Re: Rational Use of Analgesics- Rula

[Guest guest]

Dear Rula, Thanks for your active participation. The problem of irrational combination of analgesics also a serious concern

here. These combinations not only give rise to possibility of drug interactions as suggested by you, but also increases the cost of therapy significantly. We shall discuss it in detail. Apart from that, use of injectable analgesics in the situation where oral analgesics could have been sufficient is also matter of concern. Also we shall discuss the pharmacovigilance of analgesics. We need your valuable input in the course of our discussion. Regards Trupti Swain OrissaRula Ghandour <gh_rula@...> wrote: Dear all HI from Palestine Nice to be here with you... Regarding my experience in Analgesics, there is a clear misuse. One aspect is in the combination of NSAID such as Ibuprofen and Diclofenac to be taken together, or Diclofenac tablets, suppositories and ampoule for the same patient... - Another problem is the interaction between NSAID and other medications or health conditions such as hypertension. What can be done for a hypertensive patient who has low back pain? I think this a problem many physicians face. Diclofenac and Ranitidine to minimize gastric side effects, at the same time absorption of Diclofenac will be decreased. - Can these

agents be used for a long time and what monitoring should be done for patients in order to minimize gastric and renal side effects (in case of chronic use)? What about selective cox II inhibitors, can they be used for a long time and what is its possible side effects. It'll be good to discuss these points... Have a nice day… Rula Trupti Swain <drtruptiswain > wrote: Dear Friends, I am really happy that the present topic follows the discussion on “access to controlled Medication” in which we

discussed in details, the importance of access to vital drugs like Opioids analgesics. Pain is the most common symptom which brings the patient to the physician. Yet analgesics are very commonly misused or irrationally used. The emotional component of pain makes its use more vulnerable for inappropriate selection. The age old Opioid analgesics also possess the fear of drug dependence. Thus “Rational use of analgesics” is very crucial for the patient and to the community. We can discuss rational use of analgesics in following points. - Selection of proper analgesics - Rationality of analgesic combinations - Problem of tolerance and dependence on analgesics - Side

effect and toxicities of Analgesics - Are we too cautious to use Opioids? - Analgesics for chronic severe pain - Rationality of selective -2 Inhibitors Before we proceed for rationality, I request the members to share their experience on any problem pertaining to irrational analgesics use. Trupti Swain Orissa Be a better friend, newshound, and know-it-all with Mobile. Try it now. Never miss a thing. Make your homepage.

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hi...It'll be interesting to discuss these subjects here... find attached file for some information on the most commonly prescribed analgesics in my country...Have a nice day...Rula Medication Adult dose Pediatric dose Possible Precautions Aspirin 300 – 900 mg each 4-6 hours max 4g/day Should not be used under 16 years old (risk for Reye's syndrome) ACE inhibitors, Angiotensin II receptor antagonists : risk renal impairment, antagonize hypotensive effect Kaolin: reduced absorption NSAID: increase side effects Ibuprofen: antiplatelet effect decreases Antacids: increase excretion Anticoagulants, antidepressants: increase risk of bleeding Corticosteroids: increased risk of GI bleeding Spiranolactone: aspirin antagonize its effect Metclopramide: increase aspirin absorption Sulfinpyrazone: aspirin antagonize its effect

Prescribed with caution for asthmatic patients, or who has problems in kidney or liver, and for pregnant women. Contraindicated: Patients with hypersensitivity to salicylates Lactating women, children under 16 years old, patients with peptic ulcer disease. Paracetamol 0.5 -1 g 4 to 6 times daily Max. 4000 mg 0-3 months: 10mg/kg each 4 to 6 hrs 3-12 months: 15mg/kg each 4to 6 hrs caumarin anticoagulants (caumadin): long term use enhance their

effect Domperidone (motilium), metclopramide (Emestop): increase absorption of Paracetamol Prescribed with cautious for patients with liver and kidney problems Ibuprofen 200-400 mg 4-6 times daily 6 months –to 12 years: 5-10 mg/kg each 4 to 6 hrs contraindicated for children less then 6 months ACE inhibitors, Angiotensin II receptor antagonists: increased risk of renal impairment, hypotensive effect antagonized Warfarin (caumadin): enhance their effect SSRI & venlafaxine: increased risk of bleeding Alpha blockers Beta blockers, Calcium channel blockers, nitrates : antagonize hypotensive

effect Digoxin: increase plasma level Diuretics: increase nephrotoxic risk of NSAID Prescribed with cautious for elderly, patients with kidney or liver or heart problems Patients with asthma Pregnancy and lactation Contraindicated: patients with hypersensitivity to salicylates and NSAID Naproxen 05-1 mg once or twice daily Contraindicated for children less than 16 years Diclofenac 75-150 mg daily < 1 year: contraindicated 1-12 year: 3mg/kg only in case of Juvenile arthritis Trupti Swain <drtruptiswain@...> wrote: Dear Rula, Thanks for your active participation. The problem of irrational combination of analgesics also a serious concern here. These combinations not only give rise to possibility of drug

interactions as suggested by you, but also increases the cost of therapy significantly. We shall discuss it in detail. Apart from that, use of injectable analgesics in the situation where oral analgesics could have been sufficient is also matter of concern. Also we shall discuss the pharmacovigilance of analgesics. We need your valuable input in the course of our discussion. Regards Trupti Swain OrissaRula Ghandour <gh_rula > wrote: Dear all HI from Palestine Nice to be here with you... Regarding my experience in Analgesics, there is a clear misuse. One aspect is in the combination of NSAID such as Ibuprofen and Diclofenac to be taken

together, or Diclofenac tablets, suppositories and ampoule for the same patient... - Another problem is the interaction between NSAID and other medications or health conditions such as hypertension. What can be done for a hypertensive patient who has low back pain? I think this a problem many physicians face. Diclofenac and Ranitidine to minimize gastric side effects, at the same time absorption of Diclofenac will be decreased. - Can these agents be used for a long time and what monitoring should be done for patients in order to minimize gastric and renal side effects (in case of chronic use)? What about selective cox II inhibitors, can they be used for a long time and what is its possible side effects. It'll be good to discuss these points... Have a nice day… Rula Trupti Swain <drtruptiswain > wrote: Dear Friends, I am really happy that the present topic follows the discussion on “access to controlled Medication” in which we discussed in details, the importance of access to vital drugs like Opioids analgesics. Pain is the most common symptom which brings the patient to the physician. Yet analgesics are very commonly misused or irrationally

used. The emotional component of pain makes its use more vulnerable for inappropriate selection. The age old Opioid analgesics also possess the fear of drug dependence. Thus “Rational use of analgesics” is very crucial for the patient and to the community. We can discuss rational use of analgesics in following points. - Selection of proper analgesics - Rationality of analgesic combinations - Problem of tolerance and dependence on analgesics - Side effect and toxicities of Analgesics - Are we too cautious to use Opioids? - Analgesics for

chronic severe pain - Rationality of selective -2 Inhibitors Before we proceed for rationality, I request the members to share their experience on any problem pertaining to irrational analgesics use. Trupti Swain Orissa Be a better friend, newshound, and know-it-all with Mobile. Try it now. Never miss a thing. Make your homepage. Looking for last minute shopping deals? Find them fast with Search.

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[Guest guest]

hello Trupti and all,

I am in the habit of popping an Aspirin when i am in pain ( which is about once a week on average) so that i can go thru the day so as not to disturb others' routine if I take to bed.I know it may not be rational but I find it most convenient. Has any one else the same experience, and if yes ant solution?

kunda

kunda

Dear Friends,

I am really happy that the present topic follows the discussion on “access

to controlled Medication†in which we discussed in details, the importance of access to vital drugs like Opioids analgesics.

Pain is the most common symptom which brings the patient to the physician. Yet analgesics are very commonly misused or irrationally used. The emotional component of pain makes its use more vulnerable for inappropriate selection. The age old Opioid analgesics also possess the fear of drug dependence. Thus “Rational use of analgesics†is very crucial for the patient and to the community.

We can discuss rational use of analgesics in following points.

- Selection of proper analgesics

- Rationality of analgesic combinations

- Problem of tolerance and dependence on analgesics

- Side effect and toxicities of Analgesics

- Are we too cautious to use Opioids?

- Analgesics for chronic severe pain

- Rationality of selective -2 Inhibitors

Before we proceed for rationality, I request the members to share their experience on any problem pertaining to irrational analgesics use.

Trupti Swain

Orissa

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[Guest guest]

Hi Kunda what is the dose of aspirin that you consume?

rakesh

On 3/18/08, kunda gharpure <gharpurekunda@...> wrote:

hello Trupti and all,

I am in the habit of popping an Aspirin when i am in pain ( which is about once a week on average) so that i can go thru the day so as not to disturb others' routine if I take to bed.I know it may not be rational but I find it most convenient. Has any one else the same experience, and if yes ant solution?

kunda

kunda

Dear Friends,

I am really happy that the present topic follows the discussion on "access

to controlled Medication" in which we discussed in details, the importance of access to vital drugs like Opioids analgesics.

Pain is the most common symptom which brings the patient to the physician. Yet analgesics are very commonly misused or irrationally used. The emotional component of pain makes its use more vulnerable for inappropriate selection. The age old Opioid analgesics also possess the fear of drug dependence. Thus "Rational use of analgesics" is very crucial for the patient and to the community.

We can discuss rational use of analgesics in following points.

- Selection of proper analgesics

- Rationality of analgesic combinations

- Problem of tolerance and dependence on analgesics

- Side effect and toxicities of Analgesics

- Are we too cautious to use Opioids?

- Analgesics for chronic severe pain

- Rationality of selective -2 Inhibitors

Before we proceed for rationality, I request the members to share their experience on any problem pertaining to irrational analgesics use.

Trupti Swain

Orissa

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[Guest guest]

Dear Kunda Madam, Aspirin taken once a while for analgesic purpose (0.6- 0.65 Gm) orally is not that harmful.Infact medicines are there to ease our life.But I

think you also have some good alternatives like ibuprofen and naproxen. Providing some date regarding use of aspirin. There is a potential for a competitive interaction between aspirin and other analgesic and anti inflammatory agents. There is a role of acetaminophen and aspirin ( analgesic dose) in the progression of renal disease to chronic

renal failure. Each patient must be considered individually with respect to the risk of cardiovascular events, gastro intestinal side effects and progressive renal failure N Engl J Med, Vol. 345, No 25. 1844 Aspirin can serve its beneficial effect as - Anti thrombotic - Prevention of Colon cancer - Prevention of hypertension - and favorable immunomodulatory activity Trupti Swainkunda gharpure <gharpurekunda@...> wrote: hello Trupti and all, I am in the habit of popping an Aspirin when i am in pain ( which is about once a week on average) so that i can go thru the day so as not to disturb others' routine if I take to bed.I know it may not be rational but I

find it most convenient. Has any one else the same experience, and if yes ant solution? kunda kunda Dear Friends, I am really happy that the present topic follows the discussion on “access to controlled Medication†in which we discussed in details, the importance of access to vital drugs like Opioids analgesics. Pain is the most common symptom which brings the patient to the physician. Yet analgesics are very commonly misused or irrationally used. The emotional component of pain makes its use more vulnerable for inappropriate selection. The age old Opioid analgesics also possess the fear of drug dependence. Thus “Rational use of analgesics†is very crucial for the patient and to the community. We can discuss rational use of analgesics in following points. - Selection of proper analgesics - Rationality of analgesic combinations - Problem of tolerance and dependence on analgesics - Side effect and toxicities of Analgesics - Are we too cautious to use Opioids? - Analgesics for chronic severe pain - Rationality of selective -2 Inhibitors Before we proceed for rationality, I request the members to share their experience on any problem pertaining to irrational analgesics use. Trupti Swain Orissa Be a better friend, newshound, and know-it-all with Mobile. Try it now. Never miss a thing. Make your homepage. Looking for last minute shopping deals? Find them fast with Search. Why delete messages? Unlimited storage is just a click away.

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[Guest guest]

hello,

thank god I get relief with just one tab. (300mg) of aspirin.And till now do not have any complaint of HT, diabetes,or GI disturbance. and I belong to the old school who is still faithful to Aspirin.

kunda

Dear Friends,

I am really happy that the present topic follows the discussion on “access

to controlled Medication� in which we discussed in details, the importance of access to vital drugs like Opioids analgesics.

Pain is the most common symptom which brings the patient to the physician. Yet analgesics are very commonly misused or irrationally used. The emotional component of pain makes its use more vulnerable for inappropriate selection. The age old Opioid analgesics also possess the fear of drug dependence. Thus “Rational use of analgesics� is very crucial for the patient and to the community.

We can discuss rational use of analgesics in following points.

- Selection of proper analgesics

- Rationality of analgesic combinations

- Problem of tolerance and dependence on analgesics

- Side effect and toxicities of Analgesics

- Are we too cautious to use Opioids?

- Analgesics for chronic severe pain

- Rationality of selective -2 Inhibitors

Before we proceed for rationality, I request the members to share their experience on any problem pertaining to irrational analgesics use.

Trupti Swain

Orissa

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