Anti-inflammatory agents – Indomethacin MCQs With Answer

Anti-inflammatory agents like Indomethacin are pivotal in B. Pharm curricula, blending core pharmacology with clinical application. This concise, keyword-rich introduction and question set focuses on Indomethacin MCQs with answers, covering mechanism of action, NSAID classification, pharmacokinetics, dosing, adverse effects, contraindications, drug interactions, and monitoring. Questions explore COX inhibition, prostaglandin synthesis, hepatic metabolism, protein binding, renal and gastrointestinal safety, and therapeutic uses such as gout and patent ductus arteriosus. Designed to deepen conceptual understanding and exam readiness, these MCQs help students integrate theory with practical considerations. Study systematically and confidently. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which chemical class does Indomethacin belong to?

• Indole acetic acid derivative
• Salicylate
• Propionic acid derivative
• Coxib (selective COX-2 inhibitor)

Correct Answer: Indole acetic acid derivative

Q2. The primary mechanism of action of Indomethacin is:

• Selective COX-2 inhibition only
• Non-selective inhibition of cyclooxygenase (COX-1 and COX-2)
• Inhibition of lipoxygenase pathway only
• Activation of phospholipase A2

Correct Answer: Non-selective inhibition of cyclooxygenase (COX-1 and COX-2)

Q3. Indomethacin reduces inflammation mainly by decreasing synthesis of:

• Leukotrienes
• Histamine
• Prostaglandins
• Cytokines via TNF-alpha blockade

Correct Answer: Prostaglandins

Q4. Which additional pharmacodynamic effect is associated with Indomethacin apart from COX inhibition?

• Inhibition of neutrophil chemotaxis
• Beta-adrenergic blockade
• Calcium channel blocking
• Monoamine oxidase inhibition

Correct Answer: Inhibition of neutrophil chemotaxis

Q5. Indomethacin is particularly indicated in acute management of:

• Chronic heart failure
• Gouty arthritis attacks
• Type 2 diabetes mellitus
• Schizophrenia

Correct Answer: Gouty arthritis attacks

Q6. Which pediatric or neonatal indication is Indomethacin used for?

• Closure of patent ductus arteriosus (PDA)
• Treatment of neonatal sepsis
• Prevention of intraventricular hemorrhage
• Management of neonatal hypoglycemia

Correct Answer: Closure of patent ductus arteriosus (PDA)

Q7. The oral bioavailability of Indomethacin is best described as:

• Very low due to poor absorption
• High, with rapid absorption from the gastrointestinal tract
• Zero because it is only given parenterally
• Complete only after rectal administration

Correct Answer: High, with rapid absorption from the gastrointestinal tract

Q8. Indomethacin has a high degree of plasma protein binding. This affects its pharmacokinetics by:

• Increasing renal clearance dramatically
• Reducing free drug concentration and prolonging half-life
• Causing rapid hepatic uptake and immediate excretion
• Preventing it from crossing the blood-brain barrier

Correct Answer: Reducing free drug concentration and prolonging half-life

Q9. The approximate elimination half-life of Indomethacin in adults is:

• 0.5–1 hour
• 2–5 hours
• 24–48 hours
• 7–14 days

Correct Answer: 2–5 hours

Q10. Major metabolic pathways for Indomethacin include:

• Renal excretion unchanged only
• Hepatic metabolism (O-demethylation and glucuronidation)
• Direct sulfation in plasma exclusively
• Metabolism by monoamine oxidase

Correct Answer: Hepatic metabolism (O-demethylation and glucuronidation)

Q11. Which adverse effect is most characteristically associated with Indomethacin?

• Severe gastrointestinal ulceration and bleeding
• Chronic hyperglycemia
• Permanent hearing loss in all patients
• Profound immunosuppression

Correct Answer: Severe gastrointestinal ulceration and bleeding

Q12. Indomethacin is contraindicated in which stage of pregnancy?

• First trimester only
• Second trimester only
• Third trimester because of premature closure of ductus arteriosus
• It is safe throughout pregnancy

Correct Answer: Third trimester because of premature closure of ductus arteriosus

Q13. Which renal adverse effect can result from prolonged Indomethacin therapy?

• Renal papillary necrosis and reduced renal perfusion
• Polyuria and diabetes insipidus
• Increased creatinine clearance
• Nephrogenic adenoma formation

Correct Answer: Renal papillary necrosis and reduced renal perfusion

Q14. Indomethacin interaction with ACE inhibitors is clinically important because NSAIDs may:

• Enhance ACE inhibitor antihypertensive effect
• Reduce the antihypertensive effect and impair renal function
• Cause a direct chemical inactivation of ACE inhibitors
• Prevent ACE inhibitors absorption in the gut

Correct Answer: Reduce the antihypertensive effect and impair renal function

Q15. Indomethacin increases the risk of bleeding when combined with:

• Vitamin C supplements
• Warfarin or other oral anticoagulants
• Metformin
• Proton pump inhibitors

Correct Answer: Warfarin or other oral anticoagulants

Q16. Which laboratory test should be monitored when a patient is on chronic Indomethacin therapy?

• Fasting blood glucose only
• Renal function tests and liver function tests
• Thyroid function tests routinely
• Blood ethanol concentration

Correct Answer: Renal function tests and liver function tests

Q17. Indomethacin’s central nervous system adverse effects include:

• Headache, dizziness, and sometimes confusion or depression
• Seizures in all patients within hours
• Muscle hypertrophy
• Peripheral neuropathy exclusively

Correct Answer: Headache, dizziness, and sometimes confusion or depression

Q18. Compared to ibuprofen, Indomethacin is generally considered:

• Less potent and safer for GI tract
• More potent with higher risk of CNS and GI adverse effects
• A selective COX-2 inhibitor
• Inactive when taken orally

Correct Answer: More potent with higher risk of CNS and GI adverse effects

Q19. Which formulation of Indomethacin may be used for localized topical pain relief?

• Oral capsule only
• Rectal suppository
• Topical gel/ointment
• Intravenous infusion exclusively

Correct Answer: Topical gel/ointment

Q20. The use of Indomethacin with lithium may result in:

• Reduced lithium levels due to enhanced renal clearance
• No interaction expected clinically
• Increased lithium levels and potential toxicity due to reduced renal clearance
• Complete inactivation of lithium in plasma

Correct Answer: Increased lithium levels and potential toxicity due to reduced renal clearance

Q21. In a patient with peptic ulcer disease, Indomethacin should be:

• Preferred because it heals ulcers
• Used with caution or avoided due to risk of exacerbation
• Given at very high doses to avoid irritation
• Combined with aspirin to reduce ulcer risk

Correct Answer: Used with caution or avoided due to risk of exacerbation

Q22. Which of the following is a sign of Indomethacin overdose?

• Hypotension, renal impairment, and CNS depression
• Excessive salivation and sweating only
• Hyperglycemia and polydipsia exclusively
• Marked hyperreflexia without other symptoms

Correct Answer: Hypotension, renal impairment, and CNS depression

Q23. Indomethacin’s effect on platelet function is due to:

• Stimulation of platelet aggregation
• Inhibition of thromboxane A2 synthesis via COX inhibition
• Direct binding and inactivation of fibrinogen
• Activation of vitamin K dependent clotting factors

Correct Answer: Inhibition of thromboxane A2 synthesis via COX inhibition

Q24. Indomethacin is often avoided in elderly patients because they are:

• At lower risk for cardiovascular events
• More susceptible to NSAID-related renal, GI, and CNS adverse effects
• Universally resistant to Indomethacin’s effects
• Less likely to take other medications

Correct Answer: More susceptible to NSAID-related renal, GI, and CNS adverse effects

Q25. Which enzyme system primarily contributes to Indomethacin metabolism?

• CYP3A4 only
• CYP2C9 and conjugation pathways
• CYP1A2 exclusively
• MAO-B primarily

Correct Answer: CYP2C9 and conjugation pathways

Q26. Enterohepatic recirculation of Indomethacin can cause:

• Reduced duration of action
• Prolonged plasma presence and sustained effects
• Complete prevention of GI side effects
• Immediate renal elimination

Correct Answer: Prolonged plasma presence and sustained effects

Q27. Which vital sign or parameter may worsen with NSAID therapy including Indomethacin?

• Blood pressure (may increase due to fluid retention)
• Resting heart rate always decreases
• Respiratory rate increases dramatically
• Pupillary constriction occur

Correct Answer: Blood pressure (may increase due to fluid retention)

Q28. Which monitoring is important when combining Indomethacin with methotrexate?

• No monitoring required
• Monitor for increased risk of methotrexate toxicity (hematologic and hepatic)
• Only monitor blood glucose
• Only monitor serum magnesium

Correct Answer: Monitor for increased risk of methotrexate toxicity (hematologic and hepatic)

Q29. Which statement about Indomethacin’s COX selectivity is correct?

• Highly selective for COX-2, sparing COX-1
• Non-selective but with relatively greater COX-1 inhibition contributing to GI toxicity
• Does not inhibit COX enzymes at therapeutic doses
• Selective for lipoxygenase rather than COX

Correct Answer: Non-selective but with relatively greater COX-1 inhibition contributing to GI toxicity

Q30. For acute gout, an advantage of Indomethacin is:

• Rapid anti-inflammatory action effective in relieving acute pain
• It dissolves urate crystals directly
• It increases uric acid excretion dramatically
• It has no gastrointestinal side effects compared to other NSAIDs

Correct Answer: Rapid anti-inflammatory action effective in relieving acute pain

Q31. Which GI protective measure can be combined with Indomethacin to reduce ulcer risk?

• Concomitant use of proton pump inhibitors or misoprostol
• High-dose aspirin co-therapy
• Administration with concentrated orange juice only
• No protective strategies exist

Correct Answer: Concomitant use of proton pump inhibitors or misoprostol

Q32. Indomethacin is classified under which pregnancy category in many formularies (historically)?

• Category A (safe in pregnancy)
• Category C/D (risk in later pregnancy, avoid especially third trimester)
• Category X (absolutely contraindicated at all times)
• Category B (no risk shown)

Correct Answer: Category C/D (risk in later pregnancy, avoid especially third trimester)

Q33. Which symptom should prompt immediate discontinuation of Indomethacin?

• Mild occasional headache
• Black, tarry stools suggestive of GI bleeding
• Slight thirst after exercise
• Mild transient nausea once

Correct Answer: Black, tarry stools suggestive of GI bleeding

Q34. Compared to aspirin, Indomethacin’s antiplatelet effect is:

• Identical and irreversible
• Less predictable and generally reversible on platelet function recovery
• Completely absent
• Permanent for the life of the platelet

Correct Answer: Less predictable and generally reversible on platelet function recovery

Q35. Which of the following is a CNS adverse reaction more commonly reported with Indomethacin than many other NSAIDs?

• Severe sedation and hallucinations in some patients
• Paralysis of extremities
• Increased intellectual performance
• Immediate anesthesia

Correct Answer: Severe sedation and hallucinations in some patients

Q36. When counseling patients on Indomethacin, advise them to avoid which of the following?

• Using concomitant NSAIDs or high-dose aspirin without medical advice
• Light exercise
• Eating a balanced meal
• Regular dental checkups

Correct Answer: Using concomitant NSAIDs or high-dose aspirin without medical advice

Q37. Indomethacin can precipitate which cardiovascular effect in susceptible patients?

• Reduction of blood pressure to dangerous levels
• Fluid retention and exacerbation of hypertension or heart failure
• Immediate vasodilation leading to syncope in all patients
• Permanent bradycardia

Correct Answer: Fluid retention and exacerbation of hypertension or heart failure

Q38. Which of the following pharmacological properties explains Indomethacin’s effectiveness in closing a patent ductus arteriosus?

• Enhancement of prostaglandin E2 synthesis
• Inhibition of prostaglandin synthesis leading to ductal constriction
• Direct stimulation of smooth muscle relaxation in the ductus
• Promotion of nitric oxide production

Correct Answer: Inhibition of prostaglandin synthesis leading to ductal constriction

Q39. Which dosing strategy is commonly used for acute pain/inflammation with Indomethacin in adults?

• Single daily dose of 500 mg
• 25–50 mg two to three times daily, adjusted to response
• Microgram dosing due to extreme potency
• Only continuous IV infusion is effective

Correct Answer: 25–50 mg two to three times daily, adjusted to response

Q40. Which patient condition requires special caution or dose adjustment when prescribing Indomethacin?

• Severe hepatic impairment or severe renal impairment
• Allergic rhinitis controlled by antihistamines
• Mild controlled myopia
• Previous appendectomy without complications

Correct Answer: Severe hepatic impairment or severe renal impairment

Q41. Which of the following best describes Indomethacin’s effect on uterine contractions?

• It increases uterine tone and is used to induce labor
• It decreases uterine prostaglandins and may reduce contractions, hence avoided in late pregnancy
• It has no effect on uterine activity
• It causes irreversible paralysis of uterine muscle

Correct Answer: It decreases uterine prostaglandins and may reduce contractions, hence avoided in late pregnancy

Q42. What pharmacokinetic property explains why Indomethacin may require less frequent dosing in some formulations?

• Extremely rapid renal excretion
• High protein binding and possible enterohepatic recirculation prolong its effect
• Immediate metabolism to inactive water-soluble metabolites only
• Rapid evaporation from tissues

Correct Answer: High protein binding and possible enterohepatic recirculation prolong its effect

Q43. Which adverse effect is a dermatologic reaction associated with Indomethacin?

• Severe photosensitivity, rash, and rarely Stevens-Johnson syndrome
• Painless thickening of nails only
• Immediate hair regrowth stimulation
• Permanent tattooing of the skin

Correct Answer: Severe photosensitivity, rash, and rarely Stevens-Johnson syndrome

Q44. Indomethacin should be used with caution in patients taking which class of antidepressants due to increased bleeding risk?

• Tricyclic antidepressants (TCAs) exclusively
• Selective serotonin reuptake inhibitors (SSRIs)
• Monoamine oxidase inhibitors (MAOIs) with no interaction
• Bupropion only

Correct Answer: Selective serotonin reuptake inhibitors (SSRIs)

Q45. Which is true regarding Indomethacin’s use for chronic inflammatory conditions like ankylosing spondylitis?

• It is never used because it has no effect on chronic inflammation
• It can be effective but long-term use requires monitoring for GI, renal, and cardiovascular risks
• It cures ankylosing spondylitis with a single dose
• It is the safest long-term option without monitoring

Correct Answer: It can be effective but long-term use requires monitoring for GI, renal, and cardiovascular risks

Q46. Which patient history would be a contraindication to prescribing Indomethacin?

• History of aspirin-exacerbated respiratory disease (AERD) with bronchospasm on NSAIDs
• Controlled mild seasonal allergies
• History of treated seborrheic dermatitis
• Previous vaccine administration months ago

Correct Answer: History of aspirin-exacerbated respiratory disease (AERD) with bronchospasm on NSAIDs

Q47. Which statement is true regarding Indomethacin and protein binding displacement interactions?

• Drugs that displace Indomethacin from protein binding sites may increase its free concentration and toxicity
• Protein binding interactions are clinically irrelevant for Indomethacin
• Indomethacin always displaces other drugs without risk
• Protein binding is so low that displacement does not occur

Correct Answer: Drugs that displace Indomethacin from protein binding sites may increase its free concentration and toxicity

Q48. Which adverse metabolic change can occur with NSAID therapy including Indomethacin?

• Hyperkalemia due to decreased renal prostaglandin-mediated potassium excretion
• Persistent hypokalemia in all patients
• Marked increase in insulin secretion
• Severe lactic acidosis routinely

Correct Answer: Hyperkalemia due to decreased renal prostaglandin-mediated potassium excretion

Q49. In pharmacology practical exams, an important point about Indomethacin’s structure is that it contains:

• An indole ring attached to an acetic acid moiety
• A sulfonylurea nucleus
• A benzodiazepine core
• A glycopeptide backbone

Correct Answer: An indole ring attached to an acetic acid moiety

Q50. Which patient counseling point is essential when starting Indomethacin therapy?

• Stop other medications immediately without consulting a physician
• Report any signs of GI bleeding, rash, decreased urine output, or severe headache promptly
• Double the dose if pain persists after a single dose
• It is safe to use in late pregnancy to relieve pain

Correct Answer: Report any signs of GI bleeding, rash, decreased urine output, or severe headache promptly

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