Anti-inflammatory agents – Tolmetin MCQs With Answer
Tolmetin is a nonsteroidal anti-inflammatory drug (NSAID) commonly studied by B. Pharm students for its mechanism, pharmacology, and clinical use. This introduction covers key concepts: tolmetin’s nonselective inhibition of cyclooxygenase (COX-1 and COX-2), reduction of prostaglandin synthesis, therapeutic indications such as rheumatoid and osteoarthritis, common adverse effects (gastrointestinal, renal, hypersensitivity), and important drug interactions. Understanding pharmacokinetics, monitoring parameters, contraindications in pregnancy and peptic ulcer disease, and counseling points will strengthen clinical decision-making. Keywords: Anti-inflammatory agents, Tolmetin, NSAID, mechanism of action, adverse effects, drug interactions, B. Pharm. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. What is the primary mechanism of action of tolmetin?
- Selective COX-2 inhibition only
- Nonselective inhibition of COX-1 and COX-2, reducing prostaglandin synthesis
- Inhibition of lipoxygenase and leukotriene synthesis
- Opioid receptor agonism in the CNS
Correct Answer: Nonselective inhibition of COX-1 and COX-2, reducing prostaglandin synthesis
Q2. Which of the following is a primary clinical indication for tolmetin?
- Type 1 diabetes mellitus
- Rheumatoid arthritis and osteoarthritis
- Bacterial pneumonia
- Hyperthyroidism
Correct Answer: Rheumatoid arthritis and osteoarthritis
Q3. What is the most common route of administration for tolmetin in clinical practice?
- Topical gel only
- Oral tablets
- Intramuscular depot injections weekly
- Inhalation aerosol
Correct Answer: Oral tablets
Q4. Which adverse effect is most closely associated with tolmetin therapy?
- Hyperglycemia
- Gastrointestinal irritation and ulceration
- Excessive salivation
- Hypothermia
Correct Answer: Gastrointestinal irritation and ulceration
Q5. How does tolmetin affect platelet function?
- Irreversibly inhibits platelet aggregation (like aspirin)
- Reversibly inhibits platelet aggregation
- Stimulates platelet production in bone marrow
- No effect on platelets
Correct Answer: Reversibly inhibits platelet aggregation
Q6. Which renal effect can result from tolmetin use?
- Improved glomerular filtration in renal failure
- Reduced renal blood flow and possible renal impairment due to prostaglandin inhibition
- Selective increase in tubular secretion of potassium
- Stimulation of erythropoietin production
Correct Answer: Reduced renal blood flow and possible renal impairment due to prostaglandin inhibition
Q7. Tolmetin can reduce the antihypertensive effect of which drug classes?
- Beta-blockers and calcium channel blockers
- ACE inhibitors and diuretics
- Direct thrombin inhibitors only
- Statins
Correct Answer: ACE inhibitors and diuretics
Q8. What is the recommendation regarding tolmetin use during late pregnancy?
- Safe throughout pregnancy
- Contraindicated in the third trimester due to risk of premature closure of the ductus arteriosus
- Recommended to prevent preterm labor
- Only topical use is contraindicated
Correct Answer: Contraindicated in the third trimester due to risk of premature closure of the ductus arteriosus
Q9. Which organs are primarily responsible for tolmetin metabolism and elimination?
- Skin metabolism and pulmonary elimination
- Hepatic metabolism with renal excretion of metabolites
- Direct biliary elimination without hepatic metabolism
- Metabolism by bone and excretion in sweat
Correct Answer: Hepatic metabolism with renal excretion of metabolites
Q10. Tolmetin is classified pharmacologically as which type of drug?
- Nonsteroidal anti-inflammatory drug (NSAID)
- Systemic corticosteroid
- Disease-modifying antirheumatic drug (DMARD)
- Local anesthetic
Correct Answer: Nonsteroidal anti-inflammatory drug (NSAID)
Q11. Which statement correctly describes tolmetin’s half-life and dosing implication?
- It has a very long half-life and is dosed once weekly
- It has a short plasma half-life often requiring multiple daily dosing
- It accumulates extensively and is given as a loading dose only
- Half-life is irrelevant because it is administered topically
Correct Answer: It has a short plasma half-life often requiring multiple daily dosing
Q12. Tolmetin is an approved option for which pediatric condition?
- Juvenile rheumatoid arthritis (JRA)
- Acute lymphoblastic leukemia
- Type 2 diabetes in adolescents
- Attention deficit hyperactivity disorder (ADHD)
Correct Answer: Juvenile rheumatoid arthritis (JRA)
Q13. Which laboratory tests are important to monitor during long-term tolmetin therapy?
- Serum creatinine, liver function tests, and complete blood count
- Fasting blood glucose only
- Serum amylase only
- Thyroid function tests only
Correct Answer: Serum creatinine, liver function tests, and complete blood count
Q14. What is the initial approach to management in suspected tolmetin overdose?
- Administer naloxone immediately
- Supportive and symptomatic care; consider activated charcoal if early
- Immediate intravenous vitamin K
- Forced diuresis with mannitol
Correct Answer: Supportive and symptomatic care; consider activated charcoal if early
Q15. Which condition is an absolute contraindication to tolmetin therapy?
- Controlled hypertension
- Active peptic ulcer disease with bleeding
- Seasonal allergic rhinitis
- Stable hypothyroidism
Correct Answer: Active peptic ulcer disease with bleeding
Q16. Compared with aspirin, tolmetin’s effect on platelet function is characterized by:
- Longer lasting irreversible platelet inhibition
- Shorter duration reversible platelet inhibition
- No effect on platelets at any dose
- Stimulation of platelet aggregation
Correct Answer: Shorter duration reversible platelet inhibition
Q17. In patients with NSAID-exacerbated respiratory disease, tolmetin may cause bronchospasm by:
- Direct histamine release from mast cells
- Shunting arachidonic acid metabolism toward leukotriene production
- Blocking beta-2 adrenergic receptors
- Antagonizing muscarinic receptors in the airway
Correct Answer: Shunting arachidonic acid metabolism toward leukotriene production
Q18. Which counseling point reduces GI side effects when taking tolmetin?
- Take tolmetin on an empty stomach with water only
- Take tolmetin with food or milk to minimize gastric irritation
- Take tolmetin with grapefruit juice to increase absorption
- Crush and inhale the tablet powder for faster effect
Correct Answer: Take tolmetin with food or milk to minimize gastric irritation
Q19. Which drug interaction increases the risk of bleeding when combined with tolmetin?
- Metformin
- Warfarin
- Levothyroxine
- Ranitidine
Correct Answer: Warfarin
Q20. Co-administration of tolmetin with methotrexate can lead to which problem?
- Reduced methotrexate efficacy due to induction of metabolism
- Increased methotrexate toxicity due to reduced renal clearance
- Neutralization of methotrexate in the gut
- Formation of an inactive complex excreted in bile
Correct Answer: Increased methotrexate toxicity due to reduced renal clearance
Q21. Which physiological mediator’s synthesis is decreased by tolmetin, leading to reduced fever?
- Insulin
- Prostaglandin E2 in hypothalamus
- Serotonin in the gut
- Epinephrine from adrenal medulla
Correct Answer: Prostaglandin E2 in hypothalamus
Q22. Which patient group has increased risk of NSAID-induced renal adverse effects with tolmetin?
- Young healthy adults with no comorbidities
- Patients with pre-existing renal impairment or on diuretics
- Patients receiving inhaled corticosteroids only
- Patients with controlled seasonal allergies
Correct Answer: Patients with pre-existing renal impairment or on diuretics
Q23. Which adverse skin reaction, though rare, can be associated with NSAIDs including tolmetin?
- Psoriasis improvement
- Severe cutaneous reactions such as Stevens-Johnson syndrome
- Vitiligo induction in all patients
- Chronic acneiform rash always
Correct Answer: Severe cutaneous reactions such as Stevens-Johnson syndrome
Q24. Which laboratory finding may indicate NSAID-related hepatic effect during tolmetin therapy?
- Decreased serum sodium
- Elevated liver transaminases (ALT/AST)
- Low serum uric acid only
- Increased hemoglobin concentration
Correct Answer: Elevated liver transaminases (ALT/AST)
Q25. Which statement about tolmetin and cardiovascular risk is most appropriate?
- All NSAIDs, including tolmetin, may slightly increase cardiovascular risk and should be used cautiously in high-risk patients
- Tolmetin is cardio-protective and prevents myocardial infarction
- There is no cardiovascular risk with any NSAID
- Tolmetin is indicated to treat acute myocardial ischemia
Correct Answer: All NSAIDs, including tolmetin, may slightly increase cardiovascular risk and should be used cautiously in high-risk patients
Q26. Which mechanism explains NSAID-induced sodium and water retention that may occur with tolmetin?
- Activation of renal beta-adrenergic receptors
- Inhibition of renal prostaglandin synthesis leading to reduced renal perfusion
- Direct stimulation of aldosterone release from the adrenal cortex
- Blockade of aquaporin channels in collecting duct
Correct Answer: Inhibition of renal prostaglandin synthesis leading to reduced renal perfusion
Q27. For which acute condition is tolmetin an appropriate first-line symptomatic treatment?
- Acute bacterial meningitis
- Acute gouty arthritis pain control
- Type A influenza antiviral therapy
- Bacterial endocarditis
Correct Answer: Acute gouty arthritis pain control
Q28. Which concomitant medication class increases the risk of gastrointestinal bleeding when used with tolmetin?
- Proton pump inhibitors
- Systemic corticosteroids
- Topical emollients
- Vitamin supplements
Correct Answer: Systemic corticosteroids
Q29. If a patient with aspirin-exacerbated respiratory disease needs analgesia, tolmetin is:
- Always safe and recommended
- Possibly contraindicated due to cross-reactivity; use with caution
- Guaranteed to cure the respiratory disease
- An effective bronchodilator for asthma symptoms
Correct Answer: Possibly contraindicated due to cross-reactivity; use with caution
Q30. Which physiologic process reduced by tolmetin leads to decreased nociceptor sensitization?
- Reduction in prostaglandin-mediated sensitization of peripheral nociceptors
- Inhibition of acetylcholine release at neuromuscular junction
- Blocking sodium channels in peripheral nerves like local anesthetics
- Increased production of bradykinin
Correct Answer: Reduction in prostaglandin-mediated sensitization of peripheral nociceptors
Q31. Which monitoring parameter is most important in an elderly patient starting tolmetin?
- Visual acuity tests weekly
- Renal function (serum creatinine) and signs of GI bleeding
- Auditory testing monthly
- Bone density scanning immediately
Correct Answer: Renal function (serum creatinine) and signs of GI bleeding
Q32. Which statement about tolmetin and aspirin combination is correct?
- Combining tolmetin with aspirin eliminates GI risk
- Concurrent use may increase bleeding risk and reduce therapeutic advantages
- Tolmetin reverses aspirin’s antiplatelet effect permanently
- They have no pharmacodynamic interaction
Correct Answer: Concurrent use may increase bleeding risk and reduce therapeutic advantages
Q33. Which of the following best describes tolmetin’s acidity and relevance to distribution?
- Tolmetin is a weak acid, highly protein bound, affecting distribution
- Tolmetin is a strong base, water soluble only
- Tolmetin is neutral and freely diffuses into all tissues unchanged
- Tolmetin is gaseous at body temperature
Correct Answer: Tolmetin is a weak acid, highly protein bound, affecting distribution
Q34. Which symptom should prompt immediate discontinuation of tolmetin and urgent evaluation?
- Transient mild headache
- New onset black, tarry stools or hematemesis
- Mild dry mouth for one day
- Temporary increased appetite
Correct Answer: New onset black, tarry stools or hematemesis
Q35. Which effect on coagulation tests is typically seen with tolmetin?
- Marked prolongation of PT and PTT always
- Increase in bleeding time due to platelet dysfunction
- Immediate normalization of INR in warfarin therapy
- No change in bleeding risk
Correct Answer: Increase in bleeding time due to platelet dysfunction
Q36. Which pharmacological advantage is NOT true for tolmetin compared to acetaminophen?
- Tolmetin has anti-inflammatory effects while acetaminophen lacks significant peripheral anti-inflammatory action
- Tolmetin provides analgesic and anti-inflammatory effects
- Tolmetin has fewer gastrointestinal risks than acetaminophen
- Acetaminophen is preferred when anti-inflammatory action is not required
Correct Answer: Tolmetin has fewer gastrointestinal risks than acetaminophen
Q37. Which drug interaction can lead to increased lithium levels when co-administered with tolmetin?
- Concurrent use of penicillins
- NSAIDs reduce renal lithium clearance, increasing lithium levels
- Concomitant vitamin D decreases lithium absorption
- Furosemide always lowers lithium levels when combined with tolmetin
Correct Answer: NSAIDs reduce renal lithium clearance, increasing lithium levels
Q38. Which statement best describes tolmetin’s effect on prostaglandin-mediated gastric protection?
- Tolmetin increases protective gastric prostaglandins
- Tolmetin decreases gastric prostaglandin synthesis, compromising mucosal protection
- Tolmetin only affects renal prostaglandins, not gastric
- Tolmetin stimulates mucus production in stomach lining
Correct Answer: Tolmetin decreases gastric prostaglandin synthesis, compromising mucosal protection
Q39. Which patient history increases risk of NSAID hypersensitivity reactions with tolmetin?
- History of controlled hypercholesterolemia
- History of asthma and nasal polyps with aspirin sensitivity
- Past viral pharyngitis without complications
- Isolated myopia corrected with glasses
Correct Answer: History of asthma and nasal polyps with aspirin sensitivity
Q40. Which of the following statements regarding tolmetin’s pharmacology is TRUE?
- It selectively inhibits thromboxane synthase only
- It reduces prostaglandin formation by inhibiting cyclooxygenase enzymes
- It is a biologic DMARD targeting TNF-alpha
- It increases prostaglandin synthesis to reduce pain
Correct Answer: It reduces prostaglandin formation by inhibiting cyclooxygenase enzymes
Q41. A B. Pharm student is asked which patient counseling point is correct for tolmetin. Which is best?
- Avoid concurrent use with alcohol to reduce risk of GI bleeding
- Drink grapefruit juice to enhance drug effect
- Crush extended-release tablets to increase absorption
- Stop antihypertensive drugs when starting tolmetin
Correct Answer: Avoid concurrent use with alcohol to reduce risk of GI bleeding
Q42. Which of the following is a serious but uncommon hematologic adverse effect of tolmetin?
- Agranulocytosis or aplastic anemia
- Chronic compensated polycythemia
- Isolated benign thrombocytosis in all patients
- Permanent increase in white blood cells always
Correct Answer: Agranulocytosis or aplastic anemia
Q43. What effect does tolmetin have on uric acid handling relevant to gout?
- Powerfully increases renal uric acid excretion in all cases
- NSAIDs like tolmetin provide symptomatic relief in acute gout without altering uric acid metabolism long-term
- It is the preferred uricosuric agent for chronic gout control
- Tolmetin permanently lowers serum uric acid
Correct Answer: NSAIDs like tolmetin provide symptomatic relief in acute gout without altering uric acid metabolism long-term
Q44. Which of the following best describes tolmetin’s onset of analgesic action relative to its anti-inflammatory effect?
- Analgesic effects often occur sooner; anti-inflammatory effects develop with continued therapy
- Anti-inflammatory effects are immediate and analgesia takes weeks
- No analgesic effect is ever observed with tolmetin
- Analgesia and anti-inflammatory effects are identical in timing always
Correct Answer: Analgesic effects often occur sooner; anti-inflammatory effects develop with continued therapy
Q45. Which class of drugs can reduce tolmetin renal clearance and increase toxicity risk?
- Loop diuretics reduce tolmetin clearance
- ACE inhibitors, NSAIDs, and diuretics in combination can impair renal function; specifically NSAIDs may reduce clearance of other drugs like methotrexate and lithium
- Topical antihistamines
- Oral contraceptives always increase tolmetin clearance
Correct Answer: ACE inhibitors, NSAIDs, and diuretics in combination can impair renal function; specifically NSAIDs may reduce clearance of other drugs like methotrexate and lithium
Q46. When counseling a patient on potential CNS side effects of tolmetin, which symptom should be mentioned?
- Drowsiness, dizziness, or headache are possible CNS side effects
- Immediate improvement in memory function
- Permanent hearing loss within hours
- Increased visual acuity
Correct Answer: Drowsiness, dizziness, or headache are possible CNS side effects
Q47. Which statement about tolmetin and breastfeeding is most appropriate?
- All NSAIDs are strictly contraindicated during breastfeeding
- Use with caution during breastfeeding; consider alternatives or lowest effective dose while monitoring infant
- Tolmetin is the preferred analgesic in breastfeeding and requires no monitoring
- It concentrates highly in breast milk and always requires cessation of breastfeeding
Correct Answer: Use with caution during breastfeeding; consider alternatives or lowest effective dose while monitoring infant
Q48. Which is an important pharmacovigilance point for long-term tolmetin therapy?
- Annual ophthalmologic exams are the only requirement
- Monitor for signs of GI bleeding, renal dysfunction, hepatic abnormalities, and hypersensitivity reactions
- No monitoring is necessary for long-term NSAID use
- Only blood glucose monitoring is needed
Correct Answer: Monitor for signs of GI bleeding, renal dysfunction, hepatic abnormalities, and hypersensitivity reactions
Q49. Which laboratory change might suggest NSAID-related renal impairment after starting tolmetin?
- Decreased serum potassium with normal creatinine
- Rising serum creatinine and decreased urine output
- Lowered hemoglobin A1c immediately
- Elevated serum calcium only
Correct Answer: Rising serum creatinine and decreased urine output
Q50. Which of the following summarizes tolmetin’s clinical profile accurately?
- Tolmetin is an NSAID that provides analgesic, anti-inflammatory and antipyretic effects but carries risks of GI, renal and hypersensitivity adverse effects and important drug interactions
- Tolmetin is an antibiotic used to treat urinary tract infections
- Tolmetin is an immunosuppressive monoclonal antibody
- Tolmetin is a vitamin supplement with anti-inflammatory pro properties
Correct Answer: Tolmetin is an NSAID that provides analgesic, anti-inflammatory and antipyretic effects but carries risks of GI, renal and hypersensitivity adverse effects and important drug interactions
