A 50-year-old patient, Sally, presents with osteoarthritis diagnosed three months ago and has been taking Ibuprofen.
Osteoarthritis, Celebrex, and Ibuprofen
A 50-year-old patient, Sally, presents with osteoarthritis diagnosed three months ago and has been taking Ibuprofen. However, Sally reports that Ibuprofen is not helping with her osteoarthritis, and it causes her stomach discomfort. Based on her complaints, her medication was changed from Ibuprofen to celecoxib. Osteoarthritis is characterized by cartilage degeneration causing joint pain, stiffness, and discomfort on the knees, hips, and thumb joints (Kloppenburg & Berenbaum, 2020). Relying on the symptoms and signs associated with osteoarthritis and how such affects Sally’s daily activities, such as jogging, she needs a therapy that reduces the signs and symptoms. As a result, she can function well with less or no pain, reduced stiffness, and delayed cartilage degeneration.
According to D’Arcy et al. (2021), Acetaminophen is the first line of therapy for osteoarthritis. Acetaminophen aids in reducing mild pains and fever. However, the exact mechanism of Acetaminophen is debatable despite the drug being placed in a similar class as non-steroidal anti-inflammatory drugs (NSAIDs). In this case, D’Arcy et al. (2021) indicate that Acetaminophen alleviates cyclooxygenase pathways which help transmit the pain message making an individual with osteoarthritis feel pain. Thus, as Acetaminophen alleviates the pathways, the patient is cushioned from pain (D’Arcy et al., 2021). As a result of alleviated cyclooxygenase pathways, the prostaglandin production that sends pain sensations is inhibited, thus, alleviating the pain the patient feels.
Sally raised concerns about using celecoxib to replace Ibuprofen, fearing heart problems. Celecoxib helps relieve pain, stiffness, swelling, and tenderness caused by osteoarthritis (D’Arcy et al., 2021). In addition, Ramazani et al. (2019) revealed that celecoxib reduces the risk of gastrointestinal bleeding compared to other NSAIDs. In Sally’s case, the Ibuprofen was causing her stomach discomfort; thus, the change to celecoxib addresses the stomach issues as it has fewer risks of gastrointestinal bleeding. However, the healthcare provider needs to inform Sally of the cardiovascular health problems associated with celecoxib which research has shown on the use of NSAIDs (Bindu et al., 2020).
Sally suffers from osteoarthritis that causes cartilage degeneration leading to signs such as pain, stiffness, and swelling. NSAIDs, Ibuprofen, and celecoxib are used to alleviate osteoarthritis symptoms, specifically pain (Varrassi et al., 2019). Thus, Ibuprofen and celecoxib both relieve osteoarthritis symptoms. However, the mechanism of action for the two NSAIDs differs. The prostaglandin synthesis comprises cycloxygenase-1 and cyclooxygenase-2 (Ramazani et al., 2019). The ibuprofen mechanism involves blocking cycloxygenase-1 and cyclooxygenase-2, which has been associated with an increased risk of stomach ulcers. Conversely, the celecoxib mechanism of action blocks cyclooxygenase-2 only, reducing the risk of stomach ulcers. Thus, Sally needs to be educated on such information that celecoxib and Ibuprofen belong to the same class and perform the same functions of exhibiting prostaglandin to interrupt the sending of pain sensation. Notably, she needs an explanation of the reduced risk of stomach problems with celecoxib and why Ibuprofen was causing her stomach issues by highlighting that Ibuprofen inhibits both cycloxygenase-1 and cyclooxygenase-2 while celecoxib inhibits only cyclooxygenase-2 (Ramazani et al., 2019).
References
Bindu, S., Mazumder, S., & Bandyopadhyay, U. (2020). Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochemical Pharmacology, 180, 114147. https://doi.org/10.1016/j.bcp.2020.114147
D’Arcy, Y., Mantyh, P., Yaksh, T., Donevan, S., Hall, J., Sadrarhami, M., & Viktrup, L. (2021). Treating osteoarthritis pain: mechanisms of action of Acetaminophen, non-steroidal anti-inflammatory drugs, opioids, and nerve growth factor antibodies. Postgraduate Medicine, 133(8), 879-894. https://doi.org/10.1080/00325481.2021.1949199 (Links to an external site.)
Kloppenburg, M., & Berenbaum, F. (2020). Osteoarthritis year in review 2019: epidemiology and therapy. Osteoarthritis And Cartilage, 28(3), 242-248. https://doi.org/10.1016/j.joca.2020.01.002
Ramazani, E., Tayarani-Najaran, Z., & Fereidoni, M. (2019). Celecoxib, indomethacin, and Ibuprofen prevent 6-hydroxydopamine-induced PC12 cell death through the inhibition of NFκB and SAPK/JNK pathways. Iranian Journal of Basic Medical Sciences, 22(5), 477.
Varrassi, G., Pergolizzi, J., Dowling, P., & Paladini, A. (2019). Ibuprofen Safety at the Golden Anniversary: Are all NSAIDs the Same? A Narrative Review. Advances In Therapy, 37(1), 61-82. https://doi.org/10.1007/s12325-019-01144-9 (Links to an external site.)
Osteoarthritis Celebrex and Ibuprofen.docx
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- Osteoarthritis, Celebrex, and Ibuprofen
- What is the first-line therapy for osteoarthritis and the mechanism of action?
After starting physical activity or physical therapy, the first line of treatment is to take 650 mg every 4 to 6 hours or 1 gram of acetaminophen every 6 to 8 hours (Arcangelo et al., 2017). Acetaminophen’s activity is mediated via the central nervous system (Arcangelo et al., 2017). It is thought to block central cyclooxygenase, resulting in a reduction in prostaglandin synthesis (Arcangelo et al., 2017). Acetaminophen has analgesic and antipyretic properties due to prostaglandin inhibition, but it has no anti-inflammatory properties (Arcangelo et al., 2017).
- What information should be included in a teaching plan to help Sally understand about taking celecoxib and the benefits and risks?
Celebrex (celecoxib) is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are medications that are used to reduce pain and inflammation for a short period of time. Celebrex belongs to the COX-2 selective inhibitors class of NSAIDS (Shin, 2018). Celebrex even while long-term management provides an efficient anti-inflammatory and analgesic effect, there is no increased risk of GI adverse effects with its use (Shin, 2018). Given the concern for cardiovascular risk clinical studies were done on the effects of Celebrex and cardiovascular (CV) adverse effects. The results showed that there was a low incidence of CV events even with higher-than-normal doses employed in the experiment therefore such a link was deemed inconclusive (Shin, 2018).However, the US Food and Drug Administration (FDA) requested a second clinical trial to reassure the public about Celebrex’s cardiovascular safety; the study found that Celebrex was not inferior to ibuprofen or naproxen in terms of CV safety results (Shin, 2018). Inform health practitioners of any cardiovascular disease (Arcangelo et al., 2017). Celebrex should not be taken if the patient is allergic to sulfa, aspirin or NSAIDS, is pregnant or has renal impairment (Arcangelo et al., 2017). Always inform healthcare practitioners of all medications taken so as to avoid and drug interactions.
- Ibuprofen and celecoxib are both nonsteroidal anti-inflammatory drugs. Explain how they are similar and different.
Both medicines are NSAIDs, which means they have comparable adverse effects and warnings, but indications vary amongst them. They are both used for the relief of inflammatory pain caused by OA. Celebrex is a COX-2 inhibitor that is selective as it exclusively inhibits COX-2, whereas ibuprofen inhibits both COX-1 and COX-2 (Arcangelo et al., 2017). Celebrex usage is limited to treat pain associated with certain inflammatory diseases and Ibuprofen is used to treat a variety of symptoms such as fever, pain, and headaches. Celebrex is only available by prescription whereas ibuprofen is available both by prescription and over the counter. They both have risk for GI and cardiovascular events, but Celebrex has shown to have less GI side effects (Arcangelo et al., 2017). Celecoxib appears to be a superior alternative to traditional NSAIDs in patients at risk of GI bleeding, as it potentially preserves similar analgesic and anti-inflammatory activity while having greater GI tolerance than traditional NSAIDs (Shin, 2018).ReferencesArcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for Advanced Practice. Wolters Kluwer.Shin, S. (2018). Safety of Celecoxib Versus Traditional Nonsteroidal Anti-inflammatory Drugs in Older Patients with Arthritis. Journal of Pain Research, Volume 11, 3211–3219. https://doi.org/10.2147/jpr.s186000 ReplyReply to Comment
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