Wattle Pharmacy Prep

Analgesics and anti-inflammatories
Practice questions with explanations

Analgesics and anti-inflammatories belongs to Pharmacology and toxicology, which makes up about 15% of the Overseas Pharmacist Readiness Assessment (OPRA®). Answer each question yourself before opening the explanation.

1. Which explains why topical NSAIDs cause fewer systemic adverse effects than oral ones?

  1. They are not absorbed at all
  2. They act by a different mechanism
  3. They are more potent
  4. Plasma concentrations are a small fraction of those after oral dosing while local tissue concentrations are therapeutic
Show answer

D. Plasma concentrations are a small fraction of those after oral dosing while local tissue concentrations are therapeutic

Guidelines now recommend topical NSAIDs ahead of oral ones for knee and hand osteoarthritis, particularly in older patients. Absorption is not zero, so the same cautions apply in severe renal impairment and NSAID hypersensitivity, and applying to large areas or under occlusion increases systemic exposure appreciably.

2. Which mechanism explains the anti-inflammatory action of NSAIDs?

  1. Blockade of histamine receptors
  2. Direct opioid receptor agonism
  3. Inhibition of leukotriene synthesis as the primary action
  4. Inhibition of cyclo-oxygenase, reducing synthesis of prostaglandins that mediate pain, fever and inflammation
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D. Inhibition of cyclo-oxygenase, reducing synthesis of prostaglandins that mediate pain, fever and inflammation

Prostaglandins sensitise nociceptors, cause vasodilation and increase vascular permeability, and reset the hypothalamic thermostat, so blocking their synthesis is analgesic, anti-inflammatory and antipyretic at once. The same prostaglandins protect gastric mucosa and maintain renal perfusion, which is why the benefits and the harms of the class are inseparable.

3. Which explains the ceiling effect on respiratory depression with buprenorphine?

  1. It does not reach the brainstem
  2. Its partial agonism at the mu receptor means the maximal effect plateaus regardless of dose
  3. It antagonises its own respiratory effect at the kappa receptor
  4. It is rapidly metabolised at high doses
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B. Its partial agonism at the mu receptor means the maximal effect plateaus regardless of dose

Partial agonists produce a submaximal response even at full occupancy, so respiratory depression plateaus in a way that full agonists do not. This makes buprenorphine comparatively safer in opioid substitution treatment. Its high receptor affinity means naloxone reversal requires larger doses, and it precipitates withdrawal if given too soon after a full agonist.

These are 3 of the 40 questions on analgesics and anti-inflammatories in the app.

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More topics in Pharmacology and toxicology

Adverse drug reactions · Antimicrobial pharmacology · Autonomic pharmacology · Cardiovascular pharmacology · Chemotherapy and immunomodulators · CNS pharmacology · Endocrine pharmacology · Respiratory and gastrointestinal pharmacology · Toxicology and antidotes