With renal decreased glomerular filtration rate gfr

This preview shows page 5 - 7 out of 10 pages.

serious GI side effects include hemorrhage, peptic, and esophageal ulcerations. With renal, decreased glomerular filtration rate, GFR, water retention, increased BUN and creatinine, reversible renal insufficiency, and renal failure. And also the side effect may be the inability to concentrate, confusion, hepatic toxicity. Elevation of liver enzymes are mild and reversible with stopping the medication. may increase the risk of heart attacks, strokes, and related conditions. So regular use of NSAIDs should be avoided in those taking aspirin for cardioprotection because NSAIDs can interfere with the cardioprotective effects of aspirin. And many of your patients with coronary artery disease will be taking a daily aspirin, or if they've had a stroke. So be very mindful of that. And it can exacerbate heart failure, may raise blood pressure. It can have prothrombotic effects, relative contraindication is history of DVT. So you would have asked that in your review of systems, if they have a history of DVT. Use the lowest effective dose for the shortest period of time. Some of the allergic reactions, some who are allergic to aspirin may also be allergic to other NSAIDs. So you have some contraindication to the use of NSAIDs. And some are absolute, and some are relative contraindications. The absolute ones are current active peptic ulcer disease, chronic kidney disease, and heart failure. Relative contraindications, hypertension, H. pylori, history of peptic ulcer disease, they haven't had active, just history, concurrent use of SSRIs or corticosteroids. And so note the patient should not take more than one NSAID or COX-2 inhibitor. All right, here's some specific information about the use of NSAIDs in the older adult. It used to be recommended that a trial of NSAIDs be ordered if the acetaminophen did not work. They have now walked back that recommendation because it is considered risky in older adults. You have to be very careful to consider the risks and benefits before you prescribe NSAIDs to your older adult patients. If they have a low GI risk, you can consider naproxen or ibuprofen. If GI risk is higher, many providers prescribe a proton pump
Image of page 5
inhibitor. So per AGS guidelines, older adults should take a PPI or misoprostol for GI protection when taking nonselective NSAIDs or an NSAID and COX-2 inhibitor together. If a COX-2 is given due to higher GI risk, then consider prescribing a low-dose aspirin for cardioprotection. So both nonselective NSAIDs and COX-2s should only be considered rarely and with extreme caution when other therapies have not worked, the goals have not been met, and the therapeutic benefits outweigh the risks. All patients taking these medications should be assessed regularly for GI and renal issues, hypertension, heart failure, and drug disease, and drug-drug interactions. The above, all of those are good reasons to bring your patients back in for follow up. And it also guides what you will do at the next visit. So do you need to make some adjustments, and so forth. Some notes about your COX-2 inhibitors. These have fewer side effects than NSAIDs. These are good options for those patients who require long-term use of
Image of page 6

Want to read all 10 pages?

Image of page 7

Want to read all 10 pages?

You've reached the end of your free preview.

Want to read all 10 pages?

  • Fall '15
  • pain syndrome

{[ snackBarMessage ]}

Get FREE access by uploading your study materials

Upload your study materials now and get free access to over 25 million documents.

Upload now for FREE access Or pay now for instant access
Christopher Reinemann
"Before using Course Hero my grade was at 78%. By the end of the semester my grade was at 90%. I could not have done it without all the class material I found."
— Christopher R., University of Rhode Island '15, Course Hero Intern

Ask a question for free

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern