Anti-inflammatory agents – Piroxicam MCQs With Answer

Introduction

Anti-inflammatory agents – Piroxicam MCQs With Answer is a concise, student-focused resource tailored for B.Pharm learners preparing for exams and clinical practice. This set highlights piroxicam’s pharmacology, mechanism as an NSAID (oxicam class), pharmacokinetics (long half-life, high protein binding), therapeutic uses (osteoarthritis, rheumatoid arthritis), adverse effects (GI toxicity, renal impairment, hypersensitivity), contraindications, monitoring, and key drug interactions. Each question reinforces critical concepts such as COX inhibition, dosing, formulation differences, and patient safety. Clear, exam-oriented MCQs with explanations enhance retention and clinical reasoning. ‘Now let’s test your knowledge with 50 MCQs on this topic.’

Q1. Which chemical class does piroxicam belong to?

• Propionic acid derivatives
• Acetic acid derivatives
• Oxicam (enolic acid) derivatives
• Coxib (selective COX-2) class

Correct Answer: Oxicam (enolic acid) derivatives

Q2. What is the primary mechanism of action of piroxicam?

• Selective COX-2 inhibition only
• Non-selective inhibition of COX enzymes reducing prostaglandin synthesis
• Activation of opioid receptors
• Blocking leukotriene receptors

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

Q3. Which of the following is a main therapeutic indication for piroxicam?

• Type 1 diabetes mellitus
• Osteoarthritis and rheumatoid arthritis
• Uncomplicated urinary tract infection
• Acute bacterial meningitis

Correct Answer: Osteoarthritis and rheumatoid arthritis

Q4. What is the usual recommended oral dose of piroxicam for adults?

• 5 mg once daily
• 20 mg once daily
• 100 mg three times daily
• 50 mg every 6 hours

Correct Answer: 20 mg once daily

Q5. Which pharmacokinetic property is characteristic of piroxicam?

• Very short half-life (2-4 hours)
• High oral bioavailability and long elimination half-life
• Negligible plasma protein binding
• Exclusively excreted unchanged in urine

Correct Answer: High oral bioavailability and long elimination half-life

Q6. Piroxicam is highly bound to which plasma component?

• Red blood cells
• Plasma proteins (albumin)
• Glucose
• Uric acid

Correct Answer: Plasma proteins (albumin)

Q7. Which adverse effect is most commonly associated with piroxicam?

• Severe hypoglycaemia
• Gastrointestinal ulceration and bleeding
• Ototoxicity
• Hyperthyroidism

Correct Answer: Gastrointestinal ulceration and bleeding

Q8. Piroxicam should be avoided or used with caution in which patient population?

• Patients with well-controlled hypertension and no comorbidities
• Patients with a history of peptic ulcer disease or GI bleeding
• Young healthy adults without allergies
• Patients receiving vitamin supplements only

Correct Answer: Patients with a history of peptic ulcer disease or GI bleeding

Q9. Which drug interaction with piroxicam increases the risk of bleeding?

• Co-administration with proton pump inhibitors
• Co-administration with warfarin or other anticoagulants
• Co-administration with calcium supplements
• Co-administration with laxatives

Correct Answer: Co-administration with warfarin or other anticoagulants

Q10. How does piroxicam affect renal function in susceptible patients?

• It improves glomerular filtration rate in all patients
• It can reduce prostaglandin-mediated renal perfusion causing renal impairment
• It has no effect on renal blood flow
• It acts as a diuretic and increases urine output

Correct Answer: It can reduce prostaglandin-mediated renal perfusion causing renal impairment

Q11. Which monitoring parameter is most important before and during piroxicam therapy?

• Serum electrolytes only
• Renal function (serum creatinine, BUN) and liver function tests
• Serum glucose every hour
• Chest X-ray monthly

Correct Answer: Renal function (serum creatinine, BUN) and liver function tests

Q12. Piroxicam is contraindicated in which stage of pregnancy?

• First trimester only
• Second trimester only
• Third trimester due to risk of premature closure of the fetal ductus arteriosus
• Piroxicam is safe in all trimesters

Correct Answer: Third trimester due to risk of premature closure of the fetal ductus arteriosus

Q13. Which of the following extra anti-inflammatory actions is attributed to oxicam class drugs like piroxicam?

• Selective inhibition of TNF-alpha production
• Inhibition of leukocyte migration and modulation of oxygen radical production
• Direct bactericidal effect
• Activation of prostacyclin synthesis

Correct Answer: Inhibition of leukocyte migration and modulation of oxygen radical production

Q14. Which adverse skin reaction, though rare, has been reported with piroxicam?

• Psoriasis improvement only
• Photosensitivity and serious cutaneous reactions like Stevens-Johnson syndrome
• Chronic eczema only
• Tinea pedis

Correct Answer: Photosensitivity and serious cutaneous reactions like Stevens-Johnson syndrome

Q15. What is the effect of piroxicam on platelet function?

• No effect on platelets
• Irreversible platelet inhibition like aspirin
• Reversible inhibition of platelet aggregation due to COX inhibition
• Enhancement of platelet aggregation

Correct Answer: Reversible inhibition of platelet aggregation due to COX inhibition

Q16. Which route/formulation of piroxicam can reduce systemic GI side effects for localized joint pain?

• Intravenous formulation
• Topical gel formulation
• High-dose oral tablets taken with alcohol
• Rectal suppositories only

Correct Answer: Topical gel formulation

Q17. Piroxicam is mainly metabolized in the liver. Which consequence follows hepatic impairment?

• Increased clearance leading to subtherapeutic levels
• Reduced metabolism leading to increased plasma levels and risk of toxicity
• Conversion to inactive metabolites that are protective
• No change in pharmacokinetics

Correct Answer: Reduced metabolism leading to increased plasma levels and risk of toxicity

Q18. Which enzyme family is primarily involved in the hepatic metabolism of many NSAIDs including piroxicam?

• CYP450 enzymes (e.g., CYP2C9)
• Monoamine oxidases
• Alcohol dehydrogenase only
• Acetylcholinesterases

Correct Answer: CYP450 enzymes (e.g., CYP2C9)

Q19. Which statement about piroxicam’s half-life is correct?

• Piroxicam has a very short half-life (<3 hours)
• Piroxicam has a long half-life allowing once-daily dosing
• Its half-life is so long it is dosed weekly
• Its half-life is irrelevant for dosing

Correct Answer: Piroxicam has a long half-life allowing once-daily dosing

Q20. Combining piroxicam with which class of antihypertensive drugs may reduce their effectiveness?

• Beta-blockers exclusively
• ACE inhibitors and angiotensin receptor blockers
• Calcium supplements
• Topical decongestants

Correct Answer: ACE inhibitors and angiotensin receptor blockers

Q21. Which laboratory abnormality may occur with prolonged piroxicam therapy?

• Leukocytosis always
• Elevation of liver enzymes (ALT, AST) and possible anemia
• Hypokalemia exclusively
• Marked hyperglycemia only

Correct Answer: Elevation of liver enzymes (ALT, AST) and possible anemia

Q22. What counseling point is important for patients taking oral piroxicam?

• Take on an empty stomach to increase absorption
• Take with food or milk to reduce gastrointestinal irritation
• Avoid all fluids while dosing
• Double the dose if pain persists

Correct Answer: Take with food or milk to reduce gastrointestinal irritation

Q23. Which adverse cardiovascular risk is associated with NSAIDs including piroxicam?

• Decreased blood pressure only
• Increased risk of thrombotic events and worsening heart failure in susceptible patients
• Complete prevention of myocardial infarction
• No cardiovascular risks documented

Correct Answer: Increased risk of thrombotic events and worsening heart failure in susceptible patients

Q24. Piroxicam’s onset of analgesic action is generally:

• Immediate within seconds of oral dose
• Within 1–2 hours after oral administration
• After several weeks only
• Only after drug discontinuation

Correct Answer: Within 1–2 hours after oral administration

Q25. Which patient history constitutes a contraindication to piroxicam use?

• History of seasonal allergic rhinitis only
• History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
• Mild episodic headaches once a year
• Controlled hypothyroidism on levothyroxine

Correct Answer: History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs

Q26. Which of the following best describes piroxicam’s selectivity for COX enzymes?

• Highly selective COX-2 inhibitor
• Non-selective COX-1 and COX-2 inhibitor
• Selectively inhibits COX-3 only
• Does not inhibit cyclooxygenase enzymes

Correct Answer: Non-selective COX-1 and COX-2 inhibitor

Q27. Piroxicam’s risk of serious GI complications can be reduced by co-prescribing which medication?

• Systemic corticosteroids
• Proton pump inhibitor (e.g., omeprazole)
• Oral iron supplements
• Stimulant laxatives

Correct Answer: Proton pump inhibitor (e.g., omeprazole)

Q28. Which statement about piroxicam and breastfeeding is correct?

• Piroxicam is recommended and safe during breastfeeding
• Piroxicam is excreted in breast milk and use is generally not recommended
• Piroxicam increases milk production
• Piroxicam has no effect on the infant when taken by the mother

Correct Answer: Piroxicam is excreted in breast milk and use is generally not recommended

Q29. Which test should be considered in long-term piroxicam therapy to detect occult GI bleeding?

• Serum amylase
• Fecal occult blood test and periodic CBC
• Urine protein only
• Arterial blood gas

Correct Answer: Fecal occult blood test and periodic CBC

Q30. Which is a pharmacodynamic interaction of piroxicam that increases lithium levels?

• Piroxicam induces renal clearance of lithium
• Piroxicam reduces renal lithium clearance leading to lithium accumulation
• Piroxicam blocks lithium absorption from the gut
• Piroxicam chemically inactivates lithium in plasma

Correct Answer: Piroxicam reduces renal lithium clearance leading to lithium accumulation

Q31. Which condition requires dose adjustment or caution when prescribing piroxicam?

• Mild tension headache with no comorbidities
• Renal impairment or dehydration
• Myopia
• Recent vaccination only

Correct Answer: Renal impairment or dehydration

Q32. Which lab finding suggests NSAID-induced renal impairment?

• Decreased serum creatinine
• Increased serum creatinine and BUN
• Low ESR only
• Hypercalcemia only

Correct Answer: Increased serum creatinine and BUN

Q33. In a patient on methotrexate, co-administration of piroxicam may lead to:

• Reduced methotrexate toxicity
• Increased methotrexate levels and risk of toxicity due to decreased renal clearance
• No interaction at all
• Complete inactivation of methotrexate

Correct Answer: Increased methotrexate levels and risk of toxicity due to decreased renal clearance

Q34. Which adverse neurologic effect may occur with piroxicam?

• Seizures in predisposed individuals
• Complete loss of vision in all patients
• Permanent paralysis in every case
• Guaranteed improvement of cognitive function

Correct Answer: Seizures in predisposed individuals

Q35. Piroxicam is least appropriate for which type of pain?

• Inflammatory joint pain due to arthritis
• Menstrual cramps and dysmenorrhea
• Severe acute postoperative pain requiring immediate strong opioid analgesia
• Chronic musculoskeletal pain

Correct Answer: Severe acute postoperative pain requiring immediate strong opioid analgesia

Q36. Which clinical feature suggests NSAID hypersensitivity to piroxicam?

• Delayed hair growth
• Wheezing, nasal polyps, or angioedema after NSAID exposure
• Improvement of asthma symptoms
• Increased appetite only

Correct Answer: Wheezing, nasal polyps, or angioedema after NSAID exposure

Q37. Which of the following statements about topical piroxicam gel is correct?

• Topical piroxicam never causes systemic absorption
• Topical piroxicam provides local anti-inflammatory effect with lower systemic exposure than oral therapy
• Topical piroxicam is only used for systemic infections
• Topical piroxicam must be swallowed for efficacy

Correct Answer: Topical piroxicam provides local anti-inflammatory effect with lower systemic exposure than oral therapy

Q38. Which patient education point is important regarding NSAID-related cardiovascular risk?

• There are no cardiovascular risks; no precautions needed
• Use the lowest effective dose for the shortest duration, especially in patients with cardiovascular disease
• NSAIDs prevent heart attacks and are cardioprotective
• Double dosing reduces cardiovascular risk

Correct Answer: Use the lowest effective dose for the shortest duration, especially in patients with cardiovascular disease

Q39. A B.Pharm student learning about piroxicam should remember that its analgesic effect is primarily due to:

• Blocking nerve conduction like local anesthetics
• Decreasing prostaglandin-mediated sensitization of pain receptors
• Increasing serotonin release to dull pain
• Binding to opioid receptors in the CNS

Correct Answer: Decreasing prostaglandin-mediated sensitization of pain receptors

Q40. Which regulatory advice is relevant for long-term piroxicam therapy?

• No monitoring is needed regardless of duration
• Periodic monitoring of renal, hepatic function and blood counts is recommended
• Immediate cessation after one week in all patients
• Mandatory combination with anticoagulant therapy

Correct Answer: Periodic monitoring of renal, hepatic function and blood counts is recommended

Q41. What effect does food have on piroxicam absorption?

• Food markedly decreases absorption making the drug ineffective
• Food slightly delays absorption but does not significantly reduce overall bioavailability
• Food converts piroxicam to an inactive form
• Food causes immediate excretion of the drug

Correct Answer: Food slightly delays absorption but does not significantly reduce overall bioavailability

Q42. In an overdose of piroxicam, which of the following is a likely clinical finding?

• Profound hypoglycemia only
• GI bleeding, renal impairment, and CNS symptoms such as dizziness or drowsiness
• Marked bradycardia as the sole feature
• Immediate cardiac arrest in all cases

Correct Answer: GI bleeding, renal impairment, and CNS symptoms such as dizziness or drowsiness

Q43. Which statement about piroxicam and asthma is true?

• Piroxicam is therapeutic for all asthma types
• NSAID-induced bronchospasm can occur in aspirin-sensitive asthmatics
• Piroxicam cures aspirin-exacerbated respiratory disease
• It enhances bronchodilator response

Correct Answer: NSAID-induced bronchospasm can occur in aspirin-sensitive asthmatics

Q44. For fixed-dose comparison, piroxicam is generally considered to have:

• Much shorter duration than ibuprofen
• Longer duration of action than many other NSAIDs allowing once-daily dosing
• No anti-inflammatory activity
• Equal duration with immediate elimination

Correct Answer: Longer duration of action than many other NSAIDs allowing once-daily dosing

Q45. Which sign would indicate an immediate severe allergic reaction to piroxicam?

• Mild headache several days after starting drug
• Sudden angioedema, difficulty breathing, or anaphylaxis
• Gradual weight gain over months
• Improved sleep quality

Correct Answer: Sudden angioedema, difficulty breathing, or anaphylaxis

Q46. Which statement about piroxicam’s use in elderly patients is correct?

• Elderly patients have decreased risk of NSAID toxicity
• Use caution; start at lower doses due to increased sensitivity and higher risk of adverse effects
• Elderly can take maximum doses without monitoring
• Piroxicam is contraindicated in all elderly patients

Correct Answer: Use caution; start at lower doses due to increased sensitivity and higher risk of adverse effects

Q47. Which combination increases the risk of renal impairment when taken with piroxicam?

• Combination with acetaminophen only
• Combination with ACE inhibitors and diuretics (triple whammy)
• Combination with topical emollients
• Combination with vitamin D

Correct Answer: Combination with ACE inhibitors and diuretics (triple whammy)

Q48. Which pharmacological property explains once-daily dosing of piroxicam?

• Extremely low potency
• Long elimination half-life and sustained plasma concentrations
• Immediate renal clearance within minutes
• Rapid metabolism to inactive compounds within an hour

Correct Answer: Long elimination half-life and sustained plasma concentrations

Q49. In pharmacy practice, which advice is crucial when dispensing piroxicam to patients on anticoagulants?

• No special advice is needed
• Advise increased bleeding risk and recommend close monitoring of INR and signs of bleeding
• Tell patients to stop anticoagulants while taking piroxicam
• Recommend doubling the anticoagulant dose

Correct Answer: Advise increased bleeding risk and recommend close monitoring of INR and signs of bleeding

Q50. Which is the most appropriate action if a patient develops severe abdominal pain and black tarry stools while on piroxicam?

• Advise to continue medication and reassess in a month
• Immediate discontinuation of piroxicam and urgent medical evaluation for GI bleeding
• Suggest taking antacids and ignore symptoms
• Advise increasing the dose to overcome pain

Correct Answer: Immediate discontinuation of piroxicam and urgent medical evaluation for GI bleeding

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