A client tells the nurse that the healthcare provider switched the pain medication used for arthritis from ibuprofen to celecoxib and questions the reason for this change. Which is the most likely reason for change in medication?

The kidney function will be improved with celecoxib.

If insurance pays for celecoxib, it will save you money.

There is less risk of gastrointestinal bleeding with celecoxib.

A lower dose can be given and still achieve the same degree of pain relief.

Answer and Explanation

The Correct Answer is C

A. The kidney function will be improved with celecoxib: Both traditional non-steroidal anti-inflammatory drugs and COX-2 inhibitors can adversely affect renal perfusion. They inhibit prostaglandins that maintain renal blood flow, potentially leading to sodium retention or interstitial nephritis. Celecoxib does not offer a therapeutic advantage for renal health.

B. If insurance pays for celecoxib, it will save you money: Celecoxib is typically more expensive than generic ibuprofen due to its specialized pharmacological profile. Cost is rarely the primary clinical driver for switching to a selective inhibitor. Therapeutic safety and side effect profiles are the priorities in this medication transition.

C. There is less risk of gastrointestinal bleeding with celecoxib: Celecoxib selectively inhibits the COX-2 enzyme responsible for inflammation while sparing the COX-1 enzyme. COX-1 protects the gastric mucosa and facilitates platelet aggregation. By sparing COX-1, this medication significantly reduces the incidence of gastric ulcers and systemic bleeding.

D. A lower dose can be given and still achieve the same degree of pain relief: Dosage strength is not the primary reason for switching from a non-selective to a selective inhibitor. Both medications are effective for arthritis pain at their respective therapeutic ranges. The switch is based on the safety profile rather than potency.

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Correct Answer is D

Explanation

A. "The ibuprofen works faster.": Onset of action for both oral acetaminophen and ibuprofen is approximately 30 to 60 minutes. There is no significant clinical evidence to suggest that ibuprofen provides faster systemic relief for an acute injury. Speed of onset is not the primary rationale for this specific drug selection.

B. "Ibuprofen works better than acetaminophen with muscle and bone injuries.": This statement is generalized and does not explain the underlying pharmacological mechanism to the client. While true in a practical sense, it lacks the scientific depth required for professional patient education. It does not address the specific pathology of a sprain.

C. "The healthcare provider can prescribe a high dose of the ibuprofen so it will relieve the pain better.": High doses can also be prescribed for acetaminophen, but dosage size does not change the drug's therapeutic class. The efficacy of ibuprofen in this scenario is due to its mechanism of action, not simply the amount administered. This response misleads the client.

D. "The ibuprofen will also reduce the inflammation that is causing swelling, which contributes to pain.": An ankle sprain involves soft tissue trauma that triggers the arachidonic acid cascade and prostaglandin production. Ibuprofen is a non-steroidal anti-inflammatory drug that inhibits cyclooxygenase enzymes to reduce localized edema. Acetaminophen lacks these significant peripheral anti-inflammatory properties needed for this injury.

A. quality of liver function B. route of administration C. previous treatment with the prescribed medication D. protein binding capacity of the prescribed medication

Correct Answer is B

Explanation

A. quality of liver function: Hepatic function primarily influences the metabolism and biotransformation of a drug rather than its initial absorption into the systemic circulation. While the first-pass effect occurs in the liver after enteral absorption, the term "absorption" refers to the movement from the site of administration to the blood.

B. route of administration: This is the primary determinant of the speed and extent of drug absorption. Intravenous routes provide 100% bioavailability immediately, while oral routes are subject to gastric pH, presence of food, and intestinal surface area. The physical path a drug takes dictates how it enters the systemic compartment.

C. previous treatment with the prescribed medication: Past exposure to a drug may influence a client's immunological response or tolerance, but it does not change the physical absorption process. The physiological mechanisms of diffusion or active transport across membranes remain constant regardless of how many times the patient has taken the medication.

D. protein binding capacity of the prescribed medication: Protein binding is a factor of drug distribution rather than absorption. It determines how much of the drug is pharmacologically active once it has already reached the bloodstream. It does not affect how the drug initially crosses from the site of administration into the vascular system.

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A client tells the nurse that the healthcare provider switched the pain medication used for arthritis from ibuprofen to celecoxib and questions the reason for this change. Which is the most likely reason for change in medication?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

The nurse is reviewing the absorption of a client's prescribed medication. Which factor would influence the absorption of the medication?

Correct Answer is B

Explanation

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