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.