Question

PN 105 Fundamentals of Nursing I U2 Aspirin - Peptic Ulcer o v ear-old woman, has taken 650 mg of aspirin four times a day for 8 months to alleviate toms of pain and inflammation associated with arthritis. Four weeks ago a Dentiel developed. 1. Explain the process in which PQ could have a peptic ulcer. How could this have been prevented? Asparin 2. Compare the similarities and differences in the side effects of salicylates with those of acetic acid agents, propionic acid agents, COX-2 inhibitors, and phenylatic acid. 3. What patient teaching points should PQ receive before and during the time she takes the aspirin? 4. How would COX-2 prevent the development of a peptic ulcer? 5. Would DMARD's be more helpful in alleviating PQ's symptoms? Explain your answer. 6. Compare the differences in the various types of DMARD's Reviewed 11/18

Answer 1

1) PQ has been on chronic use of Aspirin 650 mg 4 times a day since 8 months. Aspirin is a NSAID and its common side effect is gastric irritation, peptic ulcer disease. Along, with aspirin she has not been taking any proton pump inhibitors like pantoprazole , rabeprazole etc. or H-1 blockers like ramotidine and famotidine . Besides, she might have had spicy food . All these led to developing peptic ulcer disease.

This could have been prevented by prescribing a PPI or H-1 blocker that decreases the gastric acid production and protects the gastric mucosa along with aspirin and also advising her to limit the use of aspirin as much as possible and also advise her not to take spicy foods.

2) The similarities in the side effects with acetic acid agents (diclofenac, ketorolac, indomethacin) , propionic acid agents( naproxen, ibuprofen) , COX-2 inhibitors ( celecoxib, etoricoxib, meloxicam) and phenylacetic acid (lumiracoxib) are gastrointestinal side effects like GI upset, GI bleed , peptic ulcer and renal side effects like acute renal failure, hyperkalemia, fluid retention.

The differences in side effects are as follows:

Aspirin reversibly inhibits COX-1 enzyme in platelets leads to decreased platelet aggregation and increased risk of bleeding when compared to above classes of NSAID's .

Selective COX-2 inhibitors like diclofenac ,celecoxib ., etc. inhibits only COX-2 enzyme leading to increased prostagladins and thromboxanes that leads to increased platelet aggregation .So, risk of myocardial infarction and stroke are high.But they are gastro protective.

Phenylacetic acid ( lumiracoxib) has fewer gastrointestinal side effects.

3) The patient teaching points that PQ should receive before and during the time of taking aspirin is she should not take any other NSAID / other anti coagulant / diuretic which potentiates the cardiac and renal adverse effects.

Before taking she should see the label to look out for enteric coated . Enteric coated tablets does not release aspirin until it crosses the stomach that way preventing gastric irritation.

Explain her the possible side effects of the drug and immediately contact the prescriber if the adverse effects worsen.

4) COX-2 is only released in the conditions of inflammation so it only produces pain and fever .It does not inhibit Prostaglandin E and prostacyclins that are resonsible for secretion of gastric mucosa and also protecting the lining of mucosa. Thereby, it does not causes gastrointestinal adverse effects like peptic ulcer.