In an elderly patient with osteoarthritis, which medication is associated with an increased risk of GI ulceration?

In an elderly patient with osteoarthritis, which medication is associated with an increased risk of GI ulceration?

• A. Warfarin
• B. Celecoxib
• C. Tramadol
• D. Amitriptyline

Answer: (B)

The key idea is that NSAIDs can injure the stomach lining by blocking prostaglandin production, which protects the gastric mucosa. In older adults with osteoarthritis, this protective barrier is already more fragile, so the risk of ulceration rises when NSAIDs are used. Celecoxib is a COX-2–selective NSAID prescribed for OA. Although it is designed to spare COX-1 and thus reduce GI irritation compared with traditional nonselective NSAIDs, it still carries a risk of gastric ulceration, especially in the elderly. That’s why it’s the medication among the options associated with an increased risk of GI ulcers. Warfarin increases the risk of GI bleeding from ulcers but doesn’t directly cause ulcers; tramadol and amitriptyline aren’t the typical drivers of ulcer formation.

The key idea is that NSAIDs can injure the stomach lining by blocking prostaglandin production, which protects the gastric mucosa. In older adults with osteoarthritis, this protective barrier is already more fragile, so the risk of ulceration rises when NSAIDs are used.

Celecoxib is a COX-2–selective NSAID prescribed for OA. Although it is designed to spare COX-1 and thus reduce GI irritation compared with traditional nonselective NSAIDs, it still carries a risk of gastric ulceration, especially in the elderly. That’s why it’s the medication among the options associated with an increased risk of GI ulcers.

Warfarin increases the risk of GI bleeding from ulcers but doesn’t directly cause ulcers; tramadol and amitriptyline aren’t the typical drivers of ulcer formation.