NAPLEX Practice Questions

Question 1: NSAID Mechanism of Action

Vignette: A 45-year-old female patient with a history of osteoarthritis presents to the pharmacy with a prescription for an NSAID. She inquires about how NSAIDs work to relieve her pain and inflammation.

A. Inhibit cyclooxygenase (COX) enzymes
B. Activate opioid receptors
C. Block calcium channels
D. Inhibit phosphodiesterase
E. Activate gamma-aminobutyric acid (GABA) receptors

Rationale: NSAIDs exert their analgesic, anti-inflammatory, and antipyretic effects primarily through the inhibition of cyclooxygenase (COX) enzymes, COX-1, and COX-2. This inhibition leads to a decrease in the synthesis of prostaglandins, which are mediators of inflammation and pain. Unlike options B, C, D, and E, which describe mechanisms of other classes of drugs (opioids, calcium channel blockers, phosphodiesterase inhibitors, and GABAergic drugs, respectively), the mechanism of action of NSAIDs is specific to the inhibition of COX enzymes.

Question 2: NSAID and Cardiovascular Risk

Vignette: A 60-year-old male with hypertension and a recent myocardial infarction is advised to avoid certain NSAIDs. He asks which characteristic of NSAIDs is the reason for this recommendation.

A. Sedation effects
B. Increased risk of cardiovascular events
C. Risk of renal impairment
D. Gastrointestinal irritation
E. Risk of respiratory depression

Rationale: NSAIDs have been associated with an increased risk of cardiovascular events, such as myocardial infarction and stroke, particularly in patients with existing cardiovascular disease or risk factors. This risk is thought to be related to the inhibition of COX-2 leading to imbalances in prostaglandin synthesis, affecting vascular and platelet functions. The other options listed (A, C, D, and E) describe other potential side effects or concerns associated with various medications but do not specifically address the reason NSAIDs are cautioned against in patients with cardiovascular risk.

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Question 3: NSAID and Gastrointestinal Side Effects

Vignette: A patient with chronic knee pain is considering starting an NSAID for pain management. She is concerned about gastrointestinal side effects and asks which of the following is a common gastrointestinal side effect of NSAIDs.

  • A. Constipation
    B. Gastrointestinal bleeding
    C. Increased appetite
    D. Esophageal spasm
    E. Decreased gastric acid secretion

Rationale: NSAIDs are known to cause gastrointestinal side effects, including ulcers and gastrointestinal bleeding, due to their inhibition of COX-1, which normally protects the stomach lining by promoting the production of gastroprotective prostaglandins. The other options do not accurately reflect the common gastrointestinal effects of NSAIDs. Constipation is more commonly associated with opioids, increased appetite and decreased gastric acid secretion are not typical effects of NSAIDs, and esophageal spasm is unrelated to NSAID use.

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Question 4: Selective COX-2 Inhibitors

Vignette: A patient with rheumatoid arthritis requires long-term NSAID treatment. She is concerned about the gastrointestinal side effects of traditional NSAIDs and inquires about an alternative with fewer gastrointestinal risks.

  • A. Ibuprofen
    B. Naproxen
    C. Celecoxib
    D. Acetaminophen
    E. Aspirin

Rationale: The drug is a selective COX-2 inhibitor, which is associated with a lower risk of gastrointestinal side effects compared to non-selective NSAIDs (such as ibuprofen, naproxen, and aspirin) that inhibit both COX-1 and COX-2. COX-1 plays a role in protecting the gastric mucosa, so its inhibition increases the risk of gastrointestinal issues. Acetaminophen is not classified as an NSAID and primarily acts centrally to reduce pain and fever, with minimal anti-inflammatory effects and lower risk of gastrointestinal side effects.

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Question 5: NSAID Allergy

Vignette: A 35-year-old woman reports an allergic reaction to aspirin. She needs an analgesic for her headache and asks for a recommendation. Which of the following NSAIDs should be avoided due to cross-reactivity in patients with aspirin allergy?

  • A. Ibuprofen
    B. Acetaminophen
    C. Celecoxib
    D. Naproxen
    E. Paracetamol

Rationale: Patients with a known allergy to aspirin (acetylsalicylic acid) may also exhibit allergic reactions to other NSAIDs, such as ibuprofen and naproxen, due to their similar mechanism of COX inhibition and potential for cross-reactivity. Acetaminophen (also known as paracetamol, which is listed as both B and E, likely due to a misunderstanding in the options) is generally considered safe for patients with aspirin allergies, as it has a different mechanism of action and is not classified as an NSAID. Celecoxib, while a COX-2 selective inhibitor, may still pose a risk for individuals with severe aspirin allergies, especially those with a history of bronchospasm or anaphylaxis, but the risk of cross-reactivity is lower compared to non-selective NSAIDs.

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Monitor renal function

Question 6: Renal Effects of NSAIDs

Vignette: A 70-year-old male with a history of chronic kidney disease stage 3 asks about the safety of using NSAIDs for his chronic back pain.

  • A. NSAIDs are safe to use in any stage of kidney disease.
    B. NSAIDs may cause renal impairment and should be used with caution.
    C. NSAIDs improve renal function in chronic kidney disease patients.
    D. NSAIDs are recommended as the first-line treatment for pain in kidney disease.
    E. NSAIDs can only be used in acute kidney injury.


Rationale: NSAIDs can adversely affect renal function by inhibiting the production of prostaglandins that are important for renal blood flow, especially in patients with pre-existing renal impairment or those at risk for renal disease. This inhibition can lead to acute kidney injury or worsen existing chronic kidney disease. Therefore, NSAIDs should be used with caution in these populations, and alternative pain management strategies should be considered. The other options are incorrect because NSAIDs do not improve renal function, are not safe to use indiscriminately in kidney disease, are not recommended as the first-line treatment for pain in renal impairment, and are not limited to use only in acute kidney injury.

Question 7: Drug Interaction with NSAIDs

Vignette: A 55-year-old man is currently taking low-dose aspirin for cardiovascular protection. He asks if he can take ibuprofen for occasional headaches.

  • A. Yes, without any considerations.
    B. No, because ibuprofen can negate the cardioprotective effects of aspirin.
    C. Only if he takes ibuprofen eight hours before aspirin.
    D. Only if he discontinues aspirin.
    E. Yes, but only with a proton pump inhibitor.


Rationale: The drug can interfere with the antiplatelet effect of low-dose aspirin when taken concurrently, potentially negating its cardioprotective benefits. This interaction occurs because ibuprofen can block the access of aspirin to its binding site on the COX-1 enzyme, reducing aspirin’s ability to inhibit platelet aggregation. Patients taking low-dose aspirin for cardiovascular protection should be advised to use alternative analgesics that do not interfere with aspirin’s action or to carefully time the administration of ibuprofen to minimize interaction risk. The suggestions to take ibuprofen eight hours before aspirin or to discontinue aspirin are not ideal management strategies for maintaining cardiovascular protection.

Question 8: NSAIDs and Asthma

Vignette: A 40-year-old female with a history of asthma is concerned about taking NSAIDs for her migraines due to potential exacerbation of her asthma.

  • A. All NSAIDs are contraindicated in patients with asthma.
    B. Only COX-2 inhibitors are safe for patients with asthma.
    C. Aspirin can be safely used by all asthma patients.
    D. Patients with asthma should avoid NSAIDs known to exacerbate asthma.
    E. NSAIDs have no effect on asthma symptoms.


Rationale: Some individuals with asthma, particularly those with aspirin-exacerbated respiratory disease (AERD), may experience worsening of asthma symptoms or precipitate an asthma attack after taking certain NSAIDs. This is due to the inhibition of COX enzymes leading to an imbalance in prostaglandin and leukotriene pathways, which can affect airway inflammation and reactivity. Not all patients with asthma have sensitivity to NSAIDs, but those with a known history of NSAID-exacerbated respiratory disease should avoid these medications. COX-2 inhibitors may be safer alternatives for some of these patients, but individual risks must be assessed.

Question 9: NSAID

Overdose Management

Vignette: A 22-year-old male is brought to the emergency department after ingesting a large quantity of ibuprofen in a suicide attempt. The medical team is assessing his condition and planning his management.

  • A. Administer activated charcoal immediately.
    B. Perform gastric lavage as the first line of treatment.
    C. Administer intravenous proton pump inhibitors.
    D. Provide supportive care and monitor for renal failure.
    E. Administer naloxone to reverse ibuprofen effects.


Rationale: In cases of NSAID overdose, the primary treatment is supportive care, focusing on the maintenance of vital functions and the monitoring and management of complications such as gastrointestinal bleeding, metabolic acidosis, and renal failure. Activated charcoal can be considered if the patient presents within a few hours of ingestion, but it’s not universally recommended as the sole treatment. Gastric lavage is rarely used and generally not recommended due to the risk of complications. Intravenous proton pump inhibitors may be used to prevent gastrointestinal bleeding, but they are not the primary treatment for NSAID overdose. Naloxone is used to reverse opioid, not NSAID, overdoses.

Question 10: NSAIDs in Pregnancy

Vignette: A pregnant woman in her second trimester asks about the safety of using NSAIDs for her chronic headache.

  • A. NSAIDs are safe throughout pregnancy.
    B. NSAIDs should be avoided in the third trimester.
    C. NSAIDs can be used freely in the first and second trimesters.
    D. NSAIDs are recommended for pain management in pregnancy.
    E. NSAIDs should only be used under a doctor’s supervision during pregnancy.


Rationale: NSAIDs are generally advised against during the third trimester of pregnancy due to the risk of premature closure of the ductus arteriosus in the fetus, which can lead to pulmonary hypertension and other complications. Additionally, NSAIDs can inhibit labor and increase the risk of hemorrhage. While their use might be considered in certain situations in the first and second trimesters, it should always be under the supervision of a healthcare provider. Saying NSAIDs can be used “freely” in the first and second trimesters or recommending them for pain management in pregnancy without qualification would be misleading, as there are potential risks at any stage of pregnancy.