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The Use And Misuse Of Nonsteroidal Anti-inflammatory Drugs (nsaids)
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The body modulates pain through several processes. The endogenous opiate system consists of neurotransmitters (e.g., enkephalins, dynorphins, and beta-endorphins) and receptors that are found throughout the central nervous system (CNS). Endogenous opioids bind to opioid receptors and inhibit the transmission of pain impulses.
The CNS also contains a descending system for control of pain transmission. This system originates in the brain and can inhibit synaptic pain transmission at the dorsal horn. Important neurotransmitters here include endogenous opioids, serotonin, norepinephrine, gama-aminobutyric acid (GABA), and neurotensin.
NEUROPATHIC PAIN
Neuropathic (chronic) pain is sustained by abnormal processing of sensory input by the peripheral or central nervous system. There are a large number of neuropathic pain syndromes that are often difficult to treat (e.g., low back pain, diabetic neuropathy, postherpetic neuralgia, cancer-related pain, spinal cord injury). Nerve damage or persistent stimulation may cause pain circuits to produce spontaneous nerve stimulation, autonomic neuronal pain stimulation, and a progressive increase in discharge of dorsal horn neurons.
The inflammatory process is the response to an injurious stimulus. It can be evoked by a wide variety of noxious agents (e.g., infections, antibodies, or physical injuries). The ability to mount an inflammatory response is essential for survival in the face of environmental pathogens and injury; in some situations and diseases, the inflammatory response may be exaggerated and sustained without apparent benefit and even with severe adverse consequences. No matter what the initiating stimulus, the classic inflammatory response includes calor (warmth), dolor (pain), rubor (redness), and tumor (swelling).
Inflammatory responses occur in three distinct temporal phases, each apparently mediated by different mechanisms:
(1) An acute phase characterized by transient local vasodilation and increased capillary permeability;
(2) A delayed, subacute phase characterized by infiltration of leukocytes and phagocytic cells; and
(3) A chronic proliferative phase, in which tissue degeneration and fibrosis occur.
Many mechanisms are involved in the promotion and resolution of the inflammatory process. Although earlier studies emphasized the promotion of migration of cells out of the microvasculature, recent work has focused on adhesive interactions, including the E-, P-, and L-selectins, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and leukocyte integrins, in the adhesion of leukocytes and platelets to endothelium at sites of inflammation.
Activated endothelial cells play a key role in "targeting" circulating cells to inflammatory sites. Expression of the adhesion molecules varies among cell types involved in the inflammatory response. Cell adhesion occurs by recognition of cell-surface glycoproteins and carbohydrates on circulating cells due to the augmented expression of adhesion molecules on resident cells. Thus, endothelial activation results in leukocyte adhesion as the leukocytes recognize newly expressed L-selectin and P-selectin; other important interactions include those of endothelial-expressed E-selectin with sialylated Lewis X and other glycoproteins on the leukocyte surface and endothelial ICAM-1 with leukocyte integrins. It has been proposed that some, but not all, NSAIDs may interfere with adhesion by inhibiting expression or activity of certain of these cell-adhesion molecules . Novel classes of antiinflammatory drugs directed against cell-adhesion molecules are under active development but have not yet entered the clinical arena.
In addition to the cell-adhesion molecules outlined above, the recruitment of inflammatory cells to sites of injury involves the concerted interactions of several types of soluble mediators. These include the complement factor C5a, platelet-activating factor, and the eicosanoid LTB4. All can act as chemotactic agonists. Several cytokines also play essential roles in orchestrating the inflammatory process, especially interleukin-1 (IL-1) and tumor necrosis factor (TNF) (Dempsey et al., 2003). IL-1 and TNF are considered principal mediators of the biological responses to bacterial lipopolysaccharide (LPS, also called endotoxin). They are secreted by monocytes and macrophages, adipocytes, and other cells. Working in concert with each other and various cytokines and growth factors (including IL-8 and granulocyte-macrophage colony-stimulating factor, they induce gene expression and protein synthesis in a variety of cells to mediate and promote inflammation.
IL-1 comprises two distinct polypeptides (IL-1a and IL-1b) that bind to the same cell-surface receptors and produce similar biological responses. Plasma IL-1 levels are increased in patients with active inflammation. IL-1 can bind to two types of receptors, an 80-kd IL-1 receptor type 1 and a 68-kd IL-1 receptor type 2, which are present on different cell types.
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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---
