ROSH Gastrointestinal Practice Exam

Which medication carries a black box warning and should be used with caution in a patient with a history of peptic ulcer disease taking NSAIDs?

1. Famotidine

2. Misoprostol

3. Omeprazole

4. Pantoprazole

The correct answer is: Misoprostol

Misoprostol is the medication that carries a black box warning and should be used with caution in patients with a history of peptic ulcer disease who are taking NSAIDs. The black box warning for misoprostol highlights the risks of abortifacient effects, as it can stimulate uterine contractions and lead to miscarriage or premature birth if used during pregnancy. This warning is particularly important for any woman of childbearing potential, hence the need for caution in this demographic. In the context of using misoprostol alongside NSAIDs, it is important to note that while this medication is used to prevent gastric ulcers induced by NSAIDs, its potential to cause serious reproductive outcomes requires healthcare providers to weigh the benefits against the risks carefully. The other medications listed, such as famotidine, omeprazole, and pantoprazole, are often used to manage or prevent peptic ulcers and typically do not carry the same level of significant warning regarding pregnancy and reproductive health, making them safer alternatives in this specific context.