Question
A 59-year-old postmenopausal woman comes to the physician because of a 6-month history of worsening pain and swelling in her left knee. She has a history of peptic ulcer disease for which she takes cimetidine. Examination shows palpable crepitus and limited range of motion of the left knee. Which of the following is the most appropriate pharmacotherapy for this patient’s symptoms?
| A. |
Ketorolac
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| B. |
Diclofenac
|
| C. |
Acetylsalicylic acid
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| D. |
Celecoxib
|
Show Answer
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Correct Answer � D
Explanation
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Ans-D-Celecoxib
Ketorolac
Ketorolac is used to treat moderate to severe pain (e.g., postoperative pain relief). However, ketorolac is a nonselective NSAID that inhibits both COX-1 and COX-2. This inhibition disrupts the production of protective gastric mucosal prostaglandin, increasing the risk for gastric and intestinal ulcers and bleeding. Therefore, ketorolac is not a preferred agent in this patient with a history of gastroduodenal ulcer (PUD).
Diclofenac
Diclofenac is used to treat acute pain and inflammation in rheumatic or non rheumatoid joint pain. However, diclofenac is a nonselective NSAID that inhibits both COX-1 and COX-2. This inhibition disrupts the production of protective gastric mucosal prostaglandin, increasing the risk for gastric and intestinal ulcers and bleeding. Therefore, diclofenac is not a preferred agent in this patient with a history of gastroduodenal ulcer (PUD).
Acetylsalicylic acid
Acetylsalicylic acid (aspirin) is used to treat acute pain and inflammation in rheumatic or non rheumatoid joint pain. However, aspirin is a nonselective NSAID that inhibits both COX-1 and COX-2. This inhibition disrupts the production of protective gastric mucosal prostaglandin, increasing the risk for gastric and intestinal ulcers and bleeding. Therefore, aspirin is not a preferred agent in this patient with a history of gastroduodenal ulcer (PUD).
Celecoxib
Celecoxib is a selective NSAID and COX-2 inhibitor, which can be used to treat acute pain. Compared to nonselective NSAIDs, COX-2 inhibitors have a reduced gastrointestinal toxicity, but nonetheless carry a minimal risk of gastrointestinal side effects. Therefore, close supervision of this patient is recommended due to a residual risk for gastrointestinal bleeds (especially in PUD). Unlike nonselective NSAIDs, selective COX-2 inhibitors do not have an effect on platelet aggregation, since platelets only possess COX-1.
