Question

A 60-year-old man presents with a 6-month history of pain in his knee joints. It has been gradually increasing, and now limits his activities. X-ray reveals osteoarthritic changes in both knee joints. You consider treating him with a non-steroidal anti-inflammatory drug (NSAID); however, you note that he has a history of gastric ulcers. In the past, the patient has not tolerated proton pump inhibitors well; he has had several episodes of severe headache, diarrhea, and dizziness when treated with them.

What is the best way to reduce the risk of NSAID-induced gastric mucosal injury in this patient?

1. Misoprostol
2. Milk of Magnesia
3. Octreotide
4. Ranitidine
5. Sucralfate

Answer 1

Misoprostol is the best choice to reduce the risk of NSAID-induced gastric mucosal injury in a patient with a history of gastric ulcers who doesn't tolerate proton pump inhibitors well.

Step-by-step explanation:

Considering the 60-year-old man with a history of gastric ulcers and poor tolerance to proton pump inhibitors, the best way to reduce the risk of NSAID-induced gastric mucosal injury is the use of Misoprostol. Misoprostol is a synthetic prostaglandin analogue that can help protect the gastric lining by replacing the protective prostaglandins diminished by NSAID therapy.

Options such as Milk of Magnesia and Sucralfate are used for different indications and would not provide the prophylactic effect against NSAID-induced ulcers as effectively as Misoprostol. Ranitidine, once a valid option, is less favored due to concerns about its safety. Octreotide is not indicated for this purpose.