Which medication should be avoided in an elderly patient who recently had a myocardial infarction?

The medication that should be avoided in an elderly patient who recently had a myocardial infarction is omeprazole. Omeprazole is a proton pump inhibitor (PPI) that can potentially increase the risk of cardiovascular events if used inappropriately. This is particularly concerning for elderly patients who may already have compromised cardiovascular health and may be taking other medications that affect heart function.

Additionally, PPIs like omeprazole can have other adverse effects, such as increasing the risk of bone fractures, especially in older adults. While they are effective in treating conditions like gastroesophageal reflux disease and peptic ulcers, in the context of recent myocardial infarction, the potential risks may outweigh the benefits.

The other medications listed—calcium citrate, famotidine, and ranitidine—do not have the same level of concern for increased cardiovascular risk, making them more suitable options for elderly patients after a myocardial infarction. Calcium citrate is often used as a supplement without significant cardiovascular risks. Famotidine and ranitidine are H2-receptor antagonists that can be prescribed with more caution in this patient population, as they are typically not associated with increased cardiovascular events in the same way as PPIs.