COX-2 Inhibitors Cardiovascular Risk — FRCA Primary MCQ
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Correct answer: B — Selective COX-2 inhibition can increase arterial thrombotic risk, particularly with higher doses and longer exposure
Explanation lettering: C = shown as B · D = shown as C · B = shown as D
C is correct. Selective COX-2 inhibitors can reduce vascular prostacyclin production without corresponding inhibition of platelet COX-1-derived thromboxane A2, potentially shifting haemostasis towards thrombosis. The cardiovascular risk is influenced by the specific drug, dose, duration and patient risk factors; it is therefore inaccurate to imply that every COX-2 inhibitor carries an identical risk at every dose. Paracetamol is not a potent peripheral COX-1/COX-2 inhibitor. Ibuprofen inhibits both COX isoenzymes and is classified as a non-selective NSAID. COX-2 is the isoenzyme characteristically induced by pro-inflammatory stimuli, although it also has constitutive physiological roles. NSAIDs share mechanisms that can impair renal perfusion, but their renal risk is not identical and depends on exposure and patient susceptibility.
Reference: Aurobindo Pharma–Milpharm Ltd, Celecoxib 100 mg Capsules: Summary of Product Characteristics, sections 4.2, 4.4 and 5.1, revised May 2026. https://www.medicines.org.uk/emc/product/2117/smpc