Anti-inflammatory agents – Ketorolac MCQs With Answer
Ketorolac is an important NSAID studied under anti-inflammatory agents for B. Pharm students. This concise introduction covers key pharmacology: nonselective COX inhibition, potent analgesic effects, pharmacokinetics (rapid onset, high protein binding, hepatic metabolism, renal excretion), common formulations (IV, IM, oral, ophthalmic), major adverse effects (GI bleeding, renal impairment, platelet dysfunction), important drug interactions, and clinical restrictions (short-term use only). Understanding ketorolac’s mechanism, safety profile, and monitoring is essential for safe dispensing and therapeutics. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which mechanism best describes ketorolac’s primary pharmacological action?
- Selective COX-2 inhibition
- Nonselective reversible inhibition of COX enzymes
- Inhibition of lipoxygenase pathway
- Opioid receptor agonism
Correct Answer: Nonselective reversible inhibition of COX enzymes
Q2. Ketorolac is classified pharmacologically as which of the following?
- Opioid analgesic
- Acetaminophen analog
- Nonsteroidal anti-inflammatory drug (NSAID)
- Corticosteroid
Correct Answer: Nonsteroidal anti-inflammatory drug (NSAID)
Q3. Which clinical use is ketorolac most commonly indicated for?
- Long-term management of osteoarthritis
- Short-term management of moderate to severe acute pain
- Chronic neuropathic pain
- As first-line therapy for rheumatoid arthritis maintenance
Correct Answer: Short-term management of moderate to severe acute pain
Q4. What is the maximum recommended duration of ketorolac therapy to reduce risk of serious adverse effects?
- 1 day
- 5 days
- 14 days
- 30 days
Correct Answer: 5 days
Q5. Which of the following adverse effects is most strongly associated with ketorolac?
- Severe hepatotoxicity as a common effect
- Significant risk of gastrointestinal bleeding and ulceration
- Hypoglycemia
- Thyroid dysfunction
Correct Answer: Significant risk of gastrointestinal bleeding and ulceration
Q6. Ketorolac’s analgesic potency is often compared to which class of drugs?
- Low-potency benzodiazepines
- Moderate potency opioids
- Tricyclic antidepressants
- Local anesthetics
Correct Answer: Moderate potency opioids
Q7. Which patient population is specifically warned against ketorolac use during late pregnancy?
- First trimester only
- Second trimester only
- Third trimester due to risk of premature closure of ductus arteriosus
- All trimesters are safe
Correct Answer: Third trimester due to risk of premature closure of ductus arteriosus
Q8. The primary route of elimination for ketorolac is:
- Renal excretion of metabolites
- Exhalation via lungs
- Fecal excretion unchanged
- Metabolism to active opioid metabolites
Correct Answer: Renal excretion of metabolites
Q9. Which laboratory parameter should be closely monitored in patients on ketorolac therapy?
- Serum potassium only
- Complete blood count and renal function tests
- Thyroid stimulating hormone
- Fasting blood glucose only
Correct Answer: Complete blood count and renal function tests
Q10. Ketorolac can adversely affect platelet function primarily by:
- Increasing platelet production in bone marrow
- Inhibiting thromboxane A2 synthesis via COX-1 inhibition
- Enhancing fibrinogen conversion
- Stimulating vitamin K activity
Correct Answer: Inhibiting thromboxane A2 synthesis via COX-1 inhibition
Q11. Regarding protein binding, ketorolac is best described as:
- Minimal protein binding (<10%)
- Moderate protein binding (~50%)
- Highly protein bound (>90%)
- Irreversibly bound to albumin
Correct Answer: Highly protein bound (>90%)
Q12. Co-administration of ketorolac with which class of drugs increases the risk of serious bleeding?
- Proton pump inhibitors
- Anticoagulants (e.g., warfarin)
- Beta-blockers
- Antacids
Correct Answer: Anticoagulants (e.g., warfarin)
Q13. Which formulation of ketorolac is available for topical ocular use?
- Ophthalmic drops
- Transdermal patch
- Inhaler
- Nasal spray
Correct Answer: Ophthalmic drops
Q14. The analgesic onset of action for IV ketorolac compared to oral is generally:
- Slower than oral
- Similar to oral
- Faster than oral
- Non-existent with IV form
Correct Answer: Faster than oral
Q15. Which statement about ketorolac metabolism is correct?
- It is primarily excreted unchanged in feces
- It undergoes hepatic metabolism and renal elimination of metabolites
- It is activated by intestinal flora
- It is metabolized to morphine-like compounds
Correct Answer: It undergoes hepatic metabolism and renal elimination of metabolites
Q16. A major contraindication to ketorolac use is:
- Active peptic ulcer disease or gastrointestinal bleeding
- Mild seasonal allergies
- Controlled hypertension without end-organ damage
- Stable hypothyroidism
Correct Answer: Active peptic ulcer disease or gastrointestinal bleeding
Q17. In patients with reduced renal function, ketorolac use requires:
- No adjustment and is always safe
- Use with caution or avoidance due to risk of further renal impairment
- Double dosing to achieve effect
- Administration together with NSAIDs to protect kidneys
Correct Answer: Use with caution or avoidance due to risk of further renal impairment
Q18. Combining ketorolac with which drug class may reduce antihypertensive efficacy and increase renal risk?
- ACE inhibitors and diuretics
- HMG-CoA reductase inhibitors
- Selective serotonin reuptake inhibitors
- Calcium supplements
Correct Answer: ACE inhibitors and diuretics
Q19. Which monitoring sign suggests possible NSAID-induced gastrointestinal complication?
- Sudden onset cough
- Melena or hematemesis
- Decreased visual acuity
- Excessive salivation
Correct Answer: Melena or hematemesis
Q20. Ketorolac’s action on which prostaglandin contributes to analgesia and anti-inflammatory effects?
- Increased synthesis of PGE2
- Decreased synthesis of prostaglandins including PGE2
- Activation of leukotriene B4
- Conversion of PGE2 to thromboxane
Correct Answer: Decreased synthesis of prostaglandins including PGE2
Q21. Which adverse effect is particularly important to consider in elderly patients taking ketorolac?
- Lower risk of GI events compared to young adults
- Increased risk of renal impairment and bleeding
- Immunity enhancement
- Decreased drug interactions
Correct Answer: Increased risk of renal impairment and bleeding
Q22. Which clinical scenario is ketorolac most appropriate for?
- Chronic back pain managed for months
- Short-term postoperative pain control
- Long-term migraine prophylaxis
- Chronic neuropathic pain management
Correct Answer: Short-term postoperative pain control
Q23. Overdose of ketorolac is most likely to present with:
- Respiratory depression as primary feature
- Signs of GI bleeding, renal impairment, and possible CNS symptoms
- Marked hyperglycemia
- Profound bradycardia due to opioid effect
Correct Answer: Signs of GI bleeding, renal impairment, and possible CNS symptoms
Q24. Which statement about ketorolac and platelet function is true regarding surgery?
- Ketorolac has no effect on surgical bleeding risk
- Ketorolac can increase bleeding risk due to platelet function impairment
- Ketorolac promotes clot formation and reduces bleeding
- Ketorolac only affects coagulation factors, not platelets
Correct Answer: Ketorolac can increase bleeding risk due to platelet function impairment
Q25. When counseling a patient discharged with a short course of oral ketorolac, which instruction is essential?
- Take it together with other NSAIDs for better effect
- Avoid alcohol and report signs of GI bleeding or decreased urine output
- Increase dose if pain persists beyond two days
- Use it during late pregnancy for back pain
Correct Answer: Avoid alcohol and report signs of GI bleeding or decreased urine output
Q26. Regarding drug interactions, concomitant use of ketorolac with which type of medication can increase risk of renal toxicity?
- Loop diuretics and ACE inhibitors
- Topical antifungals
- Oral contraceptives
- Vitamin D supplements
Correct Answer: Loop diuretics and ACE inhibitors
Q27. Ketorolac’s effect on which organ system mandates dose caution or avoidance in patients with impairment?
- Renal system
- Auditory system
- Endocrine system
- Reproductive system only
Correct Answer: Renal system
Q28. Which is a correct statement about ketorolac and asthma?
- NSAIDs like ketorolac can precipitate bronchospasm in aspirin-sensitive asthmatics
- Ketorolac is protective against asthma exacerbations
- Ketorolac is the preferred analgesic in asthma patients
- Ketorolac converts leukotrienes to inactive forms
Correct Answer: NSAIDs like ketorolac can precipitate bronchospasm in aspirin-sensitive asthmatics
Q29. For study of pharmacokinetics, which parameter best describes the time taken for plasma concentration to reduce by half?
- Clearance
- Volume of distribution
- Half-life (t1/2)
- Bioavailability index
Correct Answer: Half-life (t1/2)
Q30. Ketorolac is less suitable as a chronic therapy primarily because of:
- Lack of analgesic effect with chronic use
- High risk of cumulative GI, renal, and bleeding adverse effects
- Excessive weight gain
- Induction of tolerance within hours
Correct Answer: High risk of cumulative GI, renal, and bleeding adverse effects
Q31. Which monitoring advice is correct for a patient starting ketorolac postoperatively?
- No monitoring is required at all
- Monitor urine output, renal function, and signs of bleeding
- Monitor fasting glucose daily
- Monitor serum magnesium levels
Correct Answer: Monitor urine output, renal function, and signs of bleeding
Q32. Which statement about ketorolac and CYP enzymes is accurate for clinical considerations?
- It is a strong inducer of CYP3A4 causing many drug interactions
- Metabolism involves hepatic pathways; interactions are possible but it is not a classic strong CYP inducer
- Ketorolac is not metabolized and thus has no interactions
- It permanently inhibits CYP2D6
Correct Answer: Metabolism involves hepatic pathways; interactions are possible but it is not a classic strong CYP inducer
Q33. Which adverse effect is more typical of systemic ketorolac than topical ophthalmic ketorolac?
- Ocular irritation
- Systemic renal impairment
- Local corneal changes
- Temporary blurred vision
Correct Answer: Systemic renal impairment
Q34. If a patient is taking low-dose aspirin for cardioprotection, what is the best practice when prescribing ketorolac?
- Combining without concern is always safe
- Avoid combination when possible due to increased bleeding risk and platelet effects
- Double aspirin dose to offset interactions
- Stop aspirin permanently if ketorolac is needed
Correct Answer: Avoid combination when possible due to increased bleeding risk and platelet effects
Q35. Which statement best describes ketorolac’s selectivity for COX isoenzymes?
- Highly selective COX-2 inhibitor
- Preferential LOX inhibitor
- Nonselective COX inhibitor with prominent COX-1 activity causing GI and platelet effects
- Selective COX-3 inhibitor
Correct Answer: Nonselective COX inhibitor with prominent COX-1 activity causing GI and platelet effects
Q36. A pharmacist counseling on adverse effects should emphasize which early sign of GI toxicity with ketorolac?
- Increased appetite
- Abdominal pain, black stools, or vomiting blood
- Improved mood
- Increased salivation
Correct Answer: Abdominal pain, black stools, or vomiting blood
Q37. Ketorolac is contraindicated in which of the following in the perioperative setting?
- After major orthopedic surgery due to bleeding risk only
- In patients undergoing coronary artery bypass graft (CABG) surgery
- Following minor dermatologic procedures with no bleeding risk
- During local dental procedures
Correct Answer: In patients undergoing coronary artery bypass graft (CABG) surgery
Q38. Which pharmacodynamic property explains ketorolac’s analgesic but limited anti-inflammatory chronic use?
- Irreversible nerve blockade
- Potent prostaglandin suppression producing strong analgesia but systemic toxicity limits long-term anti-inflammatory use
- Direct serotonin reuptake inhibition
- Stimulation of endogenous opioid release
Correct Answer: Potent prostaglandin suppression producing strong analgesia but systemic toxicity limits long-term anti-inflammatory use
Q39. Which patient instruction is correct when switching from IV to oral ketorolac?
- Stop oral therapy if IV is effective
- Oral therapy can be used to continue analgesia but total duration should remain short (≤5 days)
- Oral ketorolac has no analgesic effect after IV use
- Switching to oral allows indefinite therapy
Correct Answer: Oral therapy can be used to continue analgesia but total duration should remain short (≤5 days)
Q40. Which clinical test may detect ketorolac-induced renal impairment early?
- Serum bilirubin
- Serum creatinine and urine output monitoring
- Pulse oximetry
- Skin prick test
Correct Answer: Serum creatinine and urine output monitoring
Q41. In terms of acid-base properties, ketorolac is best described as:
- A weak acid typical of many NSAIDs
- A strong base
- An amphoteric peptide
- A non-ionizable lipid
Correct Answer: A weak acid typical of many NSAIDs
Q42. Which of the following best summarizes ketorolac’s role in multimodal analgesia?
- It is not useful in multimodal analgesia
- It serves as a non-opioid analgesic adjunct to reduce opioid requirements for short-term acute pain
- It replaces all need for regional anesthesia
- It is identical to paracetamol in mechanism and efficacy
Correct Answer: It serves as a non-opioid analgesic adjunct to reduce opioid requirements for short-term acute pain
Q43. For pharmacy students, which counseling point about missed doses of short-course ketorolac is correct?
- Skip the missed dose and continue; do not double up doses
- Take double dose next time
- Stop therapy permanently
- Immediately seek emergency care for a missed dose
Correct Answer: Skip the missed dose and continue; do not double up doses
Q44. Which is a pharmacovigilance concern specific to ketorolac in real-world use?
- Under-reporting of mild headaches only
- Reports of serious GI bleeding, renal failure, and increased surgical bleeding
- Frequent allergic reactions in >50% of patients
- Universal tolerance without adverse events
Correct Answer: Reports of serious GI bleeding, renal failure, and increased surgical bleeding
Q45. Which is true about ketorolac’s use in pediatric patients?
- It is universally approved for all pediatric ages without restriction
- Pediatric use requires caution, and approval varies by age and region; dosing must follow guidelines
- It is the preferred chronic analgesic in children
- It causes growth acceleration in children
Correct Answer: Pediatric use requires caution, and approval varies by age and region; dosing must follow guidelines
Q46. Which symptom would most likely indicate an allergic reaction to ketorolac?
- Transient mild thirst
- Urticaria, angioedema, or bronchospasm
- Improved energy
- Enhanced appetite
Correct Answer: Urticaria, angioedema, or bronchospasm
Q47. In patients with coagulopathy, ketorolac should be:
- Preferentially used as it corrects bleeding
- Avoided due to increased bleeding risk
- Used only with high-dose aspirin
- Administered without concern for bleeding
Correct Answer: Avoided due to increased bleeding risk
Q48. Which factor increases systemic exposure to ketorolac and may require dose adjustment?
- Impaired renal function reducing elimination
- Concurrent administration of mineral water
- Normal hepatic function
- Low-fat meal
Correct Answer: Impaired renal function reducing elimination
Q49. Which of the following is an evidence-based benefit of perioperative ketorolac use?
- Elimination of postoperative infection risk
- Reduction in opioid consumption and improved pain control for short durations
- Guaranteed prevention of chronic pain development
- Enhanced wound healing
Correct Answer: Reduction in opioid consumption and improved pain control for short durations
Q50. Which statement best reflects safe dispensing practice for ketorolac in community pharmacy?
- Advise patients to use for as long as needed without consulting a physician
- Screen for contraindications (GI disease, renal impairment, anticoagulant use, pregnancy), counsel on short duration and adverse signs
- Recommend combination with another NSAID to increase efficacy
- Tell patients it is safe during all stages of pregnancy
Correct Answer: Screen for contraindications (GI disease, renal impairment, anticoagulant use, pregnancy), counsel on short duration and adverse signs
