Why should NSAIDs be used cautiously in patients with peptic ulcers or advanced CKD?

• A. They reduce GI injury.
• B. They impair prostaglandin synthesis, exacerbating GI injury and renal decline.
• C. They only affect the liver.
• D. They have no risks.

Answer: (B)

NSAIDs inhibit cyclooxygenase, which lowers prostaglandin production. Prostaglandins help protect the gastric lining and maintain renal blood flow by dilating the afferent arteriole. When their synthesis is inhibited, the gastric mucosa becomes less defended, increasing the risk of mucosal injury and ulcer complications in people with peptic ulcers. In advanced CKD, reduced prostaglandin activity decreases renal perfusion and GFR, potentially accelerating kidney decline. Because of these effects, NSAIDs should be used cautiously in both peptic ulcer disease and advanced CKD. This option correctly reflects how impairment of prostaglandin synthesis can worsen GI injury and renal function. The other statements are inaccurate: NSAIDs do not reduce GI injury, they can affect liver but mainly harm the GI tract and kidneys, and they do carry important risks.