In Mrs L with dyspepsia and coffee-ground vomiting while taking aspirin, which drug should be withheld until further investigations?

• A. Paracetamol
• B. Aspirin
• C. Amlodipine
• D. Atorvastatin

Answer: (B)

When there are signs of an upper GI bleed, such as coffee-ground vomiting, the medication most likely contributing to the bleed should be stopped while investigations are arranged. Aspirin is an NSAID that inhibits COX-1, reducing protective prostaglandins in the stomach lining and increasing the risk of gastric ulcers and bleeding. In this scenario, stopping aspirin helps prevent ongoing bleeding and allows evaluation (history, labs, possibly endoscopy) to determine the cause and next steps.

The other drugs listed do not carry the same immediate risk for an upper GI bleed in this context, so they are not required to be withheld solely based on these symptoms. Paracetamol is generally gentler on the GI tract; amlodipine and atorvastatin don’t directly cause acute GI bleeding and can be continued unless there are other specific concerns.