MCQ Quiz-NSAIDs

MCQ Quiz: NSAIDs

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications in the world for treating pain, inflammation, and fever. While effective and often available over-the-counter, they carry significant risks that require a pharmacist’s expertise to manage. This quiz for PharmD students will test your knowledge of their pharmacology, diverse side effect profile, drug interactions, and the critical counseling points needed for their safe and appropriate use.

1. What is the primary mechanism of action for all traditional NSAIDs?

  • They block the reuptake of serotonin.
  • They inhibit the cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.
  • They are agonists at the mu-opioid receptor.
  • They block the influx of calcium into smooth muscle cells.

Answer: They inhibit the cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis.

2. The COX-1 enzyme is primarily responsible for producing prostaglandins that ________, while the COX-2 enzyme is primarily responsible for prostaglandins involved in ________.

  • Cause pain and inflammation; protect the gastric mucosa.
  • Protect the gastric mucosa and support platelet function; pain and inflammation.
  • Cause fever; regulate blood pressure.
  • Mediate pain; mediate fever.

Answer: Protect the gastric mucosa and support platelet function; pain and inflammation.

3. Which of the following is a non-selective NSAID, meaning it inhibits both COX-1 and COX-2?

  • Celecoxib
  • Acetaminophen
  • Ibuprofen
  • Meloxicam (at low doses)

Answer: Ibuprofen

4. The gastrointestinal toxicity (e.g., ulcers, bleeding) of traditional NSAIDs is primarily caused by the inhibition of which enzyme in the stomach lining?

  • COX-1
  • COX-2
  • Lipoxygenase
  • Phospholipase A2

Answer: COX-1

5. Celecoxib is a unique NSAID because it is designed to be:

  • A selective COX-1 inhibitor.
  • A selective COX-2 inhibitor.
  • A non-selective inhibitor of both COX-1 and COX-2.
  • An irreversible inhibitor of both enzymes.

Answer: A selective COX-2 inhibitor.

6. A “black box warning” for all non-aspirin NSAIDs highlights an increased risk of:

  • Severe liver damage.
  • Agranulocytosis.
  • Serious cardiovascular thrombotic events (myocardial infarction and stroke).
  • Stevens-Johnson Syndrome.

Answer: Serious cardiovascular thrombotic events (myocardial infarction and stroke).

7. A key counseling point for a patient purchasing an over-the-counter NSAID like naproxen is to:

  • Take it on an empty stomach for best results.
  • Take it with food or milk to reduce the risk of GI upset.
  • Combine it with aspirin for better pain relief.
  • Expect the medication to cause drowsiness.

Answer: Take it with food or milk to reduce the risk of GI upset.

8. Low-dose aspirin provides its cardioprotective effect by:

  • Reversibly inhibiting COX-2.
  • Irreversibly inhibiting COX-1 in platelets, which prevents the formation of thromboxane A2 for the life of the platelet.
  • Increasing the production of prostaglandins.
  • Blocking the P2Y12 receptor.

Answer: Irreversibly inhibiting COX-1 in platelets, which prevents the formation of thromboxane A2 for the life of the platelet.

9. A patient taking warfarin for atrial fibrillation should be counseled to avoid chronic NSAID use due to an increased risk of:

  • A drug interaction that lowers the INR.
  • Bleeding.
  • A hypertensive crisis.
  • Serotonin syndrome.

Answer: Bleeding.

10. NSAIDs can increase blood pressure and interfere with the effects of which class of medications, making them a concern for patients with hypertension?

  • Statins
  • Metformin
  • ACE inhibitors
  • Proton pump inhibitors

Answer: ACE inhibitors

11. A patient with which of the following conditions should use NSAIDs with extreme caution or avoid them altogether?

  • Heart failure.
  • Chronic kidney disease.
  • A history of peptic ulcer disease.
  • All of the above.

Answer: All of the above.

12. The use of NSAIDs in a patient with heart failure can lead to:

  • An improvement in cardiac function.
  • Sodium and water retention, which can exacerbate the condition.
  • A decrease in blood pressure.
  • A reduction in peripheral edema.

Answer: Sodium and water retention, which can exacerbate the condition.

13. Which NSAID is available in an intravenous formulation and is limited to a maximum of 5 days of use due to a high risk of severe GI and renal toxicity?

  • Ibuprofen
  • Naproxen
  • Ketorolac
  • Celecoxib

Answer: Ketorolac

14. A patient with “aspirin-exacerbated respiratory disease” (AERD) may experience ________ after taking an NSAID.

  • Severe bronchospasm
  • An improvement in their breathing
  • A reduction in nasal polyps
  • A decrease in allergy symptoms

Answer: Severe bronchospasm

15. A pharmacist providing care with “geriatric sensitivity” would recognize that older adults are at a higher risk for which NSAID-related adverse effects?

  • GI bleeding and renal toxicity.
  • Opioid addiction.
  • The side effects are the same as in young adults.
  • Paradoxical excitement.

Answer: GI bleeding and renal toxicity.

16. Which of the following is NOT an NSAID?

  • Diclofenac
  • Meloxicam
  • Acetaminophen
  • Indomethacin

Answer: Acetaminophen

17. The primary reason for the development of selective COX-2 inhibitors was to:

  • Create a more potent anti-inflammatory agent.
  • Reduce the risk of gastrointestinal adverse effects compared to non-selective NSAIDs.
  • Provide better pain relief than opioids.
  • Have a medication with a lower cardiovascular risk.

Answer: Reduce the risk of gastrointestinal adverse effects compared to non-selective NSAIDs.

18. A key principle of the WHO analgesic ladder is to start with a(n) ________ for mild pain.

  • Strong opioid
  • Adjuvant analgesic
  • Non-opioid analgesic like an NSAID or acetaminophen
  • Weak opioid

Answer: Non-opioid analgesic like an NSAID or acetaminophen

19. A patient is taking an ACE inhibitor and an NSAID concurrently. The pharmacist should be aware of the increased risk for:

  • Acute kidney injury.
  • A hypertensive crisis.
  • Severe hyperkalemia.
  • Anaphylaxis.

Answer: Acute kidney injury.

20. A pharmacist’s role in the “prevention” of NSAID-related harm includes:

  • Recommending the lowest effective dose for the shortest duration.
  • Screening for contraindications and risk factors.
  • Counseling on appropriate use and when to seek medical attention.
  • All of the above.

Answer: All of the above.

21. Reye’s syndrome is a rare but serious condition associated with the use of ________ in children and teenagers recovering from a viral illness.

  • Ibuprofen
  • Acetaminophen
  • Aspirin
  • Naproxen

Answer: Aspirin

22. A topical NSAID like diclofenac gel is a good option for localized osteoarthritis pain because it:

  • Provides the same level of pain relief as an oral opioid.
  • Has no potential side effects.
  • Minimizes systemic exposure and reduces the risk of GI and cardiovascular adverse effects.
  • Is more effective than an oral NSAID.

Answer: Minimizes systemic exposure and reduces the risk of GI and cardiovascular adverse effects.

23. A patient taking low-dose aspirin for cardioprotection who also takes ibuprofen for pain should be counseled to:

  • Take both medications at the exact same time.
  • Take the ibuprofen at least 30 minutes after the aspirin or the aspirin at least 8 hours after the ibuprofen to avoid an interaction that can block aspirin’s antiplatelet effect.
  • Stop the aspirin while they are taking ibuprofen.
  • There is no interaction between these two drugs.

Answer: Take the ibuprofen at least 30 minutes after the aspirin or the aspirin at least 8 hours after the ibuprofen to avoid an interaction that can block aspirin’s antiplatelet effect.

24. The “leadership” skill of advocacy is demonstrated when a pharmacist:

  • Convinces an insurance company to cover a COX-2 inhibitor for a patient with a high GI risk who needs an NSAID.
  • Insists all patients with pain receive an NSAID.
  • Refuses to counsel any patient on an NSAID.
  • Only dispenses brand-name NSAIDs.

Answer: Convinces an insurance company to cover a COX-2 inhibitor for a patient with a high GI risk who needs an NSAID.

25. A pharmacist is using their knowledge of “pharmacology principles” when they explain to a patient that NSAIDs:

  • Can cause kidney damage by constricting the afferent arteriole of the glomerulus.
  • Are completely safe for the kidneys.
  • Should be taken with a diuretic to protect the kidneys.
  • Only affect the efferent arteriole.

Answer: Can cause kidney damage by constricting the afferent arteriole of the glomerulus.

26. Which of the following is NOT a therapeutic property of most NSAIDs?

  • Analgesic
  • Anti-inflammatory
  • Antipyretic
  • Anticoagulant (though aspirin has antiplatelet effects, most are not used for this)

Answer: Anticoagulant (though aspirin has antiplatelet effects, most are not used for this)

27. In which “practice setting” is a pharmacist most likely to recommend an OTC NSAID for a minor, self-limiting condition?

  • Hospital ICU
  • Nuclear Pharmacy
  • Community Pharmacy
  • Managed Care Organization

Answer: Community Pharmacy

28. A key part of the “Business Plan” for a new pain management service would include protocols for:

  • The safe and appropriate use of non-opioid analgesics like NSAIDs.
  • Marketing the service.
  • The financial model of the service.
  • All of the above.

Answer: All of the above.

29. The “human factors” principle applies to NSAIDs in that:

  • The availability of many different OTC products with the same active ingredient can lead to unintentional overdose.
  • The products are very difficult to use.
  • Patient education is not a factor in their safe use.
  • The packaging is designed to be confusing.

Answer: The availability of many different OTC products with the same active ingredient can lead to unintentional overdose.

30. The ultimate goal when using an NSAID is to:

  • Use the highest possible dose for the longest possible time.
  • Achieve the therapeutic goal (e.g., pain relief) using the lowest effective dose for the shortest duration necessary.
  • Ensure the patient remains on the medication indefinitely.
  • Completely eliminate all risk of side effects.

Answer: Achieve the therapeutic goal (e.g., pain relief) using the lowest effective dose for the shortest duration necessary.

31. The “Cardiovascular Principles” are relevant to NSAIDs because:

  • NSAIDs can increase blood pressure and the risk of thrombotic events.
  • They are first-line for treating heart failure.
  • They have no effect on the cardiovascular system.
  • They are known to lower cholesterol.

Answer: NSAIDs can increase blood pressure and the risk of thrombotic events.

32. A “Clinical Decision Support” alert in an EHR should fire if a physician tries to prescribe an NSAID for a patient with:

  • A high-risk condition like active peptic ulcer disease or severe chronic kidney disease.
  • A common cold.
  • A recent vaccination.
  • A history of smoking.

Answer: A high-risk condition like active peptic ulcer disease or severe chronic kidney disease.

33. The service of “deprescribing” might be considered for a patient on chronic, high-dose NSAID therapy if:

  • The risks of long-term use are thought to outweigh the benefits, especially in an elderly patient.
  • The patient is well-controlled with no side effects.
  • The patient has no other medical conditions.
  • The patient enjoys taking the medication.

Answer: The risks of long-term use are thought to outweigh the benefits, especially in an elderly patient.

34. A “negotiation” with a physician may be required if:

  • A pharmacist recommends discontinuing an NSAID in a patient with worsening heart failure, and the physician is hesitant.
  • A prescription for ibuprofen is a routine refill.
  • A patient has no questions about their medication.
  • The NSAID is on the hospital’s formulary.

Answer: A pharmacist recommends discontinuing an NSAID in a patient with worsening heart failure, and the physician is hesitant.

35. From a “policy” perspective, the decision by the FDA to require a cardiovascular risk warning on NSAIDs was a response to:

  • Evidence from clinical trials showing an increased risk.
  • Pressure from pharmaceutical companies.
  • The low cost of the medications.
  • The lack of any side effects.

Answer: Evidence from clinical trials showing an increased risk.

36. A pharmacist’s knowledge of “toxicology” is important for managing:

  • An acute overdose of ibuprofen.
  • The safe use of a low-dose NSAID.
  • A patient asking for a recommendation.
  • All of the above.

Answer: All of the above.

37. Which of the following belongs to the propionic acid class of NSAIDs?

  • Aspirin
  • Indomethacin
  • Naproxen
  • Piroxicam

Answer: Naproxen

38. The use of an “analytics and reporting system” in a health system could be used to identify:

  • All patients taking an NSAID concurrently with an anticoagulant to flag them for a safety review.
  • The total cost of NSAIDs dispensed.
  • The number of NSAID prescriptions dispensed by each pharmacist.
  • All of the above.

Answer: All of the above.

39. A “forging ahead” mindset in pharmacy means viewing common issues like NSAID-induced GI bleeds as:

  • An unavoidable cost of doing business.
  • An opportunity to develop pharmacist-led services focused on prevention and risk mitigation.
  • The patient’s fault for taking the medication.
  • A problem for physicians to solve.

Answer: An opportunity to develop pharmacist-led services focused on prevention and risk mitigation.

40. A key “human resources” consideration for a community pharmacy is:

  • Ensuring all staff are thoroughly trained to ask patients about concurrent NSAID use when dispensing high-risk drugs like warfarin.
  • The brand of computer used by the staff.
  • The pharmacy’s holiday party schedule.
  • The number of parking spaces available.

Answer: Ensuring all staff are thoroughly trained to ask patients about concurrent NSAID use when dispensing high-risk drugs like warfarin.

41. The primary anti-inflammatory effect of NSAIDs comes from the inhibition of:

  • Prostaglandin synthesis at the site of injury.
  • Platelet aggregation.
  • The release of histamine.
  • The reuptake of serotonin.

Answer: Prostaglandin synthesis at the site of injury.

42. A pharmacist’s role in addressing “health disparities” could involve:

  • Ensuring that a patient from a low-income background is counseled on the risks of combining multiple OTC NSAID products.
  • Recommending the most expensive brand-name NSAID to all patients.
  • Ignoring a patient’s inability to pay for a safer alternative.
  • Assuming all patients have the same level of health literacy.

Answer: Ensuring that a patient from a low-income background is counseled on the risks of combining multiple OTC NSAID products.

43. A pharmacist providing care to a patient after a “traumatic” injury should be cautious about recommending an NSAID if:

  • The patient is on anticoagulants.
  • There is a risk of a significant bleed.
  • The patient has underlying kidney disease.
  • All of the above.

Answer: All of the above.

44. The “antipyretic” (fever-reducing) effect of NSAIDs is thought to be due to:

  • A direct cooling effect on the skin.
  • Inhibition of prostaglandin synthesis in the hypothalamus.
  • An increase in sweating.
  • A decrease in heat production by the muscles.

Answer: Inhibition of prostaglandin synthesis in the hypothalamus.

45. A patient with a history of a “burn” should be cautious with NSAIDs if:

  • The burn was severe and led to acute kidney injury.
  • The burn is very minor and covers a small area.
  • They are also using a topical antibiotic.
  • They are not in any pain.

Answer: The burn was severe and led to acute kidney injury.

46. The service of MTM is an ideal setting to:

  • Screen for high-risk, chronic NSAID use and identify candidates for deprescribing.
  • Promote the long-term use of NSAIDs in all elderly patients.
  • Dispense as many prescriptions as possible.
  • Sell OTC products.

Answer: Screen for high-risk, chronic NSAID use and identify candidates for deprescribing.

47. From a “financials” perspective, the availability of many low-cost, generic, and OTC NSAIDs:

  • Increases the overall cost of pain management.
  • Is a key part of a pharmacy’s business model for self-care.
  • Has no impact on the pharmacy’s finances.
  • Means that brand-name products are always more effective.

Answer: Is a key part of a pharmacy’s business model for self-care.

48. An “Electronic Health Record” (EHR) can improve the safe use of NSAIDs by:

  • Alerting a prescriber if they order an NSAID for a patient with a documented history of a GI bleed or severe CKD.
  • Hiding a patient’s allergy information.
  • Making it harder to access a patient’s medication list.
  • Increasing the number of transcription errors.

Answer: Alerting a prescriber if they order an NSAID for a patient with a documented history of a GI bleed or severe CKD.

49. A key “leadership” practice for a pharmacy manager is to:

  • Create a culture of safety where technicians and pharmacists feel empowered to question prescriptions for NSAIDs in high-risk patients.
  • Insist that every prescription be filled as written without question.
  • Focus only on the speed of dispensing.
  • Discourage communication between pharmacists and technicians.

Answer: Create a culture of safety where technicians and pharmacists feel empowered to question prescriptions for NSAIDs in high-risk patients.

50. The most important principle for a pharmacist to remember regarding NSAIDs is to:

  • Always recommend them over acetaminophen for all types of pain.
  • View them as powerful medications with a significant risk profile that requires careful patient assessment and counseling.
  • Believe they are completely safe because many are available over-the-counter.
  • Assume patients already know how to use them safely.

Answer: View them as powerful medications with a significant risk profile that requires careful patient assessment and counseling.

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