Paper I
2016 February (2010 Scheme) · 40 marks · 120 min

Question

Read the clinical problem and answer the following question: Master. Vijay, 12 years had severe fever for the past 3 days and he was under treatment with antibiotics and analgesics. He developed severe pain in the stomach after taking the analgesics and he was admitted to the Hospital for severe gastritis

  • (a) List four groups of analgesics and antipyretics that produces gastritis ,
  • (b) Mention the mechanism of action and advantages of propionic acid derivatives
  • (c) Name two selective COX-2 inhibitors and its advantages
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Answer

(a) Four groups of analgesics/antipyretics that cause gastritis

  • Salicylates (Aspirin)
  • Propionic acid derivatives (Ibuprofen, Naproxen)
  • Acetic acid derivatives (Diclofenac, Indomethacin)
  • Oxicams (Piroxicam)

(b) Mechanism of action and advantages of propionic acid derivatives

  • Mechanism: Inhibit cyclooxygenase (COX-1 and COX-2, non-selectively), reducing prostaglandin synthesis — producing analgesic, antipyretic, and anti-inflammatory effects
  • Advantages: Better GI tolerability than aspirin/indomethacin at equivalent anti-inflammatory doses, shorter half-life allowing more flexible dosing, effective analgesic-antipyretic-anti-inflammatory action with comparatively lower incidence of severe GI ulceration

(c) Selective COX-2 inhibitors and advantages

  • Celecoxib, Etoricoxib
  • Advantages: Significantly reduced GI toxicity (gastritis, peptic ulceration) compared to non-selective NSAIDs, since gastric-protective prostaglandins (COX-1 dependent) are spared; no antiplatelet effect (does not increase bleeding risk from that mechanism)
  • (Caveat: increased risk of cardiovascular thrombotic events, which limits their use)

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