Case 1 Tecoids

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NJ is a 72 year-old female who has been receiving PT as an outpatient to improve her range of motion (ROM). You are now seeing her as an inpatient for gastrointestinal bleeding. Her previous medical history (PMH) is significant for rheumatoid arthritis and coronary artery disease. Her current medications include: 1. Ibuprofen :NSAID
2. Isosorbide mononitrate: NITRATE
3. Aspirin enteric-coated (low dose - 81 mg po QD): NSAID
5. Methotrexate : DMARD
6. Advil 6-8 tabs/day= 1200mg-1600mg/Day : NSAID Nursing documentation indicates that NJ reports taking 6-8 over-the-counter
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However, since these drugs are non-selective inhibitors, they also reduce the COX-1 enzymes which are detrimental because the COX-2 enzymes actually help maintain normal cellular homeostasis. More specifically, the COX-1 enzymes help to produce prostaglandins such as PGI2 and PGE2 in the stomach, where they help to protect the gastric mucosa of the stomach.1(219-233) They do this by inhibiting gastric acid secretions, increasing stomach mucosa production, and maintaining good blood flow to the gastric mucosa.1(219-233) Depletion of the COX-1 enzymes inhibits all these things and decreases the protection of the gastric mucosa in the stomach, thus leaving one more susceptible to GI bleeding and damage due to increased gastric secretions there. 4. Similar to aspirin and ibuprofen, acetaminophen (Tylenol) produces antipyretic and analgesic effects. Why will acetaminophen NOT be useful in the treatment of the symptoms accompanying NJ’s rheumatoid arthritis?
Although Acetaminophen can by helpful in reducing fever and musculoskeletal pain, it is not an anti-inflammatory drug.1(230-233) Rheumatoid arthritis is a systemic disorder associated with pain, stiffness, and also inflammation of the hands, feet, and knees.1(237) 5. What is the likely indication for the low-dose aspirin prescription, and how does aspirin produce its therapeutic