The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question?
A. Digoxin (Lanoxin)
B. Furosemide (Lasix)
C. Indomethacin (Indocin)
D. Propranolol hydrochloride (Inderal)
Correct Answer: C. Indomethacin (Indocin)
Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin are capable of producing injury to gastrointestinal mucosa in experimental animals and humans, and their use is associated with a significant risk of hemorrhage, erosions, and perforation of both gastric and intestinal ulcers.
Option A: Digoxin is a cardiac medication. The molecular basis for the gastrointestinal toxicity of NSAIDs is widely believed to be their inhibitory activity against cyclooxygenase, which causes them to block the production of prostaglandins and their therapeutic actions.
Option B: Furosemide (Lasix) is a loop diuretic. Furosemide is not contraindicated in clients with gastric disorders. Suppression of prostaglandin synthesis in NSAIDs is associated with reduction of gastric mucosal blood flow, disturbance of microcirculation, decrease in mucus secretion, lipid peroxidation, and neutrophil activation, which are involved in the pathogenesis of gastrointestinal mucosal disorders
Option D: Propranolol (Inderal) is a ?-adrenergic blocker. While the presence of acid in the lumen of the stomach may not be a primary factor in the pathogenesis of NSAID-induced gastropathy, it can make an important contribution to the severity of these lesions by impairing the restitution process, interfering with hemostasis, and inactivating several growth factors that are important in mucosal defense and repair.
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