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The Use And Misuse Of Nonsteroidal Anti-inflammatory Drugs (nsaids)
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CHAPTER FOUR
DISCUSSION
Study 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 to consult(Hunt et al, 2011), findings have also shown that some common pain conditions, including migraine and tension-type headache, facial pain, and abdominal pain, population-based studies indicate higher prevalence rates in adult women than in adult men(LeResche, 1999).
Prescribing from essential drug list and in generic are some of the World Health Organization specification for Rational drug use(WHO, 2015). It proposed 100% compliance to Essential medicine and Generic prescribing. The results obtained indicated good compliance with prescribing from EDL but poor in generic prescribing (45%). A study carried out at University of Jos Teaching Hospital showed that 70.2% of prescribed drugs were in generic. Drugs prescribed from the hospital formulary which is always in accordance with EDL were 88% (Ndukwe, 2013). A similar study carried out in Hawassa, South Ethopia obtained 98.7% and 96.6% in generic prescribing and Essential Drug List prescribing respectively (Desalegn, 2013).
Prescribing duration of most of the NSAIDs(56%) were for short course therapy(less than seven days) while about 20% were more than three weeks, although majority of those on long term were cardioprotective dose of Aspirin 75mg. Gastrointestinal side effects of NSAIDs increases with increased duration(Crow, 2015) and high dose(Rossel, 2001;Crow, 2015) has been found to be responsible for gastrointestinal and renal toxicity of NSAIDs. It has been also noted that low dose aspirin are not save in their ability to induce peptic ulcer diseases(Johnell and Fastbom, 2008). Less than 1% of patients prescribed with long term NSAIDs were coprescribed with gastroproctective agent or combined dosage form.
Diclofenac was found to be the most widely prescribed analgesic/ anti-inflammatory NSAIDs. This was consistent with a study carried out in South Western Nigeria in Physiotherapy department of three tertiary heath facilities (Teslim et al, 2014) where diclofenac was the most widely prescribed NSAID but in retard form of 75mg followed by ibuprofen. This is contrary to public use of medication in self treatment for pain and inflammatory condition which Ibuprofen was the most widely used.
Irrational use of medicines is capable of not only limiting access to medicine within a national healthcare system, it can also lead to a waste of scarce resources(Alfa and Adigwe,2014). Pharmacists role in ensuring rational use of drugs is critical in reducing the trend of misuse of drugs and remarkable role in rational use of drugs by dissemination of drug information to guide patients, physicians, and policy makers(Soleymani et al, 2013).
The study was well participated in by the respondents because of low drop out rate, less than 5%. The majority of the respondents fell within productive age( average age of 33 years) while only a few were above 60 years(Table 3.3). There was slightly balance ratio between male and female respondents (0.55:0.45) and fairly close margin between the married and the single with far less number of widowed and divorced participants. Other demographic characteristics are as shown in table 3.3.
More numbers of respondents frequently seek their medication assistance in pharmacies than any other options. It has been affirmed that Pharmacists are the most assessable health professionals in most communities (McGann, 2012; Shahid, 2014)
Although this may be as a result of the nature of pain and pain related conditions that occurs in these group of individuals. Less than one-quarter of the respondents took pain medication without having to consult any source of guide while insignificant number attend traditional medicine practitioners for their pain management and this may be as a result of existence difficult to treat pain type of pain(Hoffmand, 2015).
The use of NSADs was highest among people with body pain which is consistent with many studies (Mart van de Laar et al, 2012). The most widely used NSAIDs among the public was ibuprofen (54%). This was consistent with a study carried out by Wilcox , Cryer and , Triadafilopoulos in 2005 among residents in Roper(57%). In contrast, study by Patricia and David in 2013 found that Diclofenac was the most widely used NSAIDs using England and Canada as case studies (McGettigan,and Henry, 2013).
Majority of the respondents (74%) claimed following instruction in the use of their medication while prior knowledge of medication use accounted for majority of people (30%) not bothered about taking instruction in medicine use. The residents’ high literacy rate may influence their prior knowledge of medication as about 80% of them had secondary and tertiary education and about one third of them were civil servants. Prior knowledge of medication use as also been known to account for increased incidence of medication abuse (Huang et al, 2013; Syed et al, 2008). It has also been established that menstrual pain is one of the reasons why analgesics are used (CADT, 2014), up to 7.2%) 0f total women respondent used NSAIDs of one type or the other during menstrual pain (Table 3.4).
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ABSRACT - [ Total Page(s): 1 ]ABSTRACT COMING SOON ... Continue reading---
CHAPTER ONE - [ Total Page(s): 16 ]TNF, originally termed "cachectin" because of its ability to produce a wasting syndrome, is composed of two closely related proteins: mature TNF (TNF-a) and lymphotoxin (TNF-b), both of which are recognized by the same cell-surface receptors. There are two types of TNF receptors, a 75-kd type 1 receptor and a 55-kd type 2 receptor. IL-1 and TNF produce many of the same proinflammatory responses. A naturally occurring IL-1 receptor antagonist (IL-1ra), competes with IL-1 for receptor binding, blo ... 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 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---
