Answer and analyze the case study questions. Sarah goes to the local pharmacy and presents her prescription for a month’s supply of diclofenac. She is 63 years old and is not currently working. She...

Answer and analyze the case study questions.

Sarah goes to the local pharmacy and presents her prescription for a month’s supply of diclofenac. She is 63 years old and is not currently working. She has bilateral hip and knee osteoarthritis (OA) with occasional pain. She has been taking diclofenac 50mg three times/day for several years.

Six years ago she suffered a confirmed Helicobacter pylori-negative duodenal ulcer which has healed with conventional proton pump inhibitor (PPI) therapy. She suffers mild indigestion periodically but manages this herself with alginates and antacids (brought over-the-counter) when required. She also has hypertension and currently takes bendroflumethiazide 2.5 mg/day, ramipril 10 mg/day, and aspirin 75 mg/day; her blood pressure (BP)is maintained at around 142/92 mmHg. She does not smoke.

7. Would using a COXib with a PPI reduce Sarah’s GI risk still further, compared with a traditional NSAID plus a PPI?

8. Moving on to consider Sarah’s CV risks, what concern do you have about Diclofenac?

9. Still thinking about Sarah’s hypertension and CV risks, what would be the effect of changing her NSAID to a COXib (eg Celecoxib or Etoricoxib)?