-
The Use And Misuse Of Nonsteroidal Anti-inflammatory Drugs (nsaids)
CHAPTER ONE -- [Total Page(s) 16]
Page 12 of 16
-
-
-
Coadministration of the PGE1 analog misoprostol or proton pump inhibitors (PPIs), which now are available over the counter in the United States, in conjunction with NSAIDs can be beneficial in the prevention of duodenal and gastric ulceration (Rostom et al., 2002). While a combination of aspirin with a selective COX-2 inhibitor will undermine its distinction from a NSAID with respect to serious GI complications, we do not know if the combination retains an advantage over aspirin plus a NSAID.
Cardiovascular. Given their relatively short half-lives, tNSAIDs, unlike aspirin, are not thought to afford cardioprotection, and most epidemiological overviews are consistent with this likelihood (Garcia Rodriguez et al., 2004). An exception in some individuals may be naproxen. Although there is considerable variation, a small study suggests that platelet inhibition might be anticipated throughout the dosing interval in some but not all individuals on naproxen (Capone et al., 2004). Epidemiological evidence of cardioprotection is less impressive; it suggests about a 10% reduction in myocardial infarction, compared to 20% to 25% with low-dose aspirin. This would fit with heterogeneity of response to naproxen. Reliance on prescription databases may have constrained the ability of this approach to address the question with precision. Controlled evaluation of naproxen in cardioprotection has not been performed, and naproxen should not be used as a substitute for aspirin for this purpose. Several groups have attached nitric oxide-donating moieties to NSAIDs and to aspirin in the hope of reducing the incidence of adverse events. It seems likely that benefit may be attained by abrogation of the inhibition of angiogenesis by tNSAIDs during ulcer healing in rodents (Ma et al., 2002).
Selective inhibitors of COX-2 depress PGI2 formation by endothelial cells without concomitant inhibition of platelet thromboxane. Experiments in mice suggest that PGI2 restrains the cardiovascular effects of TXA2, affording a mechanism by which selective inhibitors might increase the risk of thrombosis (McAdam et al., 1999; Catella-Lawson et al., 1999). This mechanism should pertain to individuals otherwise at risk of thrombosis, such as those with rheumatoid arthritis, as the relative risk of myocardial infarction is increased in these patients compared to patients with osteoarthritis or no arthritis. The incidence of myocardial infarction and stroke has diverged in such at-risk patients when COX-2 inhibitors are compared with NSAIDs (FitzGerald, 2003).
Blood Pressure, Renal, and Renovascular Adverse Events. NSAIDs and COX-2 inhibitors have been associated with renal and renovascular adverse events (Cheng and Harris, 2004). NSAIDs have little effect on renal function or blood pressure in normal human subjects. However, in patients with congestive heart failure, hepatic cirrhosis, chronic kidney disease, hypovolemia, and other states of activation of the sympathoadrenal or renin-angiotensin systems, prostaglandin formation becomes crucial in model systems and in humans (Patrono and Dunn, 1987). NSAIDs are associated with loss of the prostaglandin-induced inhibition of both the reabsorption of Cl- and the action of antidiuretic hormone, leading to the retention of salt and water. Experiments in mice that attribute the generation of vasodilator prostaglandins (PGE2 and PGI2) to COX-2 raise the likelihood that the incidence of hypertensive complications (either new onset or worsened control) induced by NSAIDs in patients may correlate with the degree of inhibition of COX-2 in the kidney and the selectivity with which it is attained (Qi et al., 2002). Deletion of receptors for both PGI2 and PGE2 elevate blood pressure in mice, mechanistically integrating hypertension with a predisposition to thrombosis. Although this hypothesis has never been addressed directly, epidemiological studies suggest hypertensive complications occur more commonly in patients treated with coxibs than with NSAIDs.
NSAIDs promote reabsorption of K+ as a result of decreased availability of Na+ at distal tubular sites and suppression of the prostaglandin-induced secretion of renin. The latter effect may account in part for the usefulness of NSAIDs in the treatment of Bartter's syndrome.
Analgesic Nephropathy. Analgesic nephropathy is a condition of slowly progressive renal failure, decreased concentrating capacity of the renal tubule, and sterile pyuria. Risk factors are the chronic use of high doses of combinations of NSAIDs and frequent urinary tract infections. If recognized early, discontinuation of NSAIDs permits recovery of renal function((Burke et al, 2008)
Pregnancy and Lactation. In the hours before parturition, there is induction of myometrial COX-2 expression, and levels of prostaglandin E2 and F2a increase markedly in the myometrium during labor (Slater et al., 2002). Prolongation of gestation by NSAIDs has been demonstrated in model systems and in humans. Some NSAIDs, particularly indomethacin, have been used off-label to terminate preterm labor. However, this use is associated with closure of the ductus arteriosus and impaired fetal circulation in utero, particularly in fetuses older than 32 weeks' gestation. COX-2-selective inhibitors have been used as tocolytic agents; this use has been associated with stenosis of the ductus arteriosus and oligohydramnios. Finally, the use of NSAIDs and aspirin late in pregnancy may increase the risk of postpartum hemorrhage. Therefore pregnancy, especially close to term, is a relative contraindication to the use of all NSAIDs, and their use must be weighed against potential fetal risk, even in cases of premature labor, and especially in cases of pregnancy-induced hypertension, where they have been used with questionable effect (Duley et al., 2004).
CHAPTER ONE -- [Total Page(s) 16]
Page 12 of 16
-
-
ABSRACT - [ Total Page(s): 1 ]ABSTRACT COMING SOON ... Continue reading---
CHAPTER TWO - [ Total Page(s): 3 ]EXCLUSION CRITERIAAll pharmacists not practicing as community pharmacistsAll patent medicine vendors and outlets2.4 SAMPLE SIZE DETERMINATIONa. Retrospective review of prescriptions: All prescriptions from November 2013 and April 2014 were obtained from the Outpatient Pharmacy Department prescription bank. The prescriptions containing NSAIDs were separated from those without NSAIDs.b. Ilorin metropolis is made up of three local government areas: Ilorin West, Ilori ... Continue reading---
CHAPTER THREE - [ Total Page(s): 8 ]CHAPTER THREE RESULTS3.1 RESULTS OF ANALYSIS OF PRESCRIPTIONS/TREATMENT SHEETSOut of 1497 prescription sheets 1297 prescriptions contained NSAIDs with total of 1392 NSAIDs. The prescribing rate was hence found to be 86.6%. 7.3% of prescriptions contained more than one NSAIDs. ... Continue reading---
CHAPTER FOUR - [ Total Page(s): 2 ]CHAPTER FOURDISCUSSIONStudy of the Prescribing pattern of Nonsteroidal Antiinflammatory Drugs indicated more number of females assess health care for pain and related conditions than their male counterpart (Table 3.1), although there is widespread assumption that women will consult more readily for all symptoms or conditions and that men will be more reluctant or will delay consulting may result in health care providers assuming that women have a lower level of symptom severity before deciding ... Continue reading---
CHAPTER FIVE - [ Total Page(s): 1 ]CHAPTER FIVE CONCLUSIONThe prescribing rate of NSAIDs was high. The prevalence of NSAIDs misuse by residents was high Ibuprofen was the most highly misused among the residents. Dispensing pattern of NSAIDs by Pharmacists appeared to agree with the choice of medication use among residents. Educational status, occupation, prior knowledge of medication use and dispensing pattern of Pharmacists are factors that can influence public choice of NSAIDs use. ... Continue reading---
REFRENCES - [ Total Page(s): 5 ]Slater DM, Zervou S, Thornton S. (2002). Prostaglandins and prostanoid receptors in human pregnancy and parturition. J. Soc. Gynecol. Investig. 9:118-124.Soleymani F, Ahmadizar A and Abdollahi MA(2013). Survey on the factors influencing the pattern of medicine's use: Concerns on irrational use of drugs. J Res Pharm Pract. 2(2), 59–63.Solomon SD, McMurray JJ, Pfeffer MA, Wittes J, Fowler R, Finn P, Anderson WF, Zauber A, Hawk E, Bertagnolli M (2005). Cardiovascular risk associated with c ... Continue reading---
