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A 45-year-old woman has a long history of asthma and nasal polyps. Many years ago she had a severe asthmatic attack after ingesting aspirin. She plans dental extraction next week. Her physical examination shows large bilateral nasal polyps. The chest is clear to percussion and auscultation. Peak flow is normal at 450 L/min.
Which of the following drugs should be used for pain control?
(A) Ibuprofen
(B) Ketorolac tromethamine
© Codeine
(D) Aspirin after aspirin desensitization
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Why not ibuprofen? Use ladder?
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Ans is C...
Normally, Asprin induced asthma are also sensitive to other NSAIDS especially COX-1 inhibitors...e.g. ketorolac, ibuprofen, diclofenac, piroxicam etc...
The best drugs to use would be selective COX2 inhibitors like celcoxib etc...if you need analgesia...
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ANSWER IS C
Narcotic analgesics do not trigger exacerbation of aspirin-sensitive asthma. Codeine is an appropriate choice for postoperative pain control for this patient. Persons with aspirin-sensitive asthma have a unique sensitivity to inhibitors of cyclooxygenase, the enzyme that converts arachidonic acid to prostaglandins and thromboxanes. Aspirin and nonsteroidal anti-inflammatory drugs such as ibuprofen and ketorolac block cyclooxygenase and can trigger a severe asthma attack. The precise mechanism is unknown. Cyclooxygenase inhibi- tors cause dramatic overproduction of the sulfidopeptide leukotrienes (LTC4, LTD4, and LTE4) in association with aspirin-sensitive asthma. One theory is that cyclooxygenase inhibition decreases production of prostaglandin E2, a compound that blocks leukotriene synthesis.
Preliminary results suggest that cyclooxygenase-2 inhibitors such as celecoxib and rofecoxib may be safely administered to persons with asthma and aspirin sensitivity. More studies are needed before these drugs can be recommended with confidence. Patients with aspirin-sensitive asthma can undergo desensitization to aspirin with a careful protocol of gradually increasing doses of oral aspirin. The procedure is time consuming and poses risk of severe reactions. It is not indicated in this situation, in which suitable alternative medications are available
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Persons with aspirin-sensitive asthma have a unique sensitivity to inhibitors of cyclooxygenase, the enzyme that converts arachidonic acid to prostaglandins and thromboxanes. Aspirin and nonsteroidal anti-inflammatory drugs such as ibuprofen and ketorolac block cyclooxygenase and can trigger a severe asthma attack.
Thanks, enjoy reading explanation.
