Advantages and disadvantages of suppositories MCQs With Answer

Introduction
Suppositories are solid dosage forms designed for rectal, vaginal, or urethral administration, offering important advantages and disadvantages for drug delivery. For B.Pharm students, understanding suppository formulation, bases (cocoa butter, PEG, glycerinated gelatin), absorption mechanisms, bioavailability, first-pass metabolism avoidance, patient compliance, stability, and mucosal irritation is crucial. Key considerations include local versus systemic effects, melting/disintegration behavior, dose uniformity, compatibility, and manufacturing methods like fusion and compression. Evaluating advantages such as improved bioavailability and suitability for pediatrics against drawbacks like leakage, irritation, and storage issues prepares students for formulation challenges. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which of the following is the primary advantage of rectal suppositories for systemic drug delivery?

• Complete avoidance of enzymatic degradation in the gut
• Improved patient acceptability compared to oral tablets for adults
• Partial avoidance of first-pass hepatic metabolism
• Guaranteed precise dosing regardless of base

Correct Answer: Partial avoidance of first-pass hepatic metabolism

Q2. Which base is known for predictable melting at body temperature and was traditionally used as a suppository base?

• Polyethylene glycol (PEG)
• Cocoa butter (theobroma oil)
• Glycerinated gelatin
• Hydrophilic ointment

Correct Answer: Cocoa butter (theobroma oil)

Q3. What is a major disadvantage of glycerinated gelatin suppositories?

• They melt too rapidly at body temperature
• They can cause significant local irritation and are hygroscopic
• They are incompatible with hydrophilic drugs
• They provide no lubrication for insertion

Correct Answer: They can cause significant local irritation and are hygroscopic

Q4. Which mechanism primarily controls drug release from lipophilic cocoa butter bases?

• Diffusion through a water-soluble matrix
• Dissolution in rectal fluids followed by diffusion
• Melting of the base then diffusion of drug into mucosa
• Enzymatic degradation of the base

Correct Answer: Melting of the base then diffusion of drug into mucosa

Q5. For a weakly acidic drug, how does rectal pH affect absorption compared with the stomach?

• Rectal pH (around 7) favors ionization and reduces absorption of weak acids
• Rectal pH is the same as stomach, so no difference
• Rectal pH favors unionized form of weak acids, increasing absorption
• Rectal pH causes drug decomposition and reduces absorption

Correct Answer: Rectal pH (around 7) favors ionization and reduces absorption of weak acids

Q6. Which quality control test assesses dose uniformity in suppositories?

• Melting point determination
• Uniformity of weight and content uniformity
• Disintegration in simulated gastric fluid
• Viscosity measurement

Correct Answer: Uniformity of weight and content uniformity

Q7. Which manufacturing method is most commonly used for cocoa butter-based suppositories?

• Direct compression
• Molded fusion (hand or automated pouring)
• Spray drying
• Hot melt extrusion at high shear

Correct Answer: Molded fusion (hand or automated pouring)

Q8. Which property of PEG bases makes them suitable for water-soluble drugs?

• Their hydrophobic nature promotes slow release
• They are immiscible with rectal fluids
• They are hydrophilic and dissolve gradually in rectal fluids
• They melt at a very low temperature

Correct Answer: They are hydrophilic and dissolve gradually in rectal fluids

Q9. A disadvantage of suppositories related to patient factors is:

• Complete protection from first-pass metabolism
• Potential for poor patient acceptance and compliance
• Superior taste masking compared to oral tablets
• Uniform rectal absorption for all patients

Correct Answer: Potential for poor patient acceptance and compliance

Q10. Which anatomical feature affects rectal drug absorption and first-pass effect?

• Presence of abundant villi similar to small intestine
• Dual venous drainage with inferior and middle rectal veins bypassing liver
• Acidic environment that degrades peptides
• Continuous mucus production that dissolves drugs

Correct Answer: Dual venous drainage with inferior and middle rectal veins bypassing liver

Q11. What is the main reason suppositories are useful in pediatric patients?

• They always provide faster onset than IV injections
• They allow administration when oral route is not possible due to vomiting or unconsciousness
• They are more palatable for children than syrups
• They eliminate need for sterile technique

Correct Answer: They allow administration when oral route is not possible due to vomiting or unconsciousness

Q12. Which test evaluates the melting behavior of a suppository base?

• Hardness testing
• Melting point/declaration of melting range
• Disintegration in intestinal fluid
• Microbial limit testing

Correct Answer: Melting point/declaration of melting range

Q13. Which factor increases risk of leakage of rectal suppositories after insertion?

• Appropriate particle size of drug
• Using a base with too high melting point
• Diarrhea or poor pelvic floor sphincter control
• Increased rectal absorption

Correct Answer: Diarrhea or poor pelvic floor sphincter control

Q14. Which of the following is a disadvantage specific to lipophilic bases like cocoa butter?

• They dissolve too quickly in rectal fluids
• They may have polymorphism causing instability and exudation
• They are incompatible with lipophilic drugs
• They support microbial growth rapidly

Correct Answer: They may have polymorphism causing instability and exudation

Q15. Which excipient is commonly added to suppositories to reduce irritation and improve lubrication?

• Surfactants such as polysorbate 80
• Preservatives like benzalkonium chloride
• Lubricants or emollients such as mineral oil or cocoa butter blends
• Strong acids to maintain pH

Correct Answer: Lubricants or emollients such as mineral oil or cocoa butter blends

Q16. For assessing distribution of drug in a suppository, which analytical check is most relevant?

• Uniformity of content by assay
• Disintegration in water
• Organoleptic testing
• Assay for heavy metals

Correct Answer: Uniformity of content by assay

Q17. Which drug characteristic favors use in a suppository to achieve local effect?

• High systemic bioavailability via oral route
• Potent local activity with low required local concentration
• Strong taste that needs masking
• Extremely large required dose

Correct Answer: Potent local activity with low required local concentration

Q18. Which statement about compression-molded suppositories is true?

• Compression molding is unsuitable for heat-sensitive drugs
• It requires molten base pouring into molds
• Compression molding compacts a base and drug without melting
• It always yields more uniform products than fusion molding

Correct Answer: Compression molding compacts a base and drug without melting

Q19. Which condition is a contraindication for rectal suppository use?

• Severe hemorrhoids or rectal bleeding
• Mild constipation
• Fever requiring antipyretic
• Insomnia requiring sedative

Correct Answer: Severe hemorrhoids or rectal bleeding

Q20. Which formulation modification can reduce drug leakage from rectal suppositories?

• Use a base with a lower melting point than body temperature
• Add a water-soluble disintegrant to cause rapid melting
• Use a firmer base or incorporate a mucoadhesive polymer
• Increase particle size of the active ingredient

Correct Answer: Use a firmer base or incorporate a mucoadhesive polymer

Q21. Which advantage is associated with vaginal suppositories compared to systemic oral therapy?

• They always produce systemic effects faster than IV
• They allow targeted local therapy with lower systemic exposure
• They eliminate need for sterility in formulation
• They prevent all forms of microbial colonization

Correct Answer: They allow targeted local therapy with lower systemic exposure

Q22. Which parameter is critical when formulating suppositories containing peptides or proteins?

• Taste masking agent inclusion
• Stability against enzymatic degradation and appropriate base selection
• Presence of strong acids to denature contaminants
• High lipophilicity of the peptide

Correct Answer: Stability against enzymatic degradation and appropriate base selection

Q23. Which is a regulatory or labeling consideration specific to suppositories?

• Manufacturing date is not required
• Storage conditions and instructions for insertion and disposal must be specified
• Patient counseling is optional for nonprescription products
• Batch size information is unnecessary

Correct Answer: Storage conditions and instructions for insertion and disposal must be specified

Q24. How does particle size of the drug affect release from a suppository?

• Smaller particles increase surface area and typically increase release rate
• Particle size has no effect on release from any base
• Larger particles always dissolve faster in rectal fluids
• Particle size only affects taste, not release

Correct Answer: Smaller particles increase surface area and typically increase release rate

Q25. Which storage recommendation is important for cocoa butter suppositories?

• Store above 40°C to maintain softness
• Keep refrigerated to prevent melting and polymorphic changes
• Exposure to direct sunlight improves stability
• Freeze to prolong shelf life indefinitely

Correct Answer: Keep refrigerated to prevent melting and polymorphic changes

Q26. Which excipient can be used to enhance dissolution of a poorly soluble drug in a suppository?

• Hydrophobic waxes only
• Cyclodextrins or surfactants to improve solubility
• Strong acids to chemically modify the drug
• Colorants and flavors

Correct Answer: Cyclodextrins or surfactants to improve solubility

Q27. What is one advantage of PEG-based suppositories over cocoa butter bases?

• PEG bases undergo polymorphic transitions more readily
• PEG bases can be stored at room temperature without melting issues and are less likely to polymorph
• PEG bases are more lipophilic, increasing absorption of lipophilic drugs
• PEG bases always produce faster onset for local anesthesia

Correct Answer: PEG bases can be stored at room temperature without melting issues and are less likely to polymorph

Q28. Which clinical advantage makes suppositories useful in nausea and vomiting?

• They stimulate gastric emptying
• They bypass the oral route, allowing administration when vomiting prevents swallowing
• They always produce immediate systemic circulation within seconds
• They reduce need for dosing frequency to once per week

Correct Answer: They bypass the oral route, allowing administration when vomiting prevents swallowing

Q29. What is a potential microbiological concern with suppositories?

• Suppositories inherently sterilize the rectum
• Hygroscopic bases can support microbial growth if contaminated and preservatives may be needed
• All bases are bactericidal and no preservatives are required
• Suppositories always require aseptic manufacture

Correct Answer: Hygroscopic bases can support microbial growth if contaminated and preservatives may be needed

Q30. In designing a suppository for rapid systemic absorption, which strategy is most appropriate?

• Use a very hard, high-melting lipophilic base
• Formulate with a hydrophilic base, fine particle size, and penetration enhancers if safe
• Include slow-release polymers to prolong residence time
• Avoid any solubilizers to maintain solid integrity

Correct Answer: Formulate with a hydrophilic base, fine particle size, and penetration enhancers if safe

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