Name two major safety concerns with OTC NSAIDs.

• A. Drowsiness and dry mouth
• B. Heartburn and indigestion
• C. Liver damage and kidney injury
• D. Gastrointestinal bleeding/ulcers and kidney impairment

Answer: (D)

When using OTC NSAIDs, the biggest safety concerns come from how these drugs affect protective prostaglandins in the stomach and kidneys. Prostaglandins help maintain the stomach lining and regulate blood flow to the kidneys. Inhibiting them can lead to gastrointestinal problems and kidney issues.

Gastrointestinal bleeding and ulcers occur because NSAIDs irritate the stomach lining and can erode tissue over time, potentially causing serious bleeding. This risk is higher with older age, a history of ulcers, concurrent use of blood thinners or steroids, and longer or higher-dose use.

Kidney impairment happens because prostaglandin inhibition reduces blood flow to the kidneys, which can decrease kidney function and lead to acute kidney injury, especially in people who are dehydrated, have preexisting kidney disease, are elderly, or are using other medications that affect the kidneys.

The other options describe symptoms or organ effects that are less central to NSAID safety profiles. For example, drowsiness and dry mouth aren’t typical major risks, while liver damage is not a common major issue with NSAIDs (unlike with acetaminophen). Heartburn and indigestion can occur but do not capture the two most serious safety concerns.