<prompt> Drug causing peptic ulcer are all except: PGI Nov 2009KC1DiclofenacCyclosporineClopidegrel  <response>: Ans: C Cyclosporine Drug Causing Peptic UlcerIngestion of NSAIDs including aspirin is the main cause of gastric and duodenal ulcers that are not associated with H. pylori infection.Diclofenac :Gastric ulceration bleeding are less common- K.D.T. 6th193The isoenzymes cyclo-oxygenase-1 and cyclo-oxygenase-2 are largely responsible for the mucosal protective and antiinflammatory effects respectively of NSAIDs. Therefore newer NSAIDs, such as celecoxih and rofecoxih. that are highly selective for cyclo-oxygenase-2, control inflammation with ess risk-- of causing ulcers.The use of alternative medications such as paracetamol is the best way to prevent NSAID-associated ulcers1. NSAIDs are now generally avoided in non-inflammatory conditions such as osteoarthritis. When NSAIDs are required a cyclo- oxygenase-2-selective drug is preferred.If an ulcerogenic NSAID has to be continued in a patient at risk then ulcer prophylaxis is indicated. Proton pump inhibitors and misoprostol are both effective in healing and preventing NSAID-associated ulcers. The former are generally preferred because they have fewer side-effects: misoprostol in particular tends to cause diarrhoeaTable Harrison: Causes of Ulcers Not Caused by HelicobacterPylori and NSAIDsPathogenesis of Non-Hp and Non-NSAIDInfection Cytomegalovirus Herpes simplex virus Hel i cobacter heil manniDrugToxin Bisphosphonates Chemotherapy Clopidogrel Q Crack cocaine GlucocorticoidsQ when combined with NSAIDs Mycophenolate mofetilQ Potassium chloride0 Miscellaneous Basophilia in myeloproliferative disease Duodenal obstruction e.g., annular pancreas Infiltrating disease Ischemia Radiation therapy Sarcoidosis Crohns disease Idiopathic hypersecretory state 