A 58-year-old man with osteoarthritis requiring long-term naproxen has a high risk of NSAID-induced gastric ulcer but low cardiovascular risk. Which agent is specifically indicated to prevent such ulcers?

• A Loperamide
• B Ondansetron
• C Metoclopramide
• D Misoprostol ✓

Explanation

Misoprostol is a prostaglandin E1 analogue that replaces the protective endogenous prostaglandins suppressed by NSAID-mediated COX-1 inhibition, increasing mucus and bicarbonate secretion and maintaining mucosal blood flow. It is approved for prevention of NSAID-induced gastric ulcers in high-risk patients. Its major limitation is uterotonic activity causing abortion, so it is absolutely contraindicated in women who may become pregnant. The other agents listed have no cytoprotective role.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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