypercoagulability effect

B. NSAIDs increase renal blood flow

NSAID with least inflammatory action is: A. Indomethacin B. Paracetamol C. Ketorolac D. Ibuprofen

B. Paracetamol

Your ten year old son is running a fever of 101oF after developing a cold. To help him feel better you go to the local pharmacy to purchase an a feverlowering medication. However, as a good parent you recall that there are warnings about the risk of drug-induced Reye's syndrome in children given the wrong type of NSAID. Which NSAID is associated with this potentially serious condition? A. acetaminophen B. aspirin C.celecoxib D. montelukast

B. aspirin

During a daily visit with your 95-year-old grandmother (who is suffering from severe dementia and rheumatoid arthritis) you realize that half of the bottle of 100 aspirin tablets that you brought her yesterday are gone. She can't recall what happen to the missing tablets. Worried that she may have taken an overdose of aspirin for her arthritis, you realize that she may have also fed them to her tropical fish (one of her quirky habits). Which of the following signs or symptoms would be most consistent with grandma having taken a drug overdose? A. dead fish B. fever C.hypertension D. shallow breathing

B. fever

Analgesic effects of aspirin: A) peripheral action (inflammation) B) subcortical site of action C) both D) neither

C) both

Which of the following NSAIDs is a selective COX-2 inhibitor? A. Indomethacin B. Meloxicam C. Etoricoxib D. Mefenamic acid

C. Etoricoxib

A 54-year-old woman presented with signs and symptoms consistent with an early stage of rheumatoid arthritis. The decision was made to initiate NSAID therapy. Which of the following patient characteristics is the most compelling reason for avoiding celecoxib in the treatment of her arthritis? A History of alcohol abuse B History of gout C History of myocardial infarction D History of osteoporosis E History of peptic ulcer disease

C. History of myocardial infarction

A 16-year-old girl comes to the emergency department suffering from the effects of an aspirin overdose. Which of the following syndromes is this patient most likely to exhibit as a result of this drug overdose? A Bone marrow suppression and possibly aplastic anemia B Fever, hepatic dysfunction, and encephalopathy C Hyperthermia, metabolic acidosis, and coma D Rapid, fulminant hepatic failure E Rash, interstitial nephritis, and acute renal failure

C. Hyperthermia, metabolic acidosis, and coma

An 18-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient's death? A Arrhythmia B Hemorrhagic stroke C Liver failure D Noncardiogenic pulmonary edema E Ventilatory failure

C. Liver failure

NSAID given in once daily dose is: A. Naproxen B. Ketorolac C. Piroxicam D. Paracetamol

C. Piroxicam

Drug associated with the hepatic/renal toxic metabolite: N-acetyl-pbenzoquinone A) diclofenac B) meclofenamate C) indomethacin D) acetaminophen E) aspirin

D) acetaminophen

Mechanism of action: aspirin-platelet effects: A) promotes platelet aggregation B) activates thromboxane synthesis C) both D) neither

D) neither

NSAIDs should be avoided in which group(s) of patients? A. Kidney disease B. Myocardial infarction C.Irritable bowel syndrome D. All of the above

D. All of the above

Vasodilation by prostaglandins involves A. Arterioles B. Precapillary sphincters C. Postcapillary venules D. All of the above

D. All of the above

Which of the following statements about NSAIDs is true? A. Most NSAIDs are weak acids B. Most NSAIDs are metabolised by the liver into inactive metabolites C. Oxicams tend to have the longest half-lives of all NSAIDs D. All of the above

D. All of the above

What are the effects of aspirin? A. Pain relief only B. Prevent heart attack only C. Pain relief and anti-inflammatory only D. Anti-inflammatory, fever reduction, analgesic, and inhibition of platelet aggregation

D. Anti-inflammatory, fever reduction, analgesic, and inhibition of platelet aggregation

The main advantage of ketorolac over aspirin is that ketorolac: A Can be combined more safely with an opioid such as codeine B Can be obtained as an over-the-counter agent C Does not prolong the bleeding time D Is available in a parenteral formulation that can be injected intramuscularly or intravenously E Is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment

D. Is available in a parenteral formulation that can be injected intramuscularly or intravenously

NSAIDs increase the risk of CNS adverse effects when taken with which group of antibiotics? A. Macrolides B. Penicillins C. Aminoglycosides D. Quinolones

D. Quinolones

Highly selective COX-2 inhibitors are anti-inflammatory drugs with fewer GI side effects compared to traditional non-selective COX inhibitors, such as aspirin. What other effect do COX-2 inhibitors lack, in contrast to aspirin? A. analgesic B. antiinflammatory C. antipyretic D. antiplatelet E. lipoxygenase inhibition

D. antiplatelet

Which of the following drugs is most likely to increase serum concentrations of conventional doses of methotrexate, a weak acid that is primarily cleared in the urine? A Acetaminophen B Allopurinol C Colchicine D Hydroxychloroquine E Probenecid

E Probenecid

Paracetamol is an NSAID with a comparatively low anti-inflammatory effect compared to other NSAIDs. True or False

False

Piroxicam has a particularly long half-life (50 hours) as it undergoes enterohepatic recycling. True or False

True

Aspirin is contraindicated in pregnant women near term because (a) Labour may be delayed and prolonged (b) Blood loss during delivery may be more (c) Foetus may suffer premature closure of ductus arteriosus (d) All of the above risks

d) All of the above risks

. N-acetyl cysteine is beneficial in acute paracetamol poisoning because (a) It reacts with paracetamol to form a nontoxic complex (b) It inhibits the generation of the toxic metabosite of paracetamol (c) It is a free readical scavenger (d) It replenishes hepatic glutathione which in turn binds the toxic metabolite of paracetamol

d) It replenishes hepatic glutathione which in turn binds the toxic metabolite of paracetamol

18.Aspirin produces all of the following except: a. Frank gastric bleeding b. Prolonged prothrombin time c. Platelet dysfunction d. Constipation

d. constipation