Anti-inflammatory agents – Sodium salicylate MCQs With Answer

Anti-inflammatory agents – Sodium salicylate MCQs With Answer
Sodium salicylate is a classic anti-inflammatory agent studied in B. Pharm curricula for its mechanism, pharmacokinetics, formulation, and toxicity. This introduction covers key concepts: salicylate chemistry (2‑hydroxybenzoate), enhanced water solubility of the sodium salt, reversible inhibition of prostaglandin synthesis, metabolic pathways (glycine and glucuronide conjugation), concentration‑dependent protein binding, and distinctive adverse effects such as gastrointestinal irritation and mixed acid‑base disturbances. Understanding assays, drug interactions, clinical uses, and differences from aspirin is critical for safe pharmacotherapy. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the chemical name of salicylic acid from which sodium salicylate is derived

• 3‑Hydroxybenzoic acid
• 2‑Hydroxybenzoic acid
• 4‑Aminobenzoic acid
• Benzoic acid

Correct Answer: 2‑Hydroxybenzoic acid

Q2. Which property is increased when salicylic acid is converted to sodium salicylate

• Lipophilicity
• Water solubility
• pKa of the phenolic OH
• Melting point drastically

Correct Answer: Water solubility

Q3. The primary anti‑inflammatory action of sodium salicylate is due to inhibition of

• Lipoxygenase exclusively
• Cyclooxygenase leading to reduced prostaglandin synthesis
• Monoamine oxidase
• Phosphodiesterase only

Correct Answer: Cyclooxygenase leading to reduced prostaglandin synthesis

Q4. Unlike aspirin, sodium salicylate differs in that it

• Irreversibly acetylates COX enzymes
• Is a prodrug of salicylic acid only after hepatic activation
• Does not acetylate COX and acts by reversible inhibition
• Has stronger antiplatelet irreversible effects

Correct Answer: Does not acetylate COX and acts by reversible inhibition

Q5. Which metabolic conjugation is a major route for salicylate clearance

• Sulfation to sulfates only
• Glycine conjugation to form salicyluric acid
• Methylation only
• Oxidative deamination

Correct Answer: Glycine conjugation to form salicyluric acid

Q6. Salicylates produce a characteristic laboratory color with ferric chloride because of

• Carboxylate group reaction
• Phenolic group forming colored complex
• Amide linkage formation
• Alkene conjugation

Correct Answer: Phenolic group forming colored complex

Q7. Which acid–base disturbance is classically seen in acute salicylate toxicity

• Pure metabolic alkalosis
• Mixed respiratory alkalosis and metabolic acidosis
• Pure respiratory acidosis
• Isolated metabolic acidosis only

Correct Answer: Mixed respiratory alkalosis and metabolic acidosis

Q8. Renal elimination of salicylates is enhanced by

• Urine acidification
• Urine alkalinization
• Decreasing urine flow
• Administration of proton pump inhibitors

Correct Answer: Urine alkalinization

Q9. Which statement about protein binding of salicylates is correct

• Protein binding is constant at all concentrations
• Protein binding is concentration‑dependent and decreases at high levels
• Salicylates do not bind to plasma proteins
• Binding increases with overdose

Correct Answer: Protein binding is concentration‑dependent and decreases at high levels

Q10. Salicylates’ analgesic and antipyretic effects are mainly due to

• Peripheral blockade of opioid receptors
• Inhibition of central and peripheral prostaglandin synthesis
• Strong antihistaminic action
• Direct COX‑2 selective inhibition in kidney only

Correct Answer: Inhibition of central and peripheral prostaglandin synthesis

Q11. Which organ is primarily responsible for conjugation and metabolism of salicylates

• Kidney
• Skin
• Liver
• Pancreas

Correct Answer: Liver

Q12. The phenolic OH in salicylates contributes to which pharmacologic or chemical property

• Formation of acetylated aspirin only
• Ability to form intramolecular hydrogen bond and color reactions
• Complete lack of acidic behavior
• Resistance to glucuronidation

Correct Answer: Ability to form intramolecular hydrogen bond and color reactions

Q13. Sodium salicylate is often preferred over salicylic acid in formulations because

• It is more lipophilic for transdermal delivery
• It has better aromatic stability
• It provides improved water solubility for oral/parenteral use
• It is a stronger acid with lower pH

Correct Answer: It provides improved water solubility for oral/parenteral use

Q14. Which toxic sign is an early indicator of salicylate overdose

• Bradycardia
• Tinnitus and hearing impairment
• Hyperglycemia only
• Excessive salivation

Correct Answer: Tinnitus and hearing impairment

Q15. Salicylate interaction with warfarin can cause

• Reduced anticoagulant effect of warfarin
• No clinically relevant interaction
• Increased bleeding tendency due to displacement and platelet effects
• Prevention of warfarin metabolism causing thrombosis

Correct Answer: Increased bleeding tendency due to displacement and platelet effects

Q16. Salicylates inhibit which transcription factor involved in inflammation

• P‑glycoprotein
• Nuclear factor kappa B (NF‑κB)
• Tubulin polymerization factor
• Cyclin D only

Correct Answer: Nuclear factor kappa B (NF‑κB)

Q17. Which analytical method provides the most specific quantification of salicylates in plasma

• Paper chromatography
• High‑performance liquid chromatography (HPLC)
• Simple pH titration
• Visual ferric chloride test only

Correct Answer: High‑performance liquid chromatography (HPLC)

Q18. The carboxyl group pKa of salicylic acid is approximately

• 9.5
• 2.97
• 7.4
• 12.0

Correct Answer: 2.97

Q19. Which clinical use is NOT typical for sodium salicylate

• Anti‑inflammatory therapy in rheumatic conditions
• Topical treatment for corns (keratolytic use of salicylic acid)
• Antihypertensive monotherapy for chronic hypertension
• Antipyretic and analgesic uses

Correct Answer: Antihypertensive monotherapy for chronic hypertension

Q20. In comparing aspirin and sodium salicylate, aspirin is distinct because it

• Is the sodium salt of salicylic acid
• Irreversibly acetylates platelet COX leading to prolonged antiplatelet effect
• Has no gastrointestinal irritation potential
• Is more water soluble than sodium salicylate

Correct Answer: Irreversibly acetylates platelet COX leading to prolonged antiplatelet effect

Q21. Which patient group should avoid salicylates due to risk of Reye’s syndrome

• Adults with osteoarthritis
• Children and adolescents with viral febrile illness
• Pregnant women in third trimester only
• Patients with chronic kidney disease stage 5 only

Correct Answer: Children and adolescents with viral febrile illness

Q22. One mechanism by which high doses of salicylates produce hyperthermia is

• Enhanced hypothalamic heat loss only
• Uncoupling of oxidative phosphorylation increasing metabolic heat production
• Direct stimulation of thyroid hormone release
• Blocking acetylcholine receptors in sweat glands

Correct Answer: Uncoupling of oxidative phosphorylation increasing metabolic heat production

Q23. Which side effect is commonly associated with chronic salicylate use

• Peptic ulceration and gastrointestinal bleeding
• Hyperkalemia due to potassium retention
• Severe hyperglycemia consistently
• Megaloblastic anemia only

Correct Answer: Peptic ulceration and gastrointestinal bleeding

Q24. The most appropriate emergency treatment to enhance salicylate elimination in overdose is

• Gastric lavage only without other measures
• Sodium bicarbonate to alkalinize urine
• Administering large doses of NSAID to compete
• Sustained acid infusion

Correct Answer: Sodium bicarbonate to alkalinize urine

Q25. Which statement about COX selectivity of salicylates is true

• They are highly COX‑2 selective inhibitors
• They are non‑selective COX inhibitors with modest COX‑1 preference
• They exclusively inhibit lipoxygenase
• They only affect COX in the central nervous system

Correct Answer: They are non‑selective COX inhibitors with modest COX‑1 preference

Q26. Which formulation advantage is provided by the sodium salt of salicylate in parenteral products

• Lower osmolarity than plain saline
• Reduced need for sterile processing
• Higher aqueous solubility enabling injectable solutions
• Improved taste for oral syrups only

Correct Answer: Higher aqueous solubility enabling injectable solutions

Q27. Which laboratory finding may be observed in severe salicylate poisoning

• Isolated respiratory acidosis
• Hypoglycemia and elevated anion gap metabolic acidosis
• Marked hypernatremia only
• Profound leukocytosis exclusively

Correct Answer: Hypoglycemia and elevated anion gap metabolic acidosis

Q28. Salicylate-induced platelet dysfunction is characterized by

• Permanently increased platelet aggregation
• Reversible inhibition of platelet function without acetylation
• Enhanced platelet production in bone marrow
• Direct destruction of platelets by immune mechanisms

Correct Answer: Reversible inhibition of platelet function without acetylation

Q29. Which structural feature differentiates salicylic acid from para‑hydroxybenzoic acid

• Position of the hydroxyl group is ortho in salicylic acid
• Presence of an amino group in salicylic acid
• Salicylic acid lacks a carboxyl group
• Salicylic acid is not aromatic

Correct Answer: Position of the hydroxyl group is ortho in salicylic acid

Q30. An important pharmacokinetic consideration for dosing in renal impairment is that salicylate elimination

• Is entirely hepatic and unaffected by renal function
• Is reduced in renal impairment because of decreased renal excretion
• Is enhanced in renal failure due to accumulation of metabolites only
• Is independent of urinary pH

Correct Answer: Is reduced in renal impairment because of decreased renal excretion

Q31. Which adverse effect is more commonly associated with salicylates than with selective COX‑2 inhibitors

• Increased thrombotic risk
• Gastrointestinal mucosal damage and bleeding
• Selective renal sparing
• Hair loss primarily

Correct Answer: Gastrointestinal mucosal damage and bleeding

Q32. Which is a pharmacodynamic action of salicylates besides COX inhibition

• Activation of prostacyclin synthase
• Inhibition of IKK leading to reduced NF‑κB activity
• Direct blockade of muscarinic receptors
• Upregulation of COX expression

Correct Answer: Inhibition of IKK leading to reduced NF‑κB activity

Q33. In analytical chemistry, the ferric chloride test for salicylates gives a

• Blue‑violet complex due to phenolate formation
• No color change for salicylates
• Yellow precipitate only
• Infrared fluorescence emission

Correct Answer: Blue‑violet complex due to phenolate formation

Q34. Which pharmacokinetic parameter of salicylates changes with increasing dose due to saturable metabolism

• Elimination half‑life increases at higher doses due to saturation of conjugation pathways
• Volume of distribution becomes zero
• Absorption becomes instantaneous
• Bioavailability falls to zero

Correct Answer: Elimination half‑life increases at higher doses due to saturation of conjugation pathways

Q35. Which dosing consideration is true for anti‑inflammatory salicylate therapy compared to analgesic doses

• Anti‑inflammatory effects generally require higher and more sustained doses than simple analgesia
• Analgesic effects require higher doses than anti‑inflammatory therapy
• There is no dose relationship; effects are identical at any dose
• Anti‑inflammatory therapy uses single intermittent doses only

Correct Answer: Anti‑inflammatory effects generally require higher and more sustained doses than simple analgesia

Q36. Which organ system may be adversely affected by long‑term salicylate use leading to salt retention and edema

• Endocrine pancreas only
• Renal system due to prostaglandin inhibition altering renal hemodynamics
• Central nervous system solely
• Hair follicles exclusively

Correct Answer: Renal system due to prostaglandin inhibition altering renal hemodynamics

Q37. Which statement about salicylate absorption is correct

• Absorption from the stomach is favored for non‑ionized salicylic acid
• Only the ionized form is absorbed in the stomach
• Salicylates are not absorbed from the gastrointestinal tract
• Absorption is independent of gastric pH

Correct Answer: Absorption from the stomach is favored for non‑ionized salicylic acid

Q38. From a formulation perspective, sodium salicylate is used topically mainly for

• Tissue necrosis induction
• Local anti‑inflammatory and keratolytic effects
• Systemic antihypertensive delivery via skin
• Enhancing bacterial growth

Correct Answer: Local anti‑inflammatory and keratolytic effects

Q39. Which laboratory monitoring is most relevant during high‑dose salicylate therapy

• Serum salicylate concentration and arterial blood gases for acid‑base status
• Daily serum potassium only
• Serum bilirubin weekly only
• No monitoring is required

Correct Answer: Serum salicylate concentration and arterial blood gases for acid‑base status

Q40. Which symptom complex suggests chronic salicylate intoxication

• Pulmonary fibrosis and cyanosis only
• Tinnitus, dizziness, and subtle hearing loss with persistent GI discomfort
• Acute paralysis of limbs
• Hepatic failure exclusively

Correct Answer: Tinnitus, dizziness, and subtle hearing loss with persistent GI discomfort

Q41. The major glucuronide conjugates of salicylates are formed at which functional group

• Carboxyl and phenolic hydroxyl groups
• Alkene double bonds
• Amine groups
• Sulfhydryl groups

Correct Answer: Carboxyl and phenolic hydroxyl groups

Q42. Which statement about use of salicylates in pregnancy is generally advised

• Safe throughout all trimesters without restrictions
• Avoid in third trimester due to risk of fetal bleeding and closure of ductus arteriosus
• They are teratogenic in the first week only
• They increase uterine contractions beneficially

Correct Answer: Avoid in third trimester due to risk of fetal bleeding and closure of ductus arteriosus

Q43. Which pharmacological property of sodium salicylate is exploited in veterinary or research settings for anti‑inflammatory effects

• Long duration irreversible COX inhibition at microgram doses
• Water solubility enabling injectable dosing when oral route is unsuitable
• Selective inhibition of only COX‑3
• Direct stimulation of growth hormone

Correct Answer: Water solubility enabling injectable dosing when oral route is unsuitable

Q44. In terms of structure–activity relationship, acetylation of salicylic acid to form aspirin primarily

• Removes any anti‑inflammatory properties
• Introduces irreversible acetylation capacity conferring antiplatelet activity
• Makes the molecule completely inactive biologically
• Converts it into an opioid analgesic

Correct Answer: Introduces irreversible acetylation capacity conferring antiplatelet activity

Q45. Which enzyme system does salicylate metabolism NOT primarily involve

• Glucuronosyltransferases
• Amino acid conjugation (glycine conjugation)
• Cytochrome P450‑mediated extensive hydroxylation as the sole pathway
• Minor hydroxylation to gentisic acid

Correct Answer: Cytochrome P450‑mediated extensive hydroxylation as the sole pathway

Q46. Which is an important counseling point for patients taking salicylates chronically

• Take with food or antacid to reduce gastrointestinal irritation
• Avoid fluids while on therapy
• Take on an empty stomach only to improve absorption
• Double the dose if pain persists without consulting prescriber

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

Q47. Which mechanism explains increased salicylate toxicity in febrile children with dehydration

• Enhanced hepatic clearance reduces toxicity
• Decreased renal excretion and higher free fraction increase systemic levels
• Increased plasma protein binding reduces free drug leading to toxicity
• Elevation of gastric pH prevents absorption

Correct Answer: Decreased renal excretion and higher free fraction increase systemic levels

Q48. Which assay would be useful for qualitative bedside detection of salicylates in a clinical setting

• Ferric chloride color test for phenolic compounds
• ELISA for insulin only
• Urine dipstick for ketones exclusively
• Clotting time test for hemophilia only

Correct Answer: Ferric chloride color test for phenolic compounds

Q49. Which drug interaction increases risk of salicylate adverse effects by reducing renal excretion

• Loop diuretics that alkalinize urine
• Probenecid and other URAT inhibitors that alter renal handling of organic acids
• Vitamin C supplements exclusively
• Topical antifungals applied to skin

Correct Answer: Probenecid and other URAT inhibitors that alter renal handling of organic acids

Q50. In designing a MCQ exam for B. Pharm students on sodium salicylate, which topic integration is most valuable

• Only basic chemistry without clinical or analytical context
• Integration of mechanism, pharmacokinetics, toxicity, formulation and analytical assays
• Focus exclusively on brand names and marketing
• Examination of unrelated drug classes only

Correct Answer: Integration of mechanism, pharmacokinetics, toxicity, formulation and analytical assays

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