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The Use And Misuse Of Nonsteroidal Anti-inflammatory Drugs (nsaids)
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Over the last few years, professional organizations, including the American College of Rheumatology, the American Pain Society (Emery et al 1999) , and the European League Against Rheumatism (Silverstein et al, 2000), have published treatment guidelines to assist clinicians in achieving effective pain management. Safety is a core concern in all these guidelines, especially for chronic conditions, such as OA, that require long-term treatment. Hence, there is a consensus among recommendations that paracetamol (acetaminophen) should be the first-line analgesic agent due to its favorable side effect and safety profile, despite several meta-analyses having shown that it is less effective in pain relief than anti-inflammatory drugs (Scarpignato et al, 2015).
Concerns have been raised regarding the safety of nonsteroidal antiinflammatory drugs (NSAIDs), which havebeen linked to increased cardiovascular morbidity. This association was first established in large clinical trials investigating the effect of selective cyclooxygenase-2 (COX-2) inhibitors on preventing gastrointestinal ulcers and gastrointestinal polyps. Later, these results have been confirmed in several large-scale observational studies(FitzGerald, 2003).
Pharmacists are usually the custodian of drugs and are charged with the responsibilities of delivering safe and efficacious medicines to the public (Owusu-Ansah, 2009) . In developing countries, traders perceive drugs as items of trade. In Nigeria, a country where the ratio of pharmacist to non-pharmacist in an urban environment and commercial centre, like Lagos is approximately 1:3, NSAIDs are sold or ingested without the required level of caution. These unregistered drug outlets, usually manned by traders, are located virtually in every street of urban centers in Nigeria.
Evaluation of drug use revealed that there was a great deal of drug misuse ranging from sub – therapeutic dosing, wrong indication and irrational combination of drugs, even in high doses (Awofisayo et al, 2008)
DEFINITION
One of the conditions that necessitate the use of NSAIDs is pain. Pain is an unpleasant, subjective sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Greater understanding of pain mechanisms and growing appreciation for pain control have, however, caused rheumatologists to consider new approaches in pain management.. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Both selective and nonselective cyclooxygenase (COX) inhibitors have antipyretic, anti-inflammatory and analgesic effects and are widely used in treating many painful conditions, including rheumatic diseases. NSAIDs are effective and widely available in over-the-counter formulations and in prescription products. Examples include ibuprofen, naproxen, diclofenac, and celecoxib. NSAIDs are frequently used without considering the relative contraindications since most NSAIDs are sold over the counter. Conventional NSAIDs are associated with gastrointestinal (GI) side effects. Estimates of the number of deaths from NSAID-related gastrointestinal bleeding vary widely and figures of approx. 3500 to 16.500 per year are quoted for the US in a recent FDA report. Both conventional NSAIDs and COX-2 inhibitors are associated with increased cardiovascular risk. NSAIDs may increase blood pressure, particularly in hypertensive patients. Of all NSAIDs, naproxen seems to pose the least cardiovascular risk, although naproxen is associated with the same risk for myocardial infarction as other NSAIDs. Contrary to some clinical assumptions, gastrointestinal risk is present at first dose with a non-selective NSAID, and co-therapy with a proton pump inhibitor (PPI) does not guarantee complete protection(Well et al, 2006)
Pain could be classified into two main groups: NOCICEPTIVE PAIN and NEUROPATHIC PAIN
THE NOCICEPTIVE PAIN
Nociceptive (acute) pain is either somatic (arising from skin, bone, joint, muscle, or connective tissue) or visceral (arising from internal organs such as the large intestine or pancreas).
Stimulation of free nerve endings known as nociceptors is the first step leading to the sensation of pain. These receptors are found in both somatic and visceral structures and are activated by mechanical, thermal, and chemical impulses. Release of bradykinins, K+, prostaglandins, histamine, leukotrienes, serotonin, and substance P may sensitize and/or activate nociceptors. Receptor activation leads to action potentials that are transmitted along afferent nerve fibers to the spinal cord.
Action potentials continue from the site of noxious stimuli to the dorsal horn of the spinal cord and then ascend to higher centers. The thalamus acts as a relay station and passes the impulses to central structures where pain is processed further.
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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---
