ADC Practice Question — Ibuprofen and COX-2 inhibitors

What is the most important reason to avoid ibuprofen in this patient?

Pharmacology questions in the ADC written exam test applied prescribing decisions, not rote recall of drug names. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Mr. Rajiv Mehta, a 68-year-old man, presents with throbbing pain from the lower left second premolar. He has a mechanical heart valve and takes warfarin. His other medications include perindopril 4 mg and hydrochlorothiazide 12.5 mg for hypertension. His INR result from yesterday is 2.8. Clinical examination reveals tooth 35 has a deep distal carious lesion extending subgingivally, deemed non-restorable. He is keen to have the tooth extracted as soon as possible. The patient asks why you cannot simply prescribe ibuprofen for his pain, as it has worked well for him in the past. What is the most important reason to avoid ibuprofen in this patient?

A. Ibuprofen interacts with warfarin at the protein-binding level, displacing warfarin and causing a dangerously elevated INR
B. Ibuprofen will reduce the effectiveness of warfarin, putting the patient at risk of valve thrombosis
C. Ibuprofen is contraindicated in all patients over the age of 65
D. NSAIDs increase the risk of bleeding in patients taking antithrombotic drugs; paracetamol is preferred
E. The combination of ibuprofen with perindopril and hydrochlorothiazide creates a significant risk of acute kidney injury

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: D

According to TG, NSAIDs increase the risk of bleeding in patients taking antithrombotic drugs, and paracetamol is the preferred analgesic for postprocedural pain. While the correct answer (triple whammy — ) is also a genuine risk in this patient taking perindopril + hydrochlorothiazide, the MOST important reason is the direct bleeding risk from combining NSAID with warfarin. Both risks together make NSAIDs clearly contraindicated.

Source: Ch 23: NSAIDs increase bleeding risk with antithrombotics; Ch 5: Triple whammy risk

Remy's study tip — For pharmacology vignettes, read the patient’s medical history and allergies BEFORE looking at the drug options.

Exam preparation FAQ

How are Ibuprofen and COX-2 inhibitors questions structured in the ADC written exam?

ADC Ibuprofen and COX-2 inhibitors questions present as clinical vignettes requiring management decisions. The correct answer is always traceable to a guideline source.

Should I memorise guidelines word-for-word for Ibuprofen and COX-2 inhibitors?

Focus on decision points — when the guideline says X vs Y. The exam tests application, not recitation.

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What is the most important reason to avoid ibuprofen in this patient?

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