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The Use And Misuse Of Nonsteroidal Anti-inflammatory Drugs (nsaids)
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Pharmacokinetics and Pharmacodynamics. Most of the NSAIDs are rapidly and completely absorbed from the gastrointestinal tract, with peak concentrations occurring within 1 to 4 hours. Aspirin begins to acetylate platelets within minutes of reaching the presystemic circulation. The presence of food tends to delay absorption without affecting peak concentration. Most NSAIDs are extensively protein-bound (95% to 99%) and undergo hepatic metabolism and renal excretion. In general, NSAIDs are not recommended in the setting of advanced hepatic or renal disease due to their adverse pharmacodynamic effects. Many NSAIDs metabolized by hepatic CYPs are subject to circadian variation in their metabolic disposition; however, the implications of this observation are not clear.
PRESCRIBING PATTERN OF NSAIDS
NSAIDs are among the most commonly prescribed categories of drugs worldwide in the treatment of pain and inflammation in many conditions as over the counter drugs. Each day it is estimated that 30 million people would wide get benefit from their antimflammatory and analgesic effects (Chowdhury et al, 2012)
NSAID guidelines have been established to increase physician awareness of the complications associated with NSAID use; however, some physicians either do not recognize or do not adhere to such guidelines. A recent survey of physicians identified six major barriers that affected their use of established NSAID guidelines. The barriers mentioned were as follows: lack of familiarity with the guidelines, perceived limited validity of the guidelines, limited applicability of the guidelines to specific patient populations, clinical inertia, anecdotal experiences, and clinical heuristics. The lack of familiarity was attributed to the overwhelming number of published medical guidelines and difficulties in keeping up to date with new recommendations. In support of this, a search of the literature identified more than 20 different guidelines that mention NSAIDs and the elderly in addition to other highly acclaimed medication risk factor guidelines or tools ( Tailor et at, 2012).
Prescribers need to be aware of the possibility of overdosing on NSAIDs that might result from prescribing and/or taking OTC medications that contain the same active NSAID ingredient. A meta-analysis of data from case-control studies revealed that the odds ratio (reference point is nonuse of NSAIDs) for experiencing a serious GI complication was 4.9 in patients taking a single NSAID, 10.7 in patients taking two, and 60.0 in patients taking three NSAIDs simultaneously (Lewis et al, 2002). Combination of certain medications or herbal additives with prescribed or OTC NSAIDs may intensify or mask the side effects associated with NSAIDs; for example, corticosteroids (Tulner et al, 2008), ginkgo biloba( Abebe, 2002), warfarin ( Cheetham, 2009), and alcohol ( kauman, 1999) can increase the severity of gastrointestinal bleeding or peptic ulcers.
MISUSE OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS
Self-medication can be defined as the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms (Donkor et al, 2012).
It has also been defined as the act of taking medicines or medical devices especially designed and labeled for use in the treatment of common health problems without the authority or prescription of a physician. It is one of the rapidly growing areas of concern to medical professionals, government and the general public. Self-medication may initially result in reduction of distress but in the long-run however, it can cause many serious problems. Symptoms may rebound, resulting in stronger desires to take more drugs (Lawan et al, 2013).
Self-medication is a common practice all over the world (Abasiubong et al, 2012). In the face of current global economic downturn, a large number of countries are facing serious health challenges, with people finding it difficult to meet their health needs. In developed countries, self-medication is not uncommon, but the practice is guided because people are enlightened and could derive adequate information from various sources. Consequently, it is often regarded as consumers' luxury and very attractive. Evidence suggests that many people involved in self-medication tend to acquire knowledge of the practice from relatives, neighbours, medicine dealers, and sometimes media. The situation in developing countries is frightening, where there is poor medical services and lack of professional control of pharmaceutical products. This therefore forces people to self-medicate and various forms of substances and herbs are often used for different medical complaints(Abasiubong et al, 2012).
Other patient factors that might limit the effectiveness of pain treatment or predispose to greater risk of adverse effects are barriers to patient education regarding the proper use of medication, failure of the drug to properly and safely alleviate the pain, economic factors( cheaper NSAIDs are less safe), misperception about the safety of Over The Counter( OTC) medications regarding risk of overdosing, drug-drug interaction and chronic use and limited awareness about the NSAIDs sources whether prescription or OTC (Tailor et al, 2012).
Before taking any type of medication, patients should be fully aware of the risks involved; however, data suggest that current patient education on NSAIDs, in particular side effects and how to manage them, is not adequate (Schmitt et al, 2011)
In addition to being ill-informed on the side effects of taking a single NSAID, patients are also unaware of the consequences of taking multiple NSAIDs or taking NSAIDs for long periods of time. Some of the reasons for taking multiple doses of NSAIDs include seeking more or faster relief, experiencing no relief with the recommended dose, or a result of doctor’s suggestion (Cham et al, 2002).
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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---
