CASE STUDY 3 – Osteoarthritis – analgesics and depression

Mr KB was a fitness fanatic in his youth.  He regularly took part in triathlons and went to the gym three times a week.  This continued until he collapsed one day, aged 55, with chest pains and was admitted to hospital as an emergency.  Mr KB had to undergo coronary bypass surgery and since that operation he has been taking low dose aspirin (75mg daily), to prevent cardiovascular complications. After cardiac surgery Mr KB was forced to give up his active lifestyle and he became increasingly depressed as tissue damage to his joints from cycling and running became more and more apparent.  When he was 60, he was prescribed lofepramine (70mg, twice daily) to treat his depression and at age 65 he was prescribed buprenorphine (200g, three times a day) for his osteoarthritis..

When 85, Mr KB, went to his family doctor complaining that the buprenorphine was no longer relieving the pain in his joints.  The doctor tells Mr KB that over the next month, he will gradually switch his pain-killing drug regime from buprenorphine to Co-codamol (final dose 500mg/30mg tablets, four times a day).

One month after the new drug regime is in place, Mr KB returns to his doctor and tells him that he has become constipated and wonders if this problem could be due to his new tablets.  The doctor decides to stop the Co-codamol, replaces the drug with paracetamol (1g four times a day) and adds ibuprofen (200mg three times a day) to his treatment.

-Discuss at a molecular and cellular level, why the doctor stopped Co-codamol.
-How does ibuprofen control pain?  -What is the molecular mechanism of action of ibuprofen?

40% of Module Mark Scientific content (30%) Discussion
(20%) Structure and coherence (20%)
Excellent
(>70%) In depth knowledge of pharmacology, mechanisms of drug action and the case study.
Information obtained from diverse literature sources.
Provides an excellent overview of the case study.
Extensive recognition of relative importance of different aspects of the case.     Insightful and mature discussion of the case study.
Excellent application of pharmacological knowledge and principles to the case study.
Clear evidence of critical analysis and opinions expressed based on evidence.
Comprehensive introduction to the case study.
Logical order of facts and clear development of themes. Seamless coherence between individual speakers.
Excellent conclusion/summary.

Pick 4 main references and choose one main reference for the overall piece and highlight relevant information directly onto screenshots of the source, and include at the bottom after the reference list. include a mix of primary and review articles.

Include 3 relevant images (for each part of the question) with in-depth figure legends on what each diagram shows.