Which drug class is noted as being less likely to cause stomach ulcers?

• A. COX-2 inhibitors
• B. Nonselective NSAIDs
• C. Opioids
• D. Acetaminophen

Answer: (A)

Prostaglandins help protect the stomach lining by promoting mucus and bicarbonate production and maintaining blood flow. Traditional NSAIDs block both COX-1 and COX-2, which reduces these protective prostaglandins and raises the risk of stomach ulcers. COX-2 inhibitors are designed to target the inflammatory enzyme COX-2 while largely sparing COX-1, so they provide anti-inflammatory effects with a lower impact on the stomach’s protective mechanisms. That’s why they’re noted as being less likely to cause stomach ulcers compared with nonselective NSAIDs.

Nonselective NSAIDs increase ulcer risk because they inhibit COX-1, a key player in gastric protection. Opioids don’t primarily cause ulcers, though they can irritate the GI tract. Acetaminophen isn’t an NSAID and generally has minimal GI mucosal toxicity, which is why it’s not associated with NSAID-related ulcer risk.