6.6 Non-steroidal antiinflammatory drugs

1. Choose a drug that reduces the activity of cyclooxygenases (COX enzymes) by reducing their synthesis, but does not inhibit existing cyclooxygenases: a) Acetylsalicylic acid b) Betamethasone c) Celecoxib d) Diclofenac

Answer: b) Betamethasone. Glucocorticoids suppress COX-2 at the transcriptional/expression level rather than blocking the enzyme's active site directly, unlike NSAIDs (slide 9).

2. Choose a drug that reduces the activity of type 2 cyclooxygenases (COX-2) and phospholipase A2: a) Indomethacin b) Acetylsalicylic acid c) Celecoxib d) Dexamethasone e) Betamethasone f) Ketorolac

Answer: d) Dexamethasone and e) Betamethasone (both glucocorticoids). EXTERNAL FLAG: PLA2 inhibition mechanism (lipocortin/annexin-1) isn't detailed in this lecture, added from general pharmacology.

3. Fill in the blanks: NSAIDs act through inhibition of the [synthesis] of [prostaglandins]. The primary precursor of prostaglandins is [arachidonic acid]. Prostaglandins are [chemical mediators] released in allergic and inflammatory processes.

Answer: synthesis / prostaglandins / arachidonic acid / chemical mediators (slides 6, 7, 12).

4. Select true statement(s) on aspirin: a) May cause Reye syndrome in children b) More potent anti-inflammatory than glucocorticoids c) Suitable for peptic ulcer patients d) Inhibits phospholipase A2 e) Antiplatelet doses higher than analgesic ones f) Inactivates TXA2 synthesis reversibly g) Increases risk of bleeding h) Inhibits inflammation at large doses

Answer: a), g), h) TRUE (slides 26, 30-31, 16/25). FALSE: b) glucocorticoids are more potent; c) increases ulcer risk; d) that's a glucocorticoid effect; e) reversed - antiplatelet doses are LOWER; f) reversed - inhibition is IRREVERSIBLE.

5. Select true statement(s) on NSAIDs: a) Inhibit leukotriene synthesis b) Act on enzyme-linked receptors c) Inhibit prostaglandin synthesis d) Inhibit phospholipase A2 e) Act on G protein-coupled receptors f) Inhibit cyclooxygenase

Answer: c) and f) TRUE (slide 12). FALSE: a) NSAIDs do NOT inhibit leukotrienes (slide 35); b), e) NSAIDs inhibit an enzyme, not membrane receptors; d) that's a glucocorticoid effect.

6. Select a drug that irreversibly inhibits cyclooxygenases: a) Salicylic acid b) Acetylsalicylic acid c) Celecoxib d) Diclofenac e) Betamethasone f) Ketorolac

Answer: b) Acetylsalicylic acid (aspirin) - irreversibly acetylates COX (slide 19). Plain salicylic acid lacks the acetyl group needed.

7. Which acts as a selective inhibitor of COX-2? a) Ibuprofen b) Acetylsalicylic acid c) Etoricoxib d) Diclofenac e) Paracetamol f) Loratadine

Answer: c) Etoricoxib - a "Coxib," COX-2-selective (slides 13-14).

8. Comparison of non-selective COX vs selective COX-2 inhibitors: effects on CNS disorders, GI ulcers/bleeding, thrombosis/embolism, bronchial spasm.

Answer: GI ulcers/bleeding - non-selective cause MORE, COX-2 selective LESS (slides 30, 42). Thrombosis - non-selective LESS, COX-2 selective MORE (slide 34). Bronchospasm - non-selective MORE, COX-2 selective LESS (slide 35). FLAG: CNS-disorders row isn't clearly differentiated in this lecture.

9. Select a drug that selectively inhibits COX-2: a) Indomethacin b) Acetylsalicylic acid c) Celecoxib d) Diclofenac e) Betamethasone f) Ketorolac

Answer: c) Celecoxib (slide 39).

10. Select a drug that selectively inhibits COX-1: a) Salicylic acid b) Acetylsalicylic acid c) Celecoxib d) Diclofenac e) Betamethasone f) Ketorolac

Answer: b) Acetylsalicylic acid at low doses (75-150mg) (slide 14).

11. Choose a drug that inhibits more strongly COX-2 than COX-1: a) Ibuprofen b) Acetylsalicylic acid c) Paracetamol d) Diclofenac e) Loratadine f) Ketorolac

Answer: d) Diclofenac - WITH A FLAG. Slide 14's chart lists it under "Nonselective," not "partial COX-2 selective." External reasoning used here.

12. Choose a drug that inhibits more strongly COX-1 than COX-2: a) Ibuprofen b) Meloxicam c) Paracetamol d) Diclofenac e) Loratadine f) Ketorolac

Answer: f) Ketorolac. EXTERNAL FLAG: not explicitly ranked in this lecture's chart.

13. Which drug has the strongest analgesic effect? a) Ibuprofen b) Acetylsalicylic acid c) Paracetamol d) Diclofenac e) Loratadine f) Ketorolac

Answer: f) Ketorolac - explicitly noted for "more severe pain, short duration" (slide 23).

14. 2-year-old with chickenpox and fever, drug given, fever resolved. Which medication could NOT have been used? a) Acetylsalicylic acid b) Ibuprofen c) Paracetamol

Answer: a) Acetylsalicylic acid - Reye syndrome risk (slides 26, 46).

15. Molecular mechanism of ibuprofen's antipyretic effect? a) Blockade of PG receptors in hypothalamus b) Inhibition of PLA2 in hypothalamus c) Reduction of interleukin concentration d) Reduction of prostaglandin concentration in hypothalamus e) Blockade of oxidative phosphorylation

Answer: d) Reduction of prostaglandin concentration in the hypothalamus (slide 24).

16. Which drug does not alter nociceptor sensitivity? a) Ibuprofen b) Acetylsalicylic acid c) Paracetamol d) Diclofenac e) Ketorolac

Answer: c) Paracetamol - acts mainly centrally, minimal peripheral COX effect (slides 23, 44).

17. Which drug has the strongest anti-inflammatory activity? a) Ibuprofen b) Acetylsalicylic acid c) Indomethacin d) Celecoxib e) Ketorolac

Answer: c) Indomethacin. EXTERNAL FLAG: classic ranking, not given in this lecture.

18. Which medication carries the greatest risk of bleeding from a peptic ulcer? a) Ibuprofen b) Acetylsalicylic acid c) Indomethacin d) Celecoxib e) Paracetamol

Answer: b) Acetylsalicylic acid - ulcer risk plus irreversible antiplatelet effect (slides 27, 30-31).

19. Which medication at therapeutic doses carries greatest nephrotoxicity risk? a) Ibuprofen b) Acetylsalicylic acid c) Indomethacin d) Diclofenac e) Paracetamol

Answer: c) Indomethacin. EXTERNAL FLAG: not individually ranked in this lecture (mechanism only, slides 32-33).

20. Which medication at therapeutic doses carries greatest hepatotoxicity risk? a) Ibuprofen b) Acetylsalicylic acid c) Indomethacin d) Diclofenac e) Paracetamol

Answer: e) Paracetamol - NAPQI/glutathione mechanism (slides 45, 47). Note: lecture specifies this is mainly a large-dose phenomenon.

21. 21-year-old with hemophilia, tension headaches. Best medication? a) Ibuprofen b) Acetylsalicylic acid c) Indomethacin d) Ketorolac e) Paracetamol

Answer: e) Paracetamol - "does not affect platelet function or increase bleeding time" (slide 44).

22. 63-year-old on chronic ibuprofen, epigastric pain, 2 gastric ulcers on endoscopy. Which substance's secretion is increased? a) Gastrin b) Hydrochloric acid c) Bicarbonates d) Gastric mucus e) Bile acids

Answer: b) Hydrochloric acid - COX-1 inhibition increases acid secretion while decreasing protective mucus (slide 30).

23. 10-year-old with measles, fever, suspected glutathione synthase deficiency with hemolytic anemia. Best antipyretic? a) Ibuprofen b) Acetylsalicylic acid c) Indomethacin d) Prednisolone e) Paracetamol

Answer: a) Ibuprofen. FULLY EXTERNAL - not in the lecture. Paracetamol risky (glutathione-dependent detox), aspirin risky (Reye syndrome + hemolysis risk). Double-check this reasoning against your course materials.

24. 6-year-old with influenza, fever 4 days, given antipyretic analgesics, died day 5. Autopsy: microvascular fatty infiltration of liver/heart/kidney, cerebral edema. Likely cause? a) Ibuprofen b) Acetylsalicylic acid c) Indomethacin d) Ketorolac e) Paracetamol

Answer: b) Acetylsalicylic acid - textbook Reye syndrome presentation (slide 26).