Andrea Doyle is a 61-year-old white female with a history of type 1 diabetes and has been bothered by osteoarthritis for the past couple of years. Her diabetes is well controlled with diet and insulin. Recently she began taking over-the-counter ibuprofen 400 mg twice a day to manage the arthritis. For the past 6 weeks, Ms. Doyle has experienced abdominal pain and increased frequency of bowel movements. Her stools are loose and not formed; quite frequently they are a liquid consistency. Her life has been altered by the frequency of having to access a toilet because of the diarrhea. She had rectal bleeding and irritation from the frequent bowel movements and suffered from abdominal pain at night as well as during the day. She reported these symptoms to her primary care provider, who referred her to a gastroenterologist for evaluation. An occult blood test showed blood in her stool. A stool culture was done to rule out parasitic infections; this was negative. Because it had been 9 years since her last colonoscopy, a colonoscopy was ordered to rule out pathology within the colon such as ulcerations or tumors. This screening test was also negative. The nurse practitioner suggested that Ms. Doyle change her arthritis medication from ibuprofen to celecoxib. Within 2 weeks Ms. Doyle has normally formed bowel movements and no abdominal pain. Case Analysis The symptoms described by Ms. Doyle are consistent with abnormal patterns of elimination. The diagnostic tests performed are routine given the symptoms and the time frame since the last screening tests. Nonsteroidal antiinflammatory drugs (NSAIDs) cause gastrointestinal distress, bleeding, and diarrhea, particularly in high doses and when not administered with food or milk. Celecoxib is a COX-2 inhibitor and is indicated for osteoarthritis, particularly when gastrointestinal inflammation is experienced with other NSAIDs.
1. If you were taking Mrs. Doyle’s health history when she first reported her problems with bowel elimination, what questions would you have asked to expand on the information provided in paragraphs 1 and 2 of this case study?
2. Why is celecoxib indicated for use in the management of osteoarthritis when GI inflammation is a problem after other NSAIDs are taken? What are the potential adverse effects of celecoxib?
1.Ask about the heart burn which is common due to no selective inhibition of cyclooxygenase 1 and 2
Inhibition of Cox 1 reduce the prostaglandins production and reduce the gastrointestinal mucosal lining
Ask about the gastrointestinal problems such as irregular bowl movements , hematemisis ,peptic ulcer , gastric pain
Blood test and stool test are negitive because it was due to adverse effects of ibuprofen
2.celecoxib inhibit Cox 2 , but not Cox 1 which important for gastrointestinal function
Cox 1 is important for mucus production and bicarbonate and reduce pepsin and acid secretion
Cox 1 inhibition cause reduced mucous , bicarbonate and increased pepsin and acid secretion
Inhibition of cox2 reduce inflammatory conditions
Adverse effects of celecoxib -
Diarrhea , vomiting , constipation , stomach pain ,nausea
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