Antirheumatic drugs MCQs With Answer

Antirheumatic drugs MCQs With Answer

Antirheumatic drugs are central to B.Pharm students’ understanding of rheumatoid arthritis pharmacotherapy, covering DMARDs, NSAIDs, glucocorticoids, biologics and targeted synthetic agents. This concise introduction explores mechanisms of action, pharmacokinetics, adverse effects, monitoring requirements and clinical considerations for drugs such as methotrexate, hydroxychloroquine, sulfasalazine, leflunomide, TNF inhibitors, IL‑6 blockers and JAK inhibitors. Emphasis is placed on safety issues—teratogenicity, hepatotoxicity, infection risk, TB and hepatitis screening, and necessary laboratory monitoring (CBC, LFTs, lipids). These focused MCQs will help B.Pharm students master key concepts needed for rational selection, dosing and monitoring of antirheumatic therapies. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which term best describes drugs that slow or halt structural damage in rheumatoid arthritis?

• Disease-modifying antirheumatic drugs (DMARDs)
• Analgesic agents
• Antipyretics
• Local anesthetics

Correct Answer: Disease-modifying antirheumatic drugs (DMARDs)

Q2. Low-dose methotrexate’s primary anti-inflammatory mechanism in RA involves which action?

• Inhibition of AICAR transformylase increasing extracellular adenosine
• Direct blockade of TNF-alpha receptors
• Irreversible inhibition of monoamine oxidase
• Stimulation of prostaglandin synthesis

Correct Answer: Inhibition of AICAR transformylase increasing extracellular adenosine

Q3. Which laboratory tests are essential for routine monitoring in a patient on methotrexate?

• Complete blood count and liver function tests
• Serum amylase only
• Urinalysis only
• Blood glucose and HbA1c

Correct Answer: Complete blood count and liver function tests

Q4. Leflunomide exerts its immunomodulatory effect by inhibiting which enzyme?

• Dihydroorotate dehydrogenase (pyrimidine synthesis)
• Dihydrofolate reductase
• Xanthine oxidase
• Cyclooxygenase-2 (COX-2)

Correct Answer: Dihydroorotate dehydrogenase (pyrimidine synthesis)

Q5. A woman on leflunomide who wishes to conceive should first undergo which measure?

• Cholestyramine washout to rapidly lower plasma levels
• Start folic acid supplementation
• Switch to methotrexate
• Increase dose for two weeks

Correct Answer: Cholestyramine washout to rapidly lower plasma levels

Q6. Which antirheumatic drug requires regular ophthalmologic screening due to risk of retinopathy?

• Hydroxychloroquine
• Leflunomide
• Infliximab
• Sulfasalazine

Correct Answer: Hydroxychloroquine

Q7. Sulfasalazine is activated in the colon to release which active moieties?

• Sulfapyridine and 5-aminosalicylic acid (5-ASA)
• Methotrexate and folinic acid
• Prednisolone and cortisone
• Azathioprine and mercaptopurine

Correct Answer: Sulfapyridine and 5-aminosalicylic acid (5-ASA)

Q8. Before initiating anti-TNF biologic therapy, which screening test is mandatory?

• Latent tuberculosis screening (e.g., IGRA or tuberculin test)
• Baseline DEXA scan
• Serum CPK measurement
• Oral glucose tolerance test

Correct Answer: Latent tuberculosis screening (e.g., IGRA or tuberculin test)

Q9. The major infectious risk associated with TNF inhibitors is reactivation of which pathogen?

• Mycobacterium tuberculosis
• Human papillomavirus
• Treponema pallidum
• Clostridium difficile

Correct Answer: Mycobacterium tuberculosis

Q10. Rituximab targets which cell surface antigen in B cells?

• CD20
• CD3
• TNF-alpha
• IL-1 receptor

Correct Answer: CD20

Q11. Tocilizumab primarily blocks signaling through which cytokine receptor?

• Interleukin-6 (IL-6) receptor
• Interleukin-1 (IL-1) receptor
• Interferon-gamma receptor
• Transforming growth factor-beta receptor

Correct Answer: Interleukin-6 (IL-6) receptor

Q12. Tofacitinib belongs to which class of targeted synthetic DMARDs?

• Janus kinase (JAK) inhibitors
• Calcineurin inhibitors
• mTOR inhibitors
• Biosynthetic peptides

Correct Answer: Janus kinase (JAK) inhibitors

Q13. A notable infectious risk with JAK inhibitors is increased incidence of which viral reactivation?

• Herpes zoster
• Hepatitis A
• Human immunodeficiency virus
• Rotavirus

Correct Answer: Herpes zoster

Q14. What is the primary role of NSAIDs in rheumatic disease management?

• Symptomatic relief of pain and inflammation but not structural modification
• Permanent disease remission by modifying immune response
• Eradication of latent infections
• Promotion of cartilage regeneration

Correct Answer: Symptomatic relief of pain and inflammation but not structural modification

Q15. Long-term systemic glucocorticoid therapy commonly causes which adverse effect?

• Osteoporosis and increased fracture risk
• Permanent cure of autoimmune disease
• Reduced susceptibility to infections
• Improved glucose tolerance

Correct Answer: Osteoporosis and increased fracture risk

Q16. Which antirheumatic drug is absolutely contraindicated in pregnancy due to teratogenicity?

• Methotrexate
• Hydroxychloroquine
• Sulfasalazine
• Azathioprine

Correct Answer: Methotrexate

Q17. Which supplement is recommended to reduce methotrexate toxicity?

• Folic acid (or folinic acid)
• Vitamin B12 only
• Iron supplementation only
• Calcium carbonate only

Correct Answer: Folic acid (or folinic acid)

Q18. Prior to starting biologic therapy, screening for which viral infection is advised due to reactivation risk?

• Hepatitis B virus
• Norovirus
• Rhinovirus
• HPV

Correct Answer: Hepatitis B virus

Q19. What defines a biosimilar in the context of biologic antirheumatic drugs?

• A product highly similar to a licensed reference biologic with no clinically meaningful differences in safety or efficacy
• An identical chemical copy of a small-molecule drug
• A generic oral tablet with different mechanism
• A vaccine derived from attenuated organisms

Correct Answer: A product highly similar to a licensed reference biologic with no clinically meaningful differences in safety or efficacy

Q20. What is the recommended frequency of methotrexate dosing for rheumatoid arthritis?

• Once weekly (oral or subcutaneous)
• Daily oral dosing
• Once monthly intravenous only
• Every 6 hours around the clock

Correct Answer: Once weekly (oral or subcutaneous)

Q21. Penicillamine, an older antirheumatic, can cause which renal complication?

• Proteinuria due to membranous nephropathy
• Acute tubular necrosis exclusively
• Urinary retention
• Renal artery stenosis

Correct Answer: Proteinuria due to membranous nephropathy

Q22. Hydroxychloroquine ophthalmic screening is recommended at which interval after baseline for long-term users?

• Annually after 5 years of cumulative use (earlier if risk factors)
• Every month regardless of dose
• No screening is necessary
• Only if visual symptoms develop

Correct Answer: Annually after 5 years of cumulative use (earlier if risk factors)

Q23. Azathioprine toxicity is increased in patients with deficiency of which enzyme?

• Thiopurine methyltransferase (TPMT)
• Acetyltransferase (NAT2)
• Cytochrome P450 3A4
• Glucose-6-phosphate dehydrogenase

Correct Answer: Thiopurine methyltransferase (TPMT)

Q24. Which immunosuppressant used in refractory rheumatoid arthritis is notorious for nephrotoxicity?

• Cyclosporine
• Hydroxychloroquine
• Sulfasalazine
• Methotrexate (at low dose)

Correct Answer: Cyclosporine

Q25. Use of TNF inhibitors is generally avoided in patients with which cardiac condition?

• Moderate-to-severe congestive heart failure
• Well-controlled hypertension only
• Stable angina with no symptoms
• Mild isolated palpitations

Correct Answer: Moderate-to-severe congestive heart failure

Q26. Which type of vaccines should be avoided in patients actively receiving biologic immunosuppressive therapy?

• Live attenuated vaccines
• Inactivated influenza vaccine
• Recombinant subunit vaccines
• Toxoid vaccines

Correct Answer: Live attenuated vaccines

Q27. Which DMARD is considered relatively safe to continue during pregnancy in patients with rheumatic disease?

• Hydroxychloroquine
• Methotrexate
• Leflunomide (without washout)
• Thalidomide

Correct Answer: Hydroxychloroquine

Q28. Infliximab is classified as which type of monoclonal antibody?

• Chimeric (mouse-human) anti-TNF monoclonal antibody
• Fully human IL-6 inhibitor
• Small molecule JAK inhibitor
• Fusion protein TNF receptor analog

Correct Answer: Chimeric (mouse-human) anti-TNF monoclonal antibody

Q29. Etanercept differs from monoclonal anti-TNF antibodies because it is which of the following?

• A TNF receptor fusion protein
• A small interfering RNA
• An oral alkylating agent
• A corticosteroid derivative

Correct Answer: A TNF receptor fusion protein

Q30. Tocilizumab therapy commonly necessitates monitoring because it can cause which laboratory abnormalities?

• Elevated liver transaminases and increased serum lipids
• Marked hypokalemia and metabolic acidosis
• Profound hypercalcemia only
• Isolated decreased creatinine clearance without other changes

Correct Answer: Elevated liver transaminases and increased serum lipids

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