AANP Family Nurse Practitioner (FNP) Certification ExamPlanMedium
A 75-year-old female with a history of osteoarthritis, hypertension, and gastric reflux presents with moderate hand pain. She is currently taking lisinopril and omeprazole. The FNP is considering pharmacological management for her osteoarthritis. Which of the following medications would be the most appropriate first-line oral analgesic, considering her comorbidities?
- AAcetaminophen
- BCelecoxib
- CNaproxen
- DIbuprofen
Show answer & explanationAnswer & explanation
Correct answer: A. Acetaminophen
Acetaminophen is generally considered the first-line oral analgesic for osteoarthritis, especially in patients with comorbidities like hypertension (NSAIDs can elevate blood pressure) and gastric reflux (NSAIDs are gastrotoxic). NSAIDs (ibuprofen, naproxen, celecoxib) carry risks for these conditions.
Why the other options are wrong
- B. Celecoxib, while a COX-2 inhibitor, still carries cardiovascular risks and can exacerbate gastric issues, though less than non-selective NSAIDs.
- C. Naproxen is an NSAID, sharing similar risks as ibuprofen regarding gastric reflux and hypertension.
- D. Ibuprofen is an NSAID, which can worsen gastric reflux and elevate blood pressure, making it less ideal.
Osteoarthritis Analgesia in Comorbid Patients
For osteoarthritis pain, acetaminophen is the preferred first-line oral analgesic in patients with comorbidities like hypertension, gastric reflux, or cardiovascular disease, due to its safer GI and cardiovascular profile compared to NSAIDs.
- Acetaminophen is first-line for OA pain.
- NSAIDs carry risks for GI bleeding, renal dysfunction, and hypertension.
- COX-2 inhibitors have lower GI risk but still have cardiovascular risks.
Memory trick: Old lady aches? Acetaminophen makes sense!