NAPLEX Question of the Week: Special Populations

Most clinical studies are done in adult populations of patients. However a significant population of patients that receive care are termed "special populations". Some of these include infants, pediatrics, elderly, or pregnant patients. Evidence for safety and efficacy are often limited in these populations (especially infants and pregnancy) and clinical judgment with experience often drive selection of agent. Today we will examine a question related to one of these special populations.
NAPLEX Question of the Week: Special Populations

A 24 year old female reports to her primary care physician with reports of "dyspepsia". She takes daily fluticasone nasal spray and levothryoxine for her allergic rhinitis and hypothyroidism. Her symptoms correlate well with starting OTC ibuprofen 800mg TID after tearing her meniscus playing basketball one week ago. She is currently being evaluated for potential surgery as she is continuing to have significant swelling and pain. Which of the following agents would require a negative pregnancy test prior to initiation for her GI symptoms?

A. Calcium carbonate

B. Misoprostol

C. Omeprazole

D. Ranitidine

Answer with rationale:

Answer B is correct. Misoprostol (Cytotec) is pregnancy category X due to risk of spontaneous abortion upon administration. Female patients should have a negative pregnancy test within 2 weeks prior to starting therapy. Patients should start misoprostol on the second or third day of their next normal menstrual cycle. Keep in mind that the branded product Arthrotec contains both misoprostol and diclofenac. Answer A is incorrect as calcium products while not the most effective agents do not require a negative pregnancy test. Answer C is incorrect as PPIs do not require a pregnancy test prior to starting therapy as they are all category B or C. Answer D (Ranitidine) is pregnancy category B and therefore is not contraindicated during pregnancy.