Ms. W. is a 55-year-old patient who consulted her physician because of recurrent

Question

Ms. W. is a 55-year-old patient who consulted her physician because of recurrent epigastric pain and nausea and two recent episodes of vomiting, in which the emesis was dark-colored and granular in appearance. Her history includes heavy alcohol use, cigarette smoking, and persistent headaches. She has not followed all her physician’s previous recommendations but has been controlling her headaches by taking two aspirins every few hours. Following tests, a bleeding gastric ulcer was diagnosed.

Discuss the factors contributing to Ms. W.’s condition. (See Drug Effects: Interactions.)

Discuss synergism, antagonism and potentiation as they apply to this case. (See Interactions—Synergism, Antagonism, and Potentiation.)

Discuss the potential effects of increased bleeding from the ulcer.

Discuss issues related to patient compliance.

Explanation / Answer

*Factors contributing to gastric ulcer-
-smoking
-drinking alcohol
-untreated stress
-eating spicy foods

DRUG INTERACTIONS OF ASPIRIN-
*long term usage of Aspirin may cause stomach/intestinal bleeding and ulcer.
*synergism is an interaction between two or more agents,entities ,factors or substances that produce an effect greater than the sum of their individual effects.
*antagonism refers to,where the involvement of multiple agents reduces their overall effects.
*potentiation-is the action of a substance ,at a dose that does not itself have an adverse action,in enhancing the effect of another substance.

*potential effects of increased bleeding from ulcer are-
-anaemia
-Stool that is black
-dark red or maroon colored blood in stool
-bloody vomiting

* issues related to patient compliance-
-counselling must be focused on recurrence of disease,adherence to treatment and prevention
-dietary restrictions-avoid spicy food
-avoid alcohol and smoking.

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