JIPMER Nursing Officer - 2020
Pharmacology
Easy
Which of the following neurological side effect is anticipated in an elderly patient who is on NSAID?
Appeared in: JIPMER Nursing Officer - 2020
Explanation
- NSAIDs can cross the blood-brain barrier and cause central nervous system (CNS) side effects like headache, dizziness, and mental confusion.
- Elderly patients are particularly vulnerable to drug-induced delirium (a form of acute cognitive dysfunction) from a wide range of medications, including NSAIDs.
- Toxicity from both salicylate (e.g., aspirin) and non-salicylate NSAIDs can manifest with significant CNS symptoms, including mental confusion, drowsiness, and disorientation.
- While less common than gastrointestinal side effects, cognitive changes are a recognized risk and should be anticipated in vulnerable populations like the elderly.
Why Other Options Were Wrong
- Option B: Tremors are not a characteristic side effect of NSAIDs. They are more commonly associated with other drug classes or neurological conditions.
- Option C: Ataxia, or impaired coordination, is related to cerebellar dysfunction and is not a typical adverse effect of NSAIDs.
- Option D: Pseudoparkinsonism is an extrapyramidal symptom (EPS) caused by the blockade of dopamine receptors, a mechanism not associated with NSAIDs.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Adverse effects of NSAIDs in geriatric patients to guide bedside assessment, documentation, and the next nursing action.
- Nurses must establish a baseline cognitive status before an elderly patient starts regular NSAID therapy and perform ongoing monitoring for any changes, such as confusion or increased drowsiness.
- Patient and family education is critical. They should be taught to recognize and report early signs of cognitive dysfunction to the healthcare provider.
- The principle of 'start low, go slow' is paramount when prescribing NSAIDs for geriatric patients to minimize the risk of all adverse effects, including CNS toxicity.
How to Approach the Question
- First, identify the key components of the question: the drug class (NSAID), the patient population (elderly), and the type of side effect (neurological).
- Recall the major adverse effect profiles of NSAIDs, which primarily include gastrointestinal, renal, cardiovascular, and central nervous system (CNS) effects.
- Consider the specific vulnerability of the elderly population. Age-related changes increase their sensitivity to the CNS effects of many medications, often leading to confusion or delirium.
- Evaluate each option based on the known pharmacology of NSAIDs:
- Cognitive dysfunction/confusion is a documented CNS side effect.
- Tremors, ataxia, and pseudoparkinsonism are distinct neurological syndromes associated with other specific drug classes (e.g., antipsychotics, anticonvulsants).
Concept Tested & Keywords
- Concept Tested: Adverse effects of NSAIDs in geriatric patients
- Stem keywords: neurological side effect, elderly patient, NSAID
- Lead-in keywords: anticipated
- Clinical cues: The combination of 'elderly patient' and 'NSAID' is a clinical red flag for increased risk of adverse effects, particularly CNS, renal, and GI toxicity.
Question ID
QYDz-2XUwoWqDvQWE8sP5W
Reference Book
E6 Pharmacology Nursing Lilley 11e Part 3 p. 59-61
E6 Medicine Davidson Principles Practice 24e p. 1372-1374
E6 Pharmacology Katzung 16e p. 1005-1007
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Attempt every question from this paper in a timed mock, then review the full solution for each one.
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