Drug of choice for chronic use NSAID induced peptic ulcer:
**Core Concept**
Chronic use NSAID-induced peptic ulcers are a common complication of long-term nonsteroidal anti-inflammatory drug (NSAID) therapy, often resulting from the inhibition of cyclooxygenase (COX) enzymes and subsequent reduction of protective prostaglandins in the gastric mucosa.
**Why the Correct Answer is Right**
The drug of choice for chronic use NSAID-induced peptic ulcers is a proton pump inhibitor (PPI) such as omeprazole. PPIs effectively reduce gastric acid secretion by inhibiting the H+/K+ ATPase enzyme system at the secretory surface of gastric parietal cells, thereby promoting healing and preventing recurrence of ulcers. PPIs are more effective than H2 receptor antagonists in healing and preventing NSAID-induced ulcers.
**Why Each Wrong Option is Incorrect**
**Option A:** Misoprostol, a synthetic prostaglandin E1 analogue, is effective in preventing NSAID-induced ulcers but is not the first-line treatment for chronic use NSAID-induced peptic ulcers due to its side effects and limited efficacy in healing established ulcers.
**Option B:** Sucralfate, a cytoprotective agent, is effective in healing and preventing NSAID-induced ulcers but may not be as effective as PPIs in promoting rapid healing and preventing recurrence.
**Option C:** H2 receptor antagonists, such as ranitidine, are effective in reducing gastric acid secretion but are not as effective as PPIs in healing and preventing NSAID-induced ulcers.
**Clinical Pearl / High-Yield Fact**
When managing patients with chronic use NSAID-induced peptic ulcers, it is essential to consider co-prescribing a PPI to prevent recurrence and promote healing, as NSAIDs can continue to cause mucosal injury despite ulcer healing.
**Correct Answer:** C.