American Board of Internal Medicine (ABIM) Certification Practice Exam

What should a patient on an NSAID always co-administer for safety?

1. Antibiotics

2. Proton pump inhibitor (PPI)

3. Antacids

4. Antihistamines

The correct answer is: Proton pump inhibitor (PPI)

Patients taking non-steroidal anti-inflammatory drugs (NSAIDs) are at an increased risk for gastrointestinal side effects, mainly gastric ulcers and bleeding. The use of a proton pump inhibitor (PPI) is recommended to help mitigate these risks. PPIs work by reducing gastric acid production, which helps protect the gastric mucosa from the harmful effects of NSAIDs. This protective feature is particularly important for patients who may have a history of peptic ulcers or those who are on chronic NSAID therapy, as it significantly decreases the likelihood of developing gastrointestinal complications. In contrast, while antibiotics, antacids, and antihistamines have their own uses, they do not specifically address the gastrointestinal risks associated with NSAID use. Antibiotics are used for bacterial infections and do not provide gastrointestinal protection. Antacids may relieve symptoms of acidity but do not prevent ulcer formation or bleeding. Antihistamines are primarily used for allergic reactions or motion sickness and do not have a role in protecting the gastrointestinal tract in the context of NSAID use. Hence, the co-administration of a proton pump inhibitor is a well-established practice to ensure the safety of patients prescribed NSAIDs.