A truck driver presented to the hospital with a minor soft tissue injury. Which of the following NSAID should not be prescribed to him ?
**Core Concept**
The question is testing the student's knowledge of the pharmacological properties of nonsteroidal anti-inflammatory drugs (NSAIDs), specifically their effects on platelet aggregation. NSAIDs are a class of medications that inhibit the enzyme cyclooxygenase (COX), which is involved in the synthesis of prostaglandins and thromboxanes.
**Why the Correct Answer is Right**
The correct answer is a specific NSAID that has a unique mechanism of action. This particular NSAID is a selective COX-2 inhibitor, which means it primarily inhibits the COX-2 enzyme, responsible for producing prostaglandins that cause inflammation and pain. However, COX-2 inhibitors also have a significant effect on platelet aggregation by reducing thromboxane A2 production. Since platelet aggregation is crucial for blood clotting, a COX-2 inhibitor like this one would increase the risk of bleeding in patients who are already at risk, such as those with minor soft tissue injuries.
**Why Each Wrong Option is Incorrect**
**Option A:** This NSAID is a non-selective COX inhibitor, meaning it blocks both COX-1 and COX-2 enzymes. While it can cause gastrointestinal side effects, it does not have the same risk of bleeding as the COX-2 inhibitor.
**Option B:** This NSAID is a propionic acid derivative, which has a similar mechanism of action to the correct answer but is not a COX-2 inhibitor.
**Option C:** This NSAID is an oxicam derivative, which has a long half-life and can cause renal toxicity, but it is not a COX-2 inhibitor.
**Clinical Pearl / High-Yield Fact**
When prescribing NSAIDs, especially to patients at risk of bleeding, it is essential to consider their mechanism of action and potential side effects. COX-2 inhibitors like the correct answer should be used with caution in patients with minor soft tissue injuries, and alternative analgesics or anti-inflammatory medications may be preferred.
**Correct Answer:** C. This NSAID is a COX-2 inhibitor that can increase the risk of bleeding in patients with minor soft tissue injuries.