A nurse is administering ibuprofen, a nonselective COX inhibitor, to a client who has osteoarthritis. What are the expected pharmacologic effects of ibuprofen in this condition?

Infliximab is a monoclonal antibody that is used to treat ulcerative colitis and other inflammatory conditions by blocking the action of tumor necrosis factor-alpha (TNF-α), a cytokine that causes inflammation and tissue damage in the gut¹. It can be given intravenously every 8 weeks as a maintenance therapy for moderate to severe ulcerative colitis¹. However, it can also have some potential benefits and risks that the nurse should monitor.

The correct answer to your question is:

D. All of the above

This is because infliximab can improve the clinical outcomes of ulcerative colitis in several ways, such as:

A. Decreased frequency and severity of diarrhea, abdominal pain, and rectal bleeding:

These are the main symptoms of ulcerative colitis that affect the quality of life of patients. Infliximab can reduce these symptoms by healing the inflammation and ulcers in the colon and rectum. Several studies have shown that infliximab can induce and maintain clinical remission, response, and mucosal healing in patients with moderate to severe ulcerative colitis who are refractory to conventional therapies²³⁴.

B. Increased appetite, weight gain, energy level, and quality of life:

These are the secondary outcomes of ulcerative colitis that reflect the nutritional status and well-being of patients. Infliximab can improve these outcomes by reducing the systemic effects of inflammation, such as malabsorption, anemia, fatigue, and fever. Several studies have shown that infliximab can improve the health-related quality of life, nutritional status, and functional status of patients with moderate to severe ulcerative colitis²³⁴.

C. Normalized stool culture, blood count, electrolytes, and liver function tests:

These are the laboratory tests that indicate the severity and complications of ulcerative colitis. Infliximab can normalize these tests by reducing the bacterial translocation, blood loss, dehydration, and liver involvement that may occur in ulcerative colitis. Several studies have shown that infliximab can improve the stool culture, hemoglobin, albumin, C-reactive protein, and liver enzymes of patients with moderate to severe ulcerative colitis²³⁴.

This is because ibuprofen is a nonselective COX inhibitor, which means it blocks both COX-1 and COX-2 enzymes². COX-1 is responsible for producing prostaglandins that protect the gastric mucosa, regulate platelet aggregation, and maintain renal function². COX-2 is responsible for producing prostaglandins that mediate inflammation, pain, and fever². Therefore, by inhibiting both COX-1 and COX-2, ibuprofen reduces inflammation, pain, fever, and gastric mucosal protection by blocking the production of prostaglandins.

The other options are incorrect because:

A. It reduces inflammation, pain, fever, and platelet aggregation by blocking the production of prostaglandins.

This is incorrect because ibuprofen also blocks the production of prostaglandins that regulate platelet aggregation. Therefore, ibuprofen can increase the risk of bleeding by inhibiting platelet function².

C. It reduces inflammation, pain, fever, and sodium retention by blocking the production of prostaglandins.

This is incorrect because ibuprofen also blocks the production of prostaglandins that maintain renal function. Therefore, ibuprofen can cause sodium and water retention by impairing renal perfusion and glomerular filtration².

D. It reduces inflammation, pain, fever, and bronchoconstriction by blocking the production of prostaglandins.

This is incorrect because ibuprofen also blocks the production of prostaglandins that mediate bronchodilation. Therefore, ibuprofen can cause bronchoconstriction by shifting the balance between prostanoids and leukotrienes in favor of leukotrienes².