China
Africa
Explore chapters and articles related to this topic
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Non-pharmacological interventions include physiotherapy, weight reduction and increased exercise.24 Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in younger patients, but carry a high risk of toxicity in older adults (including gastric bleeding, renal impairment, hypertension and heart failure). Cyclooxygenase 2 (COX-2) inhibitors may be less prone to cause gastric bleeding, but have all the other risks of harm plus a possible increase in cardiac ischaemic events. For these reasons all NSAIDs should be avoided in older adults unless absolutely necessary. Paracetamol (acetaminophen) and weak opioids are safer options for analgesia. Joint replacement surgery may be considered in those who have significant disability despite other therapeutic measures. In a cohort of older adults (mean age 75) with severe OA who underwent hip or knee replacement, post-operative complications occurred in 17% (none fatal), median time to independent walking was 12 days, and surgery was associated with significant symptomatic benefits at 12 months.25
Osteoporotic thoracolumbar fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
High-quality clinical trials of pain medication use and its effectiveness in this particular cohort are limited. In practice, paracetamol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) are the first analgesics of choice. The inflammatory process that occurs at the periosteum and fracture site contributes to the pain, and NSAIDs are hypothesized to have a role in addressing this. However, this same inflammatory process has been recognized to be crucial in fracture healing, and recent studies have reported an association between NSAID use and fracture nonunion (4). This has led to a number of clinicians becoming cautious on its use in patients with acute fractures. To date, high-quality clinical trials on this is lacking, and pooled analysis of a small number of existing higher-quality studies has not reported on the risk of nonunion (4). It is also uncertain if the risk of nonunion is dependent on the type of bone fractured, as different rates of nonunion have been reported in long bones and vertebral bones (4). Further studies are clearly needed to fully address this particular area of uncertainty. NSAIDs also have to be used with caution due to the risk of gastrointestinal bleeding, kidney injury, and cardiovascular risk. This is even more of a concern in the older population, and any use of NSAIDs has to be for the shortest possible duration.
Evaluation of Anti-ulcer Potential of Sphenodesme involucrata var. paniculata (C.B. Clarke) Munir Leaves on Various Gastric Aggressive Factors
Published in Parimelazhagan Thangaraj, Phytomedicine, 2020
P. S. Sreeja, K. Arunachalam, Parimelazhagan Thangaraj
Among the exogenous factors that attack the mucosa, which predispose the formation of gastric ulcers through exposing the gastric epithelium to acid, we can mention smoking, the ingestion of alcohol and diets with food of spicy content, Helicobacter pylori infection, and the continued use of drugs (NSAIDs) that cause adverse effects. NSAIDs are the group of drugs that are used worldwide for pain, inflammation, and fever (Bhandari et al. 2010). About 60% of people who use NSAIDs are continuously prone to develop gastric lesions (Santin et al. 2013). It is known that NSAIDs promote a blockade in the biosynthesis of PGE2 due to the inhibition of COX-1. PGE2 is responsible for secreting mucus, the release of the bicarbonate, and the increase of blood flow of the gastric mucosa, which are the factors essential for gastric protection, and thus their absence/or decrease in production leads to the formation of lesions in stomach (Vane and Botting 1995; Yandrapu and Sarosiek 2015). According to Berstad et al. (2002), NSAIDs have direct effects on the degradation of phospholipids and adhered mucus, reducing hydrophobicity and facilitating the H-ion back diffusion in the gastric mucosa. This ultimately helps the other gastric aggressive agents, such as coffee, smoking, and alcohol to damage the stomach effortlessly by irritating the stomach cells to secrete more gastric acid (Burkitt et al. 2017).
Pattern of use and awareness of side-effects of non-steroidal anti-inflammatory drugs in the Jordanian population
Published in Annals of Medicine, 2023
Randa I. Farah, Aseil E. Khatib, Hiba J. Abu Ziyad, Dareen K. Jiad, Lara R. Al Qusous, Ali Jamal Ababneh, Salma Ajarmeh
This study showed that females were most likely to use NSAIDs, as several previous studies have also reported a greater frequency of NSAID use among women [10,11], possibly because female patients are more likely to develop migraines and suffer from menstrual pain. In this study, 74.5% of the responders were younger than 50 years of age. Although this could be a limitation with underrepresentation of the older population of participants who may have higher or lower prevalence of NSAIDS use. This might not be of great importance, as previous studies have shown that younger patients are more frequent users of NSAID medications [12–14]; Also may be attributed to the fact that older people are more likely to suffer from comorbidities [15] and may therefore be wary of taking NSAIDs, the increased patient education of NSAID-related side-effects during doctor appointments could have attributed to the less use too.
Spirulina supplements: an approach moderating aspirin persuaded histological and ultra-structural alterations in albino rats gastric mucosa
Published in Ultrastructural Pathology, 2022
Sherif A. Kamar, Ahmed H. Bayoumi, Hagar Yousry Rady
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs with wide range and variety. NSAIDs are often used as analgesics, antipyretics, and anti-inflammatory agents. They also have an anticoagulant effect and are used in long-term low doses to prevent heart attacks and cancer. It was reported that there is an increasing demand for finding new uses for FDA-approved cheap specially in treating new diseases, and so considering their variable effects, NSAIDs are now among drugs considered for use against serious health morbidities. The classical use of aspirin as a cardioprotective agent and treatment of atherosclerosis is considered as the oldest non-conventional use of an anti-inflammatory drug for cardiovascular disease. Recently, NSAID-induced PGs inhibitory and depletion effect gained immense importance as new generation anti-cancer agents.21
Gastrointestinal and cardiovascular adverse events associated with NSAIDs
Published in Expert Opinion on Drug Safety, 2022
María-José Domper Arnal, Gonzalo Hijos-Mallada, Angel Lanas
NSAIDs are one of the most prescribed pharmacological groups, since they are highly effective to reduce pain and inflammation in patients with musculoskeletal conditions. These drugs have also excellent bioavailability regardless of their administration route. A holistic assessment of the patient should be carried out prior to its administration, since NSAIDs have adverse effects at digestive, CV and renal levels. NSAIDs are being prescribed frequently to elderly and patients with concomitant use of other medications. In terms of CV risk, coxibs are not a first-line alternative, and in this case low-dose celecoxib should be considered if both GI and CV risk factors are present. Naproxen and low-dose ibuprofen are the best option in heart disease patients who consume NSAIDs, but the potential interaction with low-dose aspirin (although the studies are not conclusive) and the risk of heart failure must be considered. Patients anticoagulated with either NOACs or vitamin K antagonists are at risk of a major bleeding episode if treated with NSAIDs, but coxibs may carry a lower risk compared to traditional NSAIDs.