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Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) ( 4 Questions)
A nurse is teaching a client who has osteoarthritis and is prescribed celecoxib (Celebrex), a selective COX-2 inhibitor. What should the nurse include in the teaching?
Celecoxib is a selective COX-2 inhibitor that blocks the production of prostaglandins that are involved in pain and inflammation, but spares the COX-1 enzyme that is responsible for protecting the stomach lining and platelet function¹²³⁴⁵. Therefore, celecoxib has less gastrointestinal toxicity than nonselective COX inhibitors, such as ibuprofen and naproxen, that inhibit both COX-1 and COX-2 enzymes¹²³⁴⁵. However, celecoxib still carries some risk of gastrointestinal bleeding and ulceration, especially in patients with a history of peptic ulcer disease, concomitant use of anticoagulants or corticosteroids, or high doses or long-term use of celecoxib¹²³⁴⁵. Therefore, the lowest effective dose and the shortest duration of treatment should be used, and patients should be monitored for signs and symptoms of gastrointestinal adverse events¹²³⁴⁵.
This option is wrong because celecoxib is a selective COX-2 inhibitor that does not block COX-1, which is involved in the production of prostaglandins that have anti-inflammatory and analgesic effects . Therefore, celecoxib has less anti-inflammatory and analgesic effects than nonselective COX inhibitors that block both COX-1 and COX-2 enzymes .
This option is wrong because celecoxib has more cardiovascular risk than nonselective COX inhibitors because it inhibits the production of prostacyclin, a prostaglandin that has vasodilatory and antiplatelet effects, while leaving the synthesis of thromboxane A2, a prostaglandin that promotes platelet aggregation, vasoconstriction, and smooth-muscle proliferation, unchanged or increased . This imbalance may favor thrombosis and vasoconstriction in the blood vessels and increase the risk of cardiovascular events, such as heart attacks and strokes . Therefore, celecoxib should be used with caution in patients with a history or risk factors for cardiovascular disease, and the lowest effective dose and the shortest duration of treatment should be used .
This option is wrong because celecoxib has less antipyretic and antiplatelet effects than nonselective COX inhibitors because it does not block the production of prostaglandins involved in fever and platelet aggregation . Celecoxib is a selective COX-2 inhibitor that spares the COX-1 enzyme that is responsible for protecting the stomach lining and platelet function
Celecoxib is a selective COX-2 inhibitor that blocks the production of prostaglandins that are involved in pain and inflammation, but spares the COX-1 enzyme that is responsible for protecting the stomach lining and platelet function¹²³⁴⁵. Therefore, celecoxib has less gastrointestinal toxicity than nonselective COX inhibitors, such as ibuprofen and naproxen, that inhibit both COX-1 and COX-2 enzymes¹²³⁴⁵. However, celecoxib still carries some risk of gastrointestinal bleeding and ulceration, especially in patients with a history of peptic ulcer disease, concomitant use of anticoagulants or corticosteroids, or high doses or long-term use of celecoxib¹²³⁴⁵. Therefore, the lowest effective dose and the shortest duration of treatment should be used, and patients should be monitored for signs and symptoms of gastrointestinal adverse events¹²³⁴⁵.
The other options are incorrect because:
B. The drug has more anti-inflammatory and analgesic effects than nonselective COX inhibitors because it blocks both COX-1 and COX-2 enzymes.
This option is wrong because celecoxib is a selective COX-2 inhibitor that does not block COX-1, which is involved in the production of prostaglandins that have anti-inflammatory and analgesic effects . Therefore, celecoxib has less anti-inflammatory and analgesic effects than nonselective COX inhibitors that block both COX-1 and COX-2 enzymes .
C. The drug has less cardiovascular risk than nonselective COX inhibitors because it inhibits vasodilatory and antiplatelet prostaglandins produced by COX-2 in the endothelium.
This option is wrong because celecoxib has more cardiovascular risk than nonselective COX inhibitors because it inhibits the production of prostacyclin, a prostaglandin that has vasodilatory and antiplatelet effects, while leaving the synthesis of thromboxane A2, a prostaglandin that promotes platelet aggregation, vasoconstriction, and smooth-muscle proliferation, unchanged or increased . This imbalance may favor thrombosis and vasoconstriction in the blood vessels and increase the risk of cardiovascular events, such as heart attacks and strokes . Therefore, celecoxib should be used with caution in patients with a history or risk factors for cardiovascular disease, and the lowest effective dose and the shortest duration of treatment should be used .
D. The drug has more antipyretic and antiplatelet effects than nonselective COX inhibitors because it blocks the production of prostaglandins involved in fever and platelet aggregation.
This option is wrong because celecoxib has less antipyretic and antiplatelet effects than nonselective COX inhibitors because it does not block the production of prostaglandins involved in fever and platelet aggregation . Celecoxib is a selective COX-2 inhibitor that spares the COX-1 enzyme that is responsible for protecting the stomach lining and platelet function