The nurse is administering an intravenous dose of morphine sulfate to a 48-year-old postoperative patient. The dose ordered is 3 mg every 3 hours as needed for pain. The medication is supplied in vials of 4 mg/mL. How much will be drawn into the syringe for this dose?

Aspirin is a salicylate with multiple pharmacologic actions, but its main therapeutic effects are pain relief, reduction of inflammation, and fever reduction. Understanding these effects helps guide its appropriate clinical use and patient education.

Rationale for correct answers:

A. Analgesic:
Aspirin inhibits prostaglandin synthesis, which reduces pain, making it effective for mild to moderate pain such as headaches, musculoskeletal pain, or postoperative discomfort.

D. Anti-inflammatory:
By inhibiting cyclooxygenase (COX) enzymes, aspirin reduces the production of prostaglandins involved in inflammation, making it useful in conditions like arthritis.

F. Antipyretic:
Aspirin acts on the hypothalamic heat-regulating center to lower fever, helping manage febrile conditions.

Rationale for incorrect answers:

B. Anesthetic:
Aspirin does not produce loss of sensation. Local or general anesthetics are required for that effect.

C. Antidote:
Aspirin cannot reverse toxic effects of other drugs; it has no antidotal properties.

E. Antiemetic:
Aspirin does not prevent nausea or vomiting. Other medications like ondansetron are used for that purpose.

G. Antiepileptic:
Aspirin does not prevent seizures; antiepileptic drugs are required for seizure control.

Take-home points:

• Aspirin’s primary actions are analgesic, anti-inflammatory, and antipyretic.
• It does not act as an anesthetic, antidote, antiemetic, or antiepileptic.
• Understanding these effects ensures safe and effective use while minimizing unnecessary or ineffective administration.

Celecoxib is a COX-2 selective inhibitor that provides anti-inflammatory and analgesic effects while sparing COX-1 activity, which helps protect the gastric mucosa. Because of this selectivity, it causes less gastrointestinal irritation and ulceration than nonselective NSAIDs.

Rationale for correct answer:
C. Celecoxib: Unlike traditional NSAIDs, celecoxib selectively inhibits COX-2, reducing pain and inflammation while minimizing gastric irritation, ulcer risk, and GI bleeding associated with COX-1 inhibition.

Rationale for incorrect answers:
A. Aspirin: Strongly inhibits COX-1, making it highly irritating to the gastric mucosa and increasing the risk of ulcers and GI bleeding.
B. Ketorolac: A potent nonselective NSAID with a high risk of GI ulceration and bleeding, especially with prolonged use.
D. Ibuprofen: Less irritating than aspirin or ketorolac but still a nonselective COX inhibitor, so it carries moderate risk for GI upset and ulceration.

Take-home points:

• Celecoxib (COX-2 inhibitor) causes the least GI distress compared with other NSAIDs.
• Aspirin, ketorolac, and ibuprofen all inhibit COX-1, which increases the risk of gastric irritation and ulcers.
• Patients on any NSAID should be advised to take with food and report GI symptoms promptly.