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The Use And Misuse Of Nonsteroidal Anti-inflammatory Drugs (nsaids)
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Expanding the role of pharmacists is supported by evidenceâ€based outcomes and existing innovative models. The benefits translate into improved consumer outcomes that support many tenets of health reform †enhanced access and quality of care, costâ€effectiveness and patient safety. The Report is framed around four focus points that clearly articulate and present objective data that support the need for innovative practice models that include pharmacists as essential health care providers. Based on current practice models, perceptions of pharmacists’ roles, specifically as a health professional exclusively associated with drug product and delivery, should now include many additional patient care, primary care, and public health services. It is essential to note that pharmacists currently provide multiple levels of direct and indirect patient care services in a variety of practice settings. Management of disease through medication use †inclusive of Collaborative Drug herapy Management (CDTM), Comprehensive Medication Management (CMM) or Medication Therapy Management (MTM), health promotion, patient safety, disease prevention, care coordination, followâ€up care and other primary patient care services †are performed by pharmacists in a similar manner as other health care providers. The rationale for this practice model is the fact that once a diagnosis is made, patient care services rely on pharmacologic interventions as the major form of therapy. Data clearly suggest that medications are currently the cornerstone of chronic disease therapy, yet our health care system continues to fragment care and ‘reward’ reactive health care delivery models( Giberson et al, 2011) Nonsteroidal anti-inflammatory drugs (NSAIDs) represent diverse group of drug with analgesic property and most frequently prescribed drug globally. This is first choice of drug with well demonstrated efficiency for the pain management primarily musculoskeletal disorder and osteoarthritis to treat mild to moderate pain. Although its serious toxicity related to GIT limits its expediency.â€Big evil†have tendency to just cure pain relieving symptom not disease. In this study we aimed to determine the prescribing practice of multiple NSAIDs in Pakistan by healthcare practitioner and their attitude towards patient life safety and what consequences are responsible for irrational practice of these most common OTC drug. For the purpose of these evaluation descriptive studies was conducted based on prescription reading and case histories of more than 200 patients to rule out prescribing habit of physicians. Prescription collected were mostly from emergency (80%) and general physicians (20%). Nearly everyone patient came with intense pain related with muscular and arthritis pain. About 69% patients were being prescribed by double NSAIDs in which acetaminophen ratio was mostly high with Diclofenac sodium (ratio of 60:35). Single practice of NSAIDs has reported just 25% but more than prescription containing multiple NSAIDs 6%. Traditional NSAIDs prescribed more frequently compared to selective NSAIDs by physician which makes patients susceptible to GIT associated toxicity. For the prophylaxis of NSAIDs associated GIT bleeding only 15% patients were co prescribe by H 2 receptor blocker primarily ranitidine (15%) and PPis (7%) and other (2%).
After careful consideration about prescribing habit of NSAIDs by physician we conclude that the irrational practices prevalence have been rising dangerously which needs careful consideration by health authorities.(Gul S and Ayub M, 2014) Current guidelines on NSAID use have been developed by rheumatologists, gastroenterologists, cardiologists [ or multidisciplinary teams of experts. Rheumatologists were first concerned with safety, thus recommending paracetamol (acetaminophen) as a first-line analgesic. Gastroenterologists dealt mainly with GI risk factors and gastroprotection, emphasizing how misused and underused it is, while cardiologists were worried about CV safety and suggested naproxen use in patients with CV risk factors. Some multidisciplinary consensus papers discussed both Gastrointestinal and Cardiovascular risks and put forward evidence-based proposals on how to balance the benefits and risks of anti-inflammatory therapy. Despite this, some important issues have been left unsettled, partly because sufficient evidence was not available at the time of guideline drafting. Besides efficacy and safety, costs will also influence therapeutic choices. However, together with medication costs, the economic burden on the healthcare system of NSAID-induced GI or CV events should be taken into Account (Scarpignatoet al, 2015)
Pharmacists have unique, comprehensive knowledge about the safe and effective use of medications and about the adverse effects of their inappropriate use. The provision of pharmaceutical care to individual patients involves pharmacists assessing the appropriateness of pharmacotherapy, counseling, and monitoring medication-use outcomes.
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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---
