Which of the following drug is more likely to cause oral aphthous ulcers?

JIPMER Nursing Officer - 2020

Pharmacology

Easy

Appeared in: JIPMER Nursing Officer - 2020

Explanation

Diclofenac is a Non-Steroidal Anti-Inflammatory Drug (NSAID).
NSAIDs work by inhibiting cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins.
While this reduces pain and inflammation, prostaglandins also have a protective role in the gastrointestinal mucosa.
Inhibition of these protective prostaglandins can lead to mucosal damage and ulceration, which can occur in the mouth, stomach, or intestines.
Therefore, among the choices, Diclofenac is the only drug with a known mechanism that can induce the formation of oral ulcers.

Option A: Dexamethasone is a potent corticosteroid with strong anti-inflammatory properties. It is used to treat severe aphthous ulcers to reduce inflammation and pain, not cause them.
Option B: Triamcinolone is another corticosteroid, often applied topically as a paste (e.g., Kenacort oral paste). It is specifically formulated to adhere to the oral mucosa to treat ulcers by reducing local inflammation and promoting healing.
Option C: Benzocaine is a local anesthetic. It provides temporary symptomatic relief by numbing the area of the ulcer, thus reducing pain. It has no role in causing or treating the underlying ulcer.

Clinical Relevance

Nursing practice connection: Knowing Adverse Drug Reactions and Pharmacology helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility is to assess for adverse drug effects. When a patient presents with new-onset oral ulcers, it is crucial to review their medication list for potential causative agents like NSAIDs.
Patient education should include informing them about common side effects of their medications. For patients starting on long-term NSAID therapy, advising them to report any new mouth sores, stomach pain, or dark stools is an important safety measure.
What if the patient develops oral ulcers while taking an NSAID? The nurse should instruct the patient to notify the prescribing physician. The physician may decide to discontinue the NSAID, switch to a different class of pain reliever (like acetaminophen), or prescribe a medication to protect the stomach lining.

How to Approach the Question

First, identify the core of the question: which drug causes a specific problem (oral ulcers).
Next, classify each drug option by its pharmacological class: Dexamethasone/Triamcinolone (corticosteroids), Benzocaine (local anesthetic), and Diclofenac (NSAID).
Recall the primary use and major side effects of each drug class in the context of oral health.
Corticosteroids are anti-inflammatory and are used to treat ulcers.
Local anesthetics are used for pain relief from ulcers.
NSAIDs are known to have gastrointestinal side effects, including mucosal ulceration.

Concept Tested & Keywords

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