A 68-year-old man is seen in clinic for worsening bilateral knee osteoarthritis pain. Acetaminophen, topical diclofenac and intra-articular corticosteroid injections no longer give adequate relief, and after discussion with his rheumatologist a regular oral NSAID is judged necessary. Two years ago he had a gastric ulcer treated with a PPI, and H. pylori testing was negative at that time. Current medications are ASA 81 mg daily, prednisone 10 mg daily for polymyalgia rheumatica, and clopidogrel, which was added 3 weeks ago after drug-eluting stent placement for coronary artery disease. He has no abdominal pain at present, and examination of the abdomen is normal. Hemoglobin 138 g/L (130-170).
| Heart rate | 74/min |
| Respiratory rate | 14/min |
| Temperature | 36.8 °C |
| O2 saturation | 98%, room air |
| Blood pressure | 138/80 mm Hg |
Question 1 of 42
Which one of the following is the most appropriate gastroprotective medication to add if an oral NSAID is started?
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