Advantages and disadvantages of suppositories MCQs With Answer

Introduction: Advantages and Disadvantages of Suppositories MCQs With Answer

Suppositories are solid dosage forms intended for rectal, vaginal, or urethral delivery, offering local and systemic effects. Key advantages include partial avoidance of first-pass metabolism, suitability for pediatric/geriatric patients, use during vomiting or dysphagia, and targeted therapy for hemorrhoids, proctitis, or vaginal infections. Disadvantages include variable absorption due to rectal contents, leakage, irritation, patient acceptability issues, and storage/stability concerns. Understanding base selection (cocoa butter, PEG, glycerinated gelatin), bioavailability, displacement value, mold calibration, drug release mechanisms, mucoadhesion, and quality tests (liquefaction, disintegration, content uniformity) is essential for B. Pharm students. This introduction covers formulation science, clinical use, and limitations to optimize suppository design and counseling. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which key advantage of rectal suppositories can improve systemic bioavailability for certain drugs?

• Complete avoidance of hepatic first-pass metabolism
• Partial avoidance of hepatic first-pass metabolism via lower hemorrhoidal veins
• Increased gastric emptying rate
• Guaranteed 100% bioavailability

Correct Answer: Partial avoidance of hepatic first-pass metabolism via lower hemorrhoidal veins

Q2. Which base typically melts at body temperature and releases the drug by melting in the rectum?

• Polyethylene glycol (PEG) 1500/4000 blends
• Glycerinated gelatin
• Theobroma oil (cocoa butter)
• Hydroxypropyl methylcellulose (HPMC)

Correct Answer: Theobroma oil (cocoa butter)

Q3. A common disadvantage of glycerinated gelatin suppositories, especially rectally, is:

• High risk of rancidity
• Hygroscopicity leading to mucosal dehydration and irritation
• Excessive melting at room temperature
• Incompatibility with water-soluble drugs

Correct Answer: Hygroscopicity leading to mucosal dehydration and irritation

Q4. Typical onset time for systemic effect after rectal administration is approximately:

• 1–5 minutes
• 15–60 minutes
• 2–4 hours
• 12–24 hours

Correct Answer: 15–60 minutes

Q5. In which clinical scenario is a rectal suppository particularly advantageous?

• Patient with persistent vomiting and cannot retain oral medication
• Patient with chronic diarrhea
• Patient requiring immediate IV-level onset
• Patient with excellent oral compliance

Correct Answer: Patient with persistent vomiting and cannot retain oral medication

Q6. Which venous drainage primarily contributes to reducing first-pass metabolism after rectal dosing?

• Superior hemorrhoidal vein to portal circulation
• Lower and middle hemorrhoidal veins to systemic circulation
• Hepatic portal vein directly
• Mesenteric venous plexus exclusively

Correct Answer: Lower and middle hemorrhoidal veins to systemic circulation

Q7. Which base offers better stability in hot climates, reducing the disadvantage of leakage?

• Theobroma oil (cocoa butter)
• Polyethylene glycol (PEG) bases
• Witepsol (hard fat) with low slip point
• Glycerinated gelatin without preservatives

Correct Answer: Polyethylene glycol (PEG) bases

Q8. Which factor most increases variability in rectal drug absorption?

• Isotonicity of the formulation
• Presence of fecal matter and rectal contents
• Use of antioxidants
• Foil strip packaging

Correct Answer: Presence of fecal matter and rectal contents

Q9. The displacement value (DV) in suppository formulation is defined as:

• The ratio of base density to drug density
• The weight of drug that displaces 1 g of base
• The weight of base displaced by 1 g of water
• The percentage of drug released in 60 minutes

Correct Answer: The weight of drug that displaces 1 g of base

Q10. Which strategy can reduce the disadvantage of post-insertion leakage and improve retention?

• Using low-viscosity fatty bases
• Incorporating mucoadhesive polymers (e.g., carbopol, HPMC)
• Increasing suppository weight beyond 5 g
• Adding excess surfactant

Correct Answer: Incorporating mucoadhesive polymers (e.g., carbopol, HPMC)

Q11. A notable non-pharmacological disadvantage of suppositories is:

• Absolute sterility requirement
• Poor patient acceptability due to cultural and comfort concerns
• Requirement for parenteral facilities
• High manufacturing temperature

Correct Answer: Poor patient acceptability due to cultural and comfort concerns

Q12. Why is it commonly advised to moisten PEG suppositories with water before insertion?

• To prevent melting
• To facilitate dissolution and reduce mucosal irritation
• To increase lipid solubility
• To avoid oxidation

Correct Answer: To facilitate dissolution and reduce mucosal irritation

Q13. To avoid polymorphic transition of cocoa butter to a low-melting form during manufacturing, one should:

• Heat above 60°C then rapidly cool to 0°C
• Gently melt below 36°C and avoid overheating
• Add large amounts of water
• Store at 40–45°C

Correct Answer: Gently melt below 36°C and avoid overheating

Q14. Which base is most associated with the disadvantage of leakage after insertion?

• PEG base (solid dissolving matrix)
• Cocoa butter (melting fatty base)
• Glycerinated gelatin (slow-dissolving)
• Carbopol gel base

Correct Answer: Cocoa butter (melting fatty base)

Q15. Rectal dosing may still undergo noticeable first-pass metabolism when:

• Suppository is inserted shallowly to target lower hemorrhoidal veins
• Drug is highly hydrophilic
• Suppository is inserted too high, favoring superior hemorrhoidal vein drainage
• Patient lies in left lateral position

Correct Answer: Suppository is inserted too high, favoring superior hemorrhoidal vein drainage

Q16. Which quality test evaluates the softening/melting behavior of suppositories at body temperature?

• Friability test
• Liquefaction (softening) time test
• Angle of repose
• Loss on drying

Correct Answer: Liquefaction (softening) time test

Q17. Glycerinated gelatin bases are most appropriately used for:

• Rectal systemic delivery to avoid irritation
• Vaginal suppositories requiring prolonged local action
• Urethral bougies for rapid onset
• Parenteral injections

Correct Answer: Vaginal suppositories requiring prolonged local action

Q18. Reducing particle size of a suspended drug in a suppository primarily:

• Decreases dissolution rate
• Increases surface area and enhances drug release
• Prevents oxidation entirely
• Eliminates the need for surfactants

Correct Answer: Increases surface area and enhances drug release

Q19. Which is an advantage of rectal administration over oral for acid-labile drugs?

• Enhanced exposure to gastric enzymes
• Avoidance of gastric acidity and part of GI enzymatic degradation
• Guaranteed absorption independent of physiology
• Higher patient preference

Correct Answer: Avoidance of gastric acidity and part of GI enzymatic degradation

Q20. Rectal suppositories are generally unsuitable during:

• Constipation
• Diarrhea with frequent bowel movements
• Vomiting episodes
• Dysphagia

Correct Answer: Diarrhea with frequent bowel movements

Q21. The typical weight of an adult rectal suppository (cocoa butter base) is approximately:

• 0.5 g
• 1.0 g
• 2.0 g
• 4.0 g

Correct Answer: 2.0 g

Q22. An example of a drug commonly delivered vaginally for local action (advantage: targeted therapy) is:

• Clotrimazole
• Heparin
• Insulin
• Gentamicin IV

Correct Answer: Clotrimazole

Q23. Which drug–base pairing generally promotes faster release for systemic effect?

• Lipophilic drug in fatty base
• Hydrophilic drug in fatty base
• Hydrophilic drug in PEG base
• Lipophilic drug in PEG base with high PEG-400 content only

Correct Answer: Hydrophilic drug in fatty base

Q24. Inclusion of a mild surfactant (e.g., polysorbate 80) in suppositories primarily:

• Increases rancidity
• Improves wetting and spreading, enhancing drug release
• Eliminates need for preservatives
• Raises melting point significantly

Correct Answer: Improves wetting and spreading, enhancing drug release

Q25. The recommended position to improve rectal suppository insertion and retention is:

• Right lateral with lower leg flexed
• Left lateral (Sim’s) with upper leg flexed
• Prone with hips elevated
• Supine with legs straight

Correct Answer: Left lateral (Sim’s) with upper leg flexed

Q26. A disadvantage specific to urethral suppositories (bougies) is:

• Very slow onset of action
• High risk of urethral irritation and discomfort
• Requirement for general anesthesia
• Incompatibility with all antibiotics

Correct Answer: High risk of urethral irritation and discomfort

Q27. To minimize oxidation and leakage of fatty-base suppositories, a suitable packaging/storage approach is:

• Paper wraps at room temperature
• Aluminum foil strip/blister, light- and air-tight, stored cool
• Open trays under dry heat
• Clear PET bottles without seals

Correct Answer: Aluminum foil strip/blister, light- and air-tight, stored cool

Q28. Which factor most increases the risk of post-insertion leakage for fatty-base suppositories?

• High ambient temperature
• Inclusion of mucoadhesive polymer
• Use of PEG base
• Smaller particle size of drug

Correct Answer: High ambient temperature

Q29. A therapeutic advantage of local rectal therapy (e.g., hydrocortisone suppositories for proctitis) is:

• Higher systemic side effects
• Targeted action with reduced systemic exposure
• Guaranteed zero irritation
• Total independence from technique of insertion

Correct Answer: Targeted action with reduced systemic exposure

Q30. A suppository mold yields 2.0 g cocoa butter base per unit. If a drug has a displacement value (DV) of 3 and each unit must contain 0.6 g drug, how much base is displaced per unit?

• 0.10 g
• 0.20 g
• 0.30 g
• 0.60 g

Correct Answer: 0.20 g

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