COX 2 Inhibitors and our exams

[vegas]

With the advent of Cox 2 inhibitors taken off the market, what if any changes should we make to answering questions on the USMLE/Shelf with regard to arthritis and NSAID induced gastric ulcers? Should we still continue to answer Cox 2 inhibitors as the DOC, or answer acetaminophen or just hope an answer choice like NSAID's with Misoprostil (for the cytoprotective effect) will be included as an answer choice? Thanks! Any ideas on this Dr. Desai? Thanks!!

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[kristing]

With the advent of Cox 2 inhibitors taken off the market, what if any changes should we make to answering questions on the USMLE/Shelf with regard to arthritis and NSAID induced gastric ulcers? Should we still continue to answer Cox 2 inhibitors as the DOC, or answer acetaminophen or just hope an answer choice like NSAID's with Misoprostil (for the cytoprotective effect) will be included as an answer choice? Thanks! Any ideas on this Dr. Desai? Thanks!!

Depends on when you take the test. If you are taking the boards very soon (within the next 6 months), I highly doubt there will be any changes re: the Cox-2s. These tests take a while to write and time to edit. Pretend like they are still on the market for any upcoming exams...

 

[DrMom]

Since only 1 Cox-2 has been pulled and there hasn't been much time to make any changes, answer as you would have before the whole Vioxx issue came up.

 

[Idiopathic]

The only situation i can imagine where this would be an issue is if they make a very big deal out of the patient having severe heart disease in the history. Then I might consider a more traditional NSAID over a COX-2, especially if the choice is vioxx (rofecoxib?).

 

[carrigallen]

Celecoxib (Celebrex) will probably not be removed anytime soon. The important thing is to understand the mechanism of action, and adverse effects. The adverse effects of COX-2 inhibitors are nothing new.

Additionally, legislative changes are being made to limit class-action lawsuits. Hopefully this will help encourage companies to keep drugs on the market, with less fear of questionable lawsuits.

 

[fotolilith]

Celecoxib (Celebrex) will probably not be removed anytime soon. The important thing is to understand the mechanism of action, and adverse effects. The adverse effects of COX-2 inhibitors are nothing new.

Additionally, legislative changes are being made to limit class-action lawsuits. Hopefully this will help encourage companies to keep drugs on the market, with less fear of questionable lawsuits.

Yeah, I'm sure "happy" that the drug companies are "safe" to continue considering their stock holders' concerns OVER human life.


I truly hope you are not right that pharm companies will continue obfuscating reports showing drugs are dangerous in order to keep selling them to innocent victims. However, I fear this new "tort reform" (cuz everyone hates lawyers) gives them more protection.

Actually, I ust read an interesting article discussing the tort reform: "I admit, of the nearly one million lawyers in the United States, you could probably drown 90 percent and only their mothers would grieve. But as Mrs. Levenson told me, without her lawyer and the threat of a class action tort, Pfizer would not have paid her a dime of compensation (for selling her a heart valve that they KNEW was faulty)."
http://www.gregpalast.com/detail.cfm?artid=413&row=0

 

[12R34Y]

Have no fear.......our clerkship directors who routinely meet with the NBME folks to discuss testing and implementation of new things have told us repeatedly this year..........."national board exams usually lag about 5 years or so." new stuff usually isn't on there.....meaning last few years.

boards are frought with standard old fashioned drugs that aren't even used today, but are excellent "classical examples".

don't worry about that kind of stuff.

later