Question

Please provide sources for each question

1) A patient says to you “I have recently been diagnosed with osteoarthritis and was prescribed naproxen plus omeprazole. Do I really have to take the omeprazole? I read that it can cause osteoporosis”. Your records show the patient is 53 yo female with no significant medical history other than increasing pain in her right knee. How will you answer?

2) If a patient with rheumatoid arthritis has taken ibuprofen 200 mg four times daily for 2 weeks and received only mild improvement in symptoms, should we change to a different NSAID? If so, which one? Why?

3) If a patient is 50 years old and has a creatinine clearance of 50 ml/min/m², is it dangerous to start using a NSAID? Why? Is there anything we could do to minimize risk?

4) Assume that the patient in question #3 refuses to use a NSAID, but she has rheumatoid arthritis with considerable joint pain on a daily basis. Please give 2 possible recommendations for treating her acute pain and justify the pros and cons of each.

Answer 1

1. The class of PPI proton pump inhibitors reducing the bone mass is unclear as only the animal studies shows reduction in the bone density but have the examination every alternate day to prevent the complications  

Source: association of proton pump inhibitors on bone fractures. Curr gastro intestinal report, 2010 December.

2. Ibuprofen is one of the effective NSAIds which can be used for rheumatoid arthritis but many studies shows taking ibuprofen continously for a week increases the risk of heart attack and best alternative can be aspirin which even protects the heart.

Source: Morgan. Are anti inflammatory safe for you. WebMD.

3. Nsaid for long term reduces the kidney function and the creatinine clearance is 88 to 132.and to start with 50ml/min the nsaid is not much safe but still the proper monitoring of BUN and replacing the electrolytes helps to reduce kidney dysfunction.