Paper I
2025 March (Supplementary (SAY)) (2019 Scheme) · 100 marks · 180 min

Question

Enumerate the Merits and Demerits of selective Cox-2 Inhibitors

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Answer

Selective COX-2 inhibitors (Celecoxib, Etoricoxib) spare COX-1 while inhibiting COX-2, the isoform predominantly responsible for inflammatory prostaglandin synthesis.

Merits: substantially reduced GI ulceration/bleeding risk compared to non-selective NSAIDs (COX-1 mediates the protective gastric mucosal prostaglandins that non-selective NSAIDs also block); no effect on platelet thromboxane A2 synthesis (COX-1-mediated), so no antiplatelet effect/bleeding tendency; comparable anti-inflammatory and analgesic efficacy to non-selective NSAIDs.

Demerits: increased cardiovascular (thrombotic) risk with prolonged use — unopposed COX-1-mediated platelet thromboxane A2 production without the counterbalancing COX-2-mediated endothelial prostacyclin, tipping the balance toward thrombosis; still carries renal adverse effects common to the NSAID class (both COX isoforms contribute to renal prostaglandin function); higher cost than conventional NSAIDs; some GI risk still present, just reduced rather than eliminated.

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