Question-1- Elderly patients are found to be having an increased fat mass and a decreased muscle mass as well. All of these factors contribute to the ramification on drug distribution and thus, it might alter with the pain threshold. Ageing also effects on the peripheral nerves, resulting in the deterioration and decrease in myelination of the nerve fibers (Andretta, 2019). These large myelinated fibers are also affected by aging process, resulting in their atrophy and thus, altering with the pain threshold.
Non-steroidal anti-inflammatory drugs are the most commonly available over the counter drugs for pain management. It can also be considered as an effective choice of treatment as these drugs are found to have lower risk in elder patients compared to other drugs used for pain management in elderlies. It is not only recognized as one of the safest groups of medication but also the most effective to treat the elderly population (Sanyal, 2020). It is also the first line of pharmacology therapy opted by physicians for pain management in general and does not cause any addiction in the patient as well. So, it can be deemed the most trusted choice of treatment therapy for elderlies optimal for their pain threshold.
Question-2- There is an age-related decrease in the opioid treatment observed in elderly population. This also alters with the changes in the pharmacodynamics of the drugs taken by the older individuals. With the progressing age drug related complications also rises, affecting multiple organs of the body.
Apart from using Non-steroidal Anti-inflammatory drugs in such cases the use of cyclooxegenase-1 and cyclogenase-2 (COX-1 & COX-2) inhibitors are also used in elderlies. It is also one of effective nonopioid analgesic used in older patients (Wongrakpanich, 2018). COX-1 help in producing prostaglandins and thromboxane, which help in controlling the mucosal barrier in eth gastrointestinal tract. This helps with the functions such as renal homeostats, platelet aggregation and other important physiological functions of the body. COX-2 also produces prostaglandins that help with regulation of pain as well as inflammation. The inhibition brought about COX-1 and COX-2 medications helps with reduction in pain and inflammation, bringing about a desired effect similar to the Non-Steroidal Anti-Inflammatory (Parada, 2016). Aside from bringing about these symptomatic reliefs, these medication of COX-1 and COX-2 also play a major role in reducing the side effects of drug toxicity, such as gastrointestinal harm or renal toxicity (Cooper, 2019). Thus, given the patient current medical status, COX-1 and COX-2 drug group can be most suitable for pain management for the patient. The patient might have side effects due to his cancerous growth and development, therefore, it is imperative that drug interaction must be reduced for reducing the overall harm to the patient (Varrassi, 2020). All of these pointers make these medications a sound choice of treatment.
Andretta, A., Batista, E. D., Schieferdecker, M. E. M., Petterle, R. R., Boguszewski, C. L., & dos Santos Paiva, E. (2019). Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia. Advances in Rheumatology, 59(1), 55. https://doi.org/10.1186/s42358-019-0095-3
Cooper, C., Chapurlat, R., Al-Daghri, N., Herrero-Beaumont, G., Bruyère, O., Rannou, F., ... & Reginster, J. Y. (2019). Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: What does the literature say?. Drugs & Aging, 36(1), 15-24. https://doi.org/10.1007/s40266-019-00660-1
Parada, L., Marstein, J. P., & Danilov, A. (2016). Tolerability of the COX-1/COX-2 inhibitor lornoxicam in the treatment of acute and rheumatic pain. Pain Management, 6(5), 445-454. https://doi.org/10.2217/pmt.16.7
Sanyal, C., Turner, J. P., Martin, P., & Tannenbaum, C. (2020). Cost‐effectiveness of pharmacist‐led deprescribing of NSAIDs in community‐dwelling older adults. Journal of the American Geriatrics Society, 68(5), 1090-1097. https://doi.org/10.1111/jgs.16388
Varrassi, G., Yeam, C. T., Rekatsina, M., Pergolizzi, J. V., Zis, P., & Paladini, A. (2020). The Expanding Role of the COX Inhibitor/Opioid Receptor Agonist Combination in the Management of Pain. Drugs, 1-11. https://doi.org/10.1007/s40265-020-01369-x
Wongrakpanich, S., Wongrakpanich, A., Melhado, K., & Rangaswami, J. (2018). A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging and Disease, 9(1), 143. https://dx.doi.org/10.14336%2FAD.2017.0306
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