Anti-inflammatory agents – Ibuprofen MCQs With Answer

Anti-inflammatory agents – Ibuprofen MCQs With Answer
Ibuprofen is a widely used nonsteroidal anti-inflammatory drug (NSAID) crucial for B. Pharm students to master. This concise, focused set covers pharmacology, mechanism (COX inhibition), pharmacokinetics, formulations, therapeutic uses, adverse effects, drug interactions, chiral chemistry, and clinical monitoring. Emphasis is on evidence-based concepts like COX selectivity, renal and GI risks, effects on platelet function, metabolism (CYP2C9), and safe use in special populations. These MCQs are designed to deepen understanding, reinforce critical thinking, and prepare you for exams and practical dispensing decisions. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which enzyme isoform is primarily inhibited by ibuprofen to produce its anti-inflammatory effect?

• Cyclooxygenase-1 (COX-1)
• Cyclooxygenase-2 (COX-2)
• Lipoxygenase (LOX)
• Phospholipase A2 (PLA2)

Correct Answer: Cyclooxygenase-2 (COX-2)

Q2. Ibuprofen belongs to which chemical class of NSAIDs?

• Salicylates
• Propionic acid derivatives
• Acetic acid derivatives
• Oxicam derivatives

Correct Answer: Propionic acid derivatives

Q3. What is the primary pharmacological action responsible for ibuprofen’s antipyretic effect?

• Inhibition of thromboxane A2 synthesis in platelets
• Peripheral blockade of nociceptors
• Inhibition of hypothalamic prostaglandin E2 (PGE2) synthesis
• Stimulation of cortisol release from adrenal cortex

Correct Answer: Inhibition of hypothalamic prostaglandin E2 (PGE2) synthesis

Q4. Which statement about ibuprofen’s effect on platelet function is correct?

• It irreversibly inhibits platelet aggregation like aspirin
• It has no effect on platelets
• It reversibly inhibits platelet aggregation by blocking COX
• It enhances platelet aggregation by increasing thromboxane

Correct Answer: It reversibly inhibits platelet aggregation by blocking COX

Q5. Which cytochrome P450 enzyme is primarily involved in ibuprofen metabolism?

• CYP3A4
• CYP1A2
• CYP2C9
• CYP2D6

Correct Answer: CYP2C9

Q6. The S-enantiomer of ibuprofen is pharmacologically active because:

• R-enantiomer is converted to S-enantiomer in vivo (chiral inversion)
• S-enantiomer is converted to R-enantiomer in vivo
• Both enantiomers are equally active
• Ibuprofen is achiral and has no enantiomers

Correct Answer: R-enantiomer is converted to S-enantiomer in vivo (chiral inversion)

Q7. Which adverse effect is most commonly associated with therapeutic use of ibuprofen?

• Hepatic necrosis
• Gastrointestinal irritation and dyspepsia
• Sensorineural hearing loss
• Pancreatitis

Correct Answer: Gastrointestinal irritation and dyspepsia

Q8. Which of the following is a major renal adverse effect of NSAIDs including ibuprofen?

• Acute interstitial nephritis leading to glomerulonephritis
• Renal papillary necrosis and sodium retention due to reduced prostaglandins
• Direct tubular necrosis due to drug crystals
• Autoimmune-mediated nephrotic syndrome

Correct Answer: Renal papillary necrosis and sodium retention due to reduced prostaglandins

Q9. How does ibuprofen interact with ACE inhibitors and diuretics?

• It potentiates their antihypertensive effect by vasodilation
• It reduces their antihypertensive effect by decreasing renal prostaglandins
• It has no clinically relevant interaction
• It increases their renal clearance leading to hypotension

Correct Answer: It reduces their antihypertensive effect by decreasing renal prostaglandins

Q10. In overdose management of ibuprofen, which intervention is most appropriate if the ingestion was recent?

• Administer activated charcoal
• Perform hemodialysis immediately
• Give intravenous N-acetylcysteine
• Induce vomiting with syrup of ipecac

Correct Answer: Administer activated charcoal

Q11. Which prostaglandin primarily mediates inflammation and is decreased by ibuprofen?

• Prostaglandin D2 (PGD2)
• Prostaglandin E2 (PGE2)
• Leukotriene B4 (LTB4)
• Thromboxane A2 (TXA2)

Correct Answer: Prostaglandin E2 (PGE2)

Q12. What is the typical plasma protein binding characteristic of ibuprofen?

• Low (<30%) protein binding
• Moderate (30–60%) protein binding
• High (>90%) protein binding
• No protein binding

Correct Answer: High (>90%) protein binding

Q13. Which pharmacokinetic property explains why ibuprofen is often dosed every 4–6 hours?

• Short half-life of about 2 hours
• Long half-life of 24 hours
• Irreversible enzyme inhibition requiring new enzyme synthesis
• Depot storage in adipose tissue with slow release

Correct Answer: Short half-life of about 2 hours

Q14. Ibuprofen’s acidic pKa (~4.9) implies which of the following about its absorption?

• Poor oral absorption due to ionization in stomach
• Good oral absorption since it is mostly non-ionized in stomach
• Requires parenteral administration to be effective
• Absorption is unaffected by pKa

Correct Answer: Good oral absorption since it is mostly non-ionized in stomach

Q15. Which patient population should avoid ibuprofen use, especially in the third trimester?

• Patients with controlled asthma
• Pregnant women due to risk of premature closure of ductus arteriosus
• Children under 12 for analgesia
• Patients with diabetes mellitus

Correct Answer: Pregnant women due to risk of premature closure of ductus arteriosus

Q16. Compared to aspirin, ibuprofen’s inhibition of platelet aggregation is:

• Irreversible and longer lasting
• Reversible and shorter acting
• More potent and irreversible
• Nonexistent—ibuprofen does not affect platelets

Correct Answer: Reversible and shorter acting

Q17. Which formulation of ibuprofen provides rapid analgesia for acute pain?

• Enteric-coated tablet
• Sustained-release capsule
• Ibuprofen lysine (soluble salt) or liquid formulation
• Topical patch only

Correct Answer: Ibuprofen lysine (soluble salt) or liquid formulation

Q18. Chronic high-dose ibuprofen therapy can increase the risk of which cardiovascular event?

• Reduced risk of stroke
• No cardiovascular effects
• Increased risk of myocardial infarction and hypertension
• Complete cardioprotection similar to aspirin

Correct Answer: Increased risk of myocardial infarction and hypertension

Q19. Which laboratory parameter should be monitored in patients on long-term high-dose ibuprofen?

• Serum amylase only
• Serum creatinine and renal function tests
• Serum bilirubin only
• Blood glucose only

Correct Answer: Serum creatinine and renal function tests

Q20. Interaction between ibuprofen and warfarin may lead to:

• Reduced anticoagulant effect of warfarin
• Increased bleeding due to additive antiplatelet effect and displacement from protein binding
• No interaction; they act on different pathways
• Warfarin enhancing ibuprofen metabolism preventing toxicity

Correct Answer: Increased bleeding due to additive antiplatelet effect and displacement from protein binding

Q21. Which of the following is an absolute contraindication to ibuprofen use?

• Controlled hypertension
• History of NSAID-induced asthma with bronchospasm
• Mild seasonal allergic rhinitis
• Hyperlipidemia

Correct Answer: History of NSAID-induced asthma with bronchospasm

Q22. Which metabolic pathway converts ibuprofen to more water-soluble metabolites for excretion?

• Direct renal excretion unchanged
• Glucuronidation and CYP-mediated oxidation
• Reduction by gut flora only
• Conjugation with glutathione only

Correct Answer: Glucuronidation and CYP-mediated oxidation

Q23. For pediatric fever management, appropriate dosing guidance of ibuprofen is based on:

• Age alone without weight consideration
• Body weight (mg/kg) dosing
• Fixed adult dose for all children
• Only on severity of fever, not weight

Correct Answer: Body weight (mg/kg) dosing

Q24. Which adverse effect is linked to NSAIDs and may worsen heart failure?

• Diuresis causing dehydration
• Sodium and water retention increasing blood volume
• Improved cardiac contractility
• Reduction of systemic vascular resistance to cause hypotension

Correct Answer: Sodium and water retention increasing blood volume

Q25. Topical ibuprofen formulations primarily provide analgesia by:

• Systemic absorption and central COX inhibition
• Local tissue penetration and peripheral COX inhibition
• Enhancing local prostaglandin synthesis
• Blocking sodium channels in peripheral nerves only

Correct Answer: Local tissue penetration and peripheral COX inhibition

Q26. Ibuprofen reduces fever by acting on which part of the central nervous system?

• Medulla oblongata
• Hypothalamus
• Cerebral cortex
• Basal ganglia

Correct Answer: Hypothalamus

Q27. Which biochemical mediator’s synthesis is inhibited by ibuprofen leading to reduced inflammation and pain?

• Histamine
• Prostaglandins
• Acetylcholine
• Gamma-aminobutyric acid (GABA)

Correct Answer: Prostaglandins

Q28. Which statement about ibuprofen’s effect on gastric mucosa is true?

• It increases mucosal prostaglandin production
• It decreases mucosal prostaglandin synthesis leading to increased risk of ulcers
• It has a protective effect preventing ulcers
• It has no effect on gastric mucosa

Correct Answer: It decreases mucosal prostaglandin synthesis leading to increased risk of ulcers

Q29. What is the role of prostacyclin (PGI2) inhibition by NSAIDs in cardiovascular risk?

• Decreased PGI2 may promote thrombosis by removing anti-platelet and vasodilatory effects
• PGI2 inhibition reduces thrombosis risk and protects the heart
• PGI2 has no role in vascular homeostasis
• Decreased PGI2 causes pronounced bleeding tendency

Correct Answer: Decreased PGI2 may promote thrombosis by removing anti-platelet and vasodilatory effects

Q30. Which monitoring parameter is particularly important in elderly patients on chronic ibuprofen therapy?

• Bone mineral density
• Renal function and blood pressure
• Pulmonary function tests
• Serum sodium only

Correct Answer: Renal function and blood pressure

Q31. Which drug interaction may be reduced by spacing dosing times between ibuprofen and low-dose aspirin?

• Interaction with warfarin
• Competitive inhibition at platelet COX restoring aspirin’s antiplatelet effect
• Inhibition of CYP3A4 metabolism of statins
• Potentiation of ACE inhibitor effects

Correct Answer: Competitive inhibition at platelet COX restoring aspirin’s antiplatelet effect

Q32. Which laboratory sign might indicate NSAID-induced interstitial nephritis?

• Isolated hyperglycemia
• Eosinophiluria and rising serum creatinine
• Marked elevation of ALT and AST
• Elevated hemoglobin only

Correct Answer: Eosinophiluria and rising serum creatinine

Q33. Which dosing strategy minimizes GI side effects of oral ibuprofen?

• Taking on an empty stomach
• Using the lowest effective dose for the shortest duration and taking with food
• High dose pulse therapy without PPI cover
• Switching to intravenous dosing routinely

Correct Answer: Using the lowest effective dose for the shortest duration and taking with food

Q34. Which clinical indication is ibuprofen commonly used for?

• Treatment of bacterial infections
• Analgesia for musculoskeletal pain and antipyresis
• Primary chemotherapy agent for cancer
• Long-term disease-modifying therapy in rheumatoid arthritis without monitoring

Correct Answer: Analgesia for musculoskeletal pain and antipyresis

Q35. Which of the following best describes ibuprofen’s mechanism at the molecular level?

• Activation of COX enzymes increasing prostaglandin synthesis
• Non-selective reversible inhibition of COX enzymes decreasing prostaglandin synthesis
• Selective irreversible inhibition of COX-2 only
• Inhibition of lipoxygenase pathway producing leukotrienes

Correct Answer: Non-selective reversible inhibition of COX enzymes decreasing prostaglandin synthesis

Q36. Which adverse effect is particularly a concern when combining ibuprofen with corticosteroids?

• Reduced therapeutic effect of steroids
• Marked increased risk of gastrointestinal ulceration and bleeding
• Corticosteroids prevent ibuprofen analgesia entirely
• No additional risk; combination is safe

Correct Answer: Marked increased risk of gastrointestinal ulceration and bleeding

Q37. Which statement about ibuprofen’s stereochemistry is correct?

• Only the R-enantiomer is present in commercial formulations
• Ibuprofen is marketed as a racemate; R-to-S inversion yields active S-form
• Enantiomers are stable and do not interconvert in vivo
• Both enantiomers are inactive until metabolized to glucuronides

Correct Answer: Ibuprofen is marketed as a racemate; R-to-S inversion yields active S-form

Q38. Which statement is true regarding ibuprofen and asthma exacerbations?

• All asthmatics tolerate NSAIDs without risk
• Some aspirin-sensitive asthmatics may cross-react and experience bronchospasm with ibuprofen
• Ibuprofen is protective against asthma attacks
• NSAIDs cure aspirin-sensitive asthma

Correct Answer: Some aspirin-sensitive asthmatics may cross-react and experience bronchospasm with ibuprofen

Q39. Which pharmacological effect differentiates selective COX-2 inhibitors from traditional NSAIDs like ibuprofen?

• Selective COX-2 inhibitors spare gastric COX-1-mediated prostaglandins, reducing GI toxicity
• COX-2 inhibitors irreversibly inhibit platelets more than ibuprofen
• COX-2 inhibitors have no cardiovascular risks
• COX-2 inhibitors are inactive as analgesics

Correct Answer: Selective COX-2 inhibitors spare gastric COX-1-mediated prostaglandins, reducing GI toxicity

Q40. Which of the following is true about ibuprofen excretion?

• Excreted mainly unchanged in feces
• Metabolites are excreted primarily in urine as glucuronide conjugates
• Eliminated entirely via pulmonary exhalation
• Stored indefinitely in the liver and slowly released

Correct Answer: Metabolites are excreted primarily in urine as glucuronide conjugates

Q41. Which clinical sign may indicate NSAID-induced gastric bleeding?

• Bradycardia and hypotension only
• Melena, hematemesis, or unexplained anemia
• Polyuria and polydipsia
• Peripheral neuropathy

Correct Answer: Melena, hematemesis, or unexplained anemia

Q42. When counseling patients on OTC ibuprofen, which advice is most appropriate?

• Take the highest possible dose for best effect
• Avoid alcohol and use the lowest effective dose for the shortest duration
• Combine with another NSAID for synergy
• It is safe to use continuously without medical review

Correct Answer: Avoid alcohol and use the lowest effective dose for the shortest duration

Q43. Which condition may be masked by ibuprofen leading to delayed diagnosis?

• Infection due to suppression of fever and inflammation
• Diabetes mellitus due to lowering blood glucose
• Hypertension due to significant blood pressure lowering
• Hyperthyroidism due to reduced symptoms

Correct Answer: Infection due to suppression of fever and inflammation

Q44. For a patient with peptic ulcer disease, which strategy is safest regarding analgesia?

• Recommend high-dose ibuprofen without protection
• Avoid NSAIDs and consider acetaminophen or add PPI if NSAID unavoidable
• Combine ibuprofen with aspirin for gastric protection
• Topical NSAIDs increase systemic risk equally and are unsafe

Correct Answer: Avoid NSAIDs and consider acetaminophen or add PPI if NSAID unavoidable

Q45. Which statement describes the onset of analgesia for oral ibuprofen?

• Onset is typically within 30–60 minutes
• Onset requires 24 hours for effect
• Onset is immediate as soon as tablet is swallowed
• Onset never occurs with oral formulation

Correct Answer: Onset is typically within 30–60 minutes

Q46. Which metabolic interaction could increase ibuprofen plasma levels and toxicity?

• Concomitant use of CYP2C9 inhibitors like fluconazole
• Concurrent use of enzyme inducers like rifampicin
• Concurrent antacids reducing absorption
• Co-administration with vitamin C

Correct Answer: Concomitant use of CYP2C9 inhibitors like fluconazole

Q47. Which statement correctly reflects ibuprofen’s use in rheumatoid arthritis?

• It is disease-modifying and halts joint destruction
• It provides symptomatic relief of pain and inflammation but is not disease-modifying
• It is contraindicated in all forms of inflammatory arthritis
• It cures rheumatoid arthritis when combined with antibiotics

Correct Answer: It provides symptomatic relief of pain and inflammation but is not disease-modifying

Q48. Why might an ibuprofen tablet be enteric-coated?

• To increase immediate stomach absorption
• To reduce gastric irritation by delaying release until the intestine
• To make the tablet taste better
• To ensure it bypasses intestinal absorption entirely

Correct Answer: To reduce gastric irritation by delaying release until the intestine

Q49. Which adverse effect necessitates immediate discontinuation of ibuprofen?

• Mild headache after administration
• Signs of severe allergic reaction such as urticaria, angioedema, or bronchospasm
• Transient mild nausea
• Brief dizziness that resolves

Correct Answer: Signs of severe allergic reaction such as urticaria, angioedema, or bronchospasm

Q50. In terms of public health, why is rational dispensing of ibuprofen important in community pharmacy?

• Ibuprofen has no risks and can be sold without counseling
• Rational dispensing minimizes misuse, avoids harmful drug interactions, and reduces adverse events
• It increases pharmacy profits irrespective of safety
• It is unnecessary because pharmacists cannot influence patient outcomes

Correct Answer: Rational dispensing minimizes misuse, avoids harmful drug interactions, and reduces adverse events

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com