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The Use And Misuse Of Nonsteroidal Anti-inflammatory Drugs (nsaids)
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The availability of a wide variety of drugs coupled with easy access and lack of effective regulatory control has led to problems associated with drug use like self-medication, drug misuse and drug abuse (Amoako et al 2003). Self medication: 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 (Lawan et al, 2013). Drug abuse is the recurrent use of illegal drugs, or the misuse of prescription or over-the-counter drugs with negative consequences. Hence, drug misuse is an aspect of drug abuse. This practice cuts across all age groups, gender, educational backgrounds, marital status, employment and occupation. Pattern of drug misuse varies from place to place and it is known to be affected by socio-economic factors (Kehinde and Ogunnowo, 2013).
Self-medication is 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 and it is one of the rapidly growing areas of concern to medical professionals, government and the general public (Lawan et al, 2013).
There is overwhelming evidence linking chronic nonselective NSAID (including aspirin) use to a variety of Gastrointestinal (GI) tract injuries. Age is a significant risk factor for NSAID-induced GI events; indeed, patients above 75 years of age carry the highest risk and are similar in this respect to patients with a history of peptic ulcer (Berardi and Welage, 2005).
NSAIDs rank second to aminoglycosides as the most common cause of drug induced renal failure (ARF) and also known to cause acute interstitial nephritis with haematuria, proteinuria and flank pain (Welton, 1999).
In a study carried out in Ghana, about 40% of prescribed analgesics were NSAIDs and diclofenac was the most widely prescribed (Owusu-Ansah, 2009).
Aspirin remains the most commonly prescribed NSAIDs in cardiovascular diseases like hypertension and ischemic heart disease where it is used as antiplatelet agent(Aguw and Adibe, 2012).
Exposure of pregnant women to any type of NSAIDs during early pregnancy predispose them to spontaneous abortion (Li et al, 2003)
A high proportion of chronic urticarial patients experience symptom aggravation when exposed to aspirin and NSAIDs known as Aspirin-exacerbated cutaneous disease (Sánchez-Borges, 2013)
MECHANISM OF ACTION OF NSAIDs
Salicylic acid and salicylates, obtained from natural sources, have long been used as medicaments. Salicylic acid was chemically synthesized in 1860 and was used as an antiseptic, an antipyretic, and an antirheumatic. Almost 40 years later, aspirin was developed as a more palatable form of salicylate. Soon after, other drugs having similar actions to aspirin were discovered, and the group was termed the "aspirin-like drugs" (also now termed the nonsteroidal anti-inflammatory drugs [NSAIDs]). Twenty-five years ago, it was proposed that the mechanism of action of NSAIDs was through their inhibition of prostaglandin biosynthesis. Since then, there has been general acceptance of the concept that these drugs work by inhibition of the enzyme cyclo-oxygenase (COX), which we now know to have at least two distinct isoforms: the constitutive isoform, COX-1, and the inducible isoform, COX-2. COX-1 has clear physiologic functions. Its activation leads, for instance, to the production of prostacyclin, which when released by the endothelium is antithrombogenic and when released by the gastric mucosa is cytoprotective. COX-2, discovered 6 years ago, is induced by inflammatory stimuli and cytokines in migratory and other cells. It is therefore attractive to suggest that the anti-inflammatory actions of NSAIDs are due to inhibition of COX-2, whereas the unwanted side-effects, such as irritation of the stomach lining, are due to inhibition of COX-1. Drugs that have the highest COX-2 activity and a more favorable COX-2: COX-1 activity ratio will have a potent anti-inflammatory activity with fewer side-effects than drugs with a less favorable COX-2.(Vane and Botting, 1998)
All NSAIDs, including the subclass of selective COX-2 inhibitors, are antiinflammatory, analgesic, and antipyretic. NSAIDs are a chemically heterogeneous group of compounds, often chemically unrelated (although most of them are organic acids), which nevertheless share certain therapeutic actions and adverse effects. Aspirin also inhibits the COX enzymes but in a manner molecularly distinct from the competitive, reversible, active site inhibitors and is often distinguished from the NSAIDs (Brunton et al, 2008).
Aspirin covalently modifies COX-1 and COX-2, irreversibly inhibiting cyclooxygenase activity. This is an important distinction from all the NSAIDs because the duration of aspirin's effects is related to the turnover rate of cyclooxygenases in different target tissues. The duration of effect of nonaspirin NSAIDs, which competitively inhibit the active sites of the COX enzymes, relates more directly to the time course of drug disposition. The importance of enzyme turnover in relief from aspirin action is most notable in platelets, which, being anucleate, have a markedly limited capacity for protein synthesis. Thus, the consequences of inhibition of platelet COX-1 (COX-2 is expressed only in megakaryocytes) last for the lifetime of the platelet. Inhibition of platelet COX-1-dependent TXA2 formation therefore is cumulative with repeated doses of aspirin (at least as low as 30 mg/day) and takes roughly 8 to 12 days¾the platelet turnover time to recover once therapy has been stopped(Brunton et al, 2008).
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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---
