Which medication class should be avoided in a patient with a history of peptic ulcer disease?

Which medication class should be avoided in a patient with a history of peptic ulcer disease?

• A. First generation NSAIDs
• B. Acetaminophen
• C. Opioid analgesics
• D. Corticosteroids

Answer: (A)

The key idea is that protecting the stomach lining is crucial in peptic ulcer disease, and certain pain medicines can damage it. Nonsteroidal anti-inflammatory drugs with non-selective (first generation) action inhibit the enzymes that make protective prostaglandins in the stomach. Those prostaglandins help maintain the stomach’s mucus layer, bicarbonate, and blood flow. When these protective prostaglandins are reduced, the gastric mucosa becomes more susceptible to irritation, ulcers can worsen or recur, and the risk of bleeding increases. That’s why this class should be avoided in someone with a history of peptic ulcers. Acetaminophen is gentler on the stomach and does not carry the same ulcer-related risk, though it doesn’t have strong anti-inflammatory effects. Opioid analgesics address pain but don’t directly cause ulcers and aren’t the primary concern for ulcer risk. Corticosteroids can irritate the GI lining and, especially with NSAID use, can increase ulcer risk, but the strongest, most direct ulcer-promoting effect comes from non-selective NSAIDs, making them the least suitable choice in this history.

The key idea is that protecting the stomach lining is crucial in peptic ulcer disease, and certain pain medicines can damage it.

Nonsteroidal anti-inflammatory drugs with non-selective (first generation) action inhibit the enzymes that make protective prostaglandins in the stomach. Those prostaglandins help maintain the stomach’s mucus layer, bicarbonate, and blood flow. When these protective prostaglandins are reduced, the gastric mucosa becomes more susceptible to irritation, ulcers can worsen or recur, and the risk of bleeding increases. That’s why this class should be avoided in someone with a history of peptic ulcers.

Acetaminophen is gentler on the stomach and does not carry the same ulcer-related risk, though it doesn’t have strong anti-inflammatory effects. Opioid analgesics address pain but don’t directly cause ulcers and aren’t the primary concern for ulcer risk. Corticosteroids can irritate the GI lining and, especially with NSAID use, can increase ulcer risk, but the strongest, most direct ulcer-promoting effect comes from non-selective NSAIDs, making them the least suitable choice in this history.