IDENTIFYING RISK FACTORS FOR INCAUTIOUS USE OF NON-PRESCRIPTION DRUGS AMONG HIGHER EDUCATION INSTITUTIONS’ STUDENTS IN EMIRATES

Morris CR, Harvey IM, Stebbings WSL, Speakman CTM, Kennedy HJ, Hart AR (School of Medicine, Health Policy and Practice, University of East Anglica, Norwich, United Kingdom). Do calcium channel blockers and antimuscarinics protect against perforated colonic diverticular disease? A case control study. Gut 2003;52:1734–1737.

Effects of Helicobacter pylori and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Disease: A Systematic Review

Response

Breastfeeding women may experience various health issues that require medication. This survey aimed to gain insights into the use of nonprescription and prescription drugs by breastfeeding women in Japan. A cross-sectional study involving women with children aged under two years was conducted in Fukuoka, Japan. Nonprescription drugs were used by 26% of participants in the breastfed-only group, 41% in the breastfed more than half the time group, 55% in the formula-fed more than half the time group, and 82% in the formula-fed-only group. We found that when breastfeeding rates decreased, the use of nonprescription drugs increased (p < 0.05, Cochran–Armitage test for trend). There were significant differences in the use of nonprescription cold medicines and oral analgesics between the formula-fed and breastfed groups, but a nonsignificant difference in prescription drugs use between the groups. These results indicated breastfeeding had a significant influence on use of nonprescription drugs, which was not observed with prescription drugs. Breastfeeding women commonly used the Internet to obtain information on both nonprescription and prescription drugs; however, this did not influence medication use.

Resolving the Enigma of the Mesoamerican Nephropathy: A Research Workshop Summary

Across the globe over the last few decades, there has been a remarkable increase in the proportion of the population which is elderly, and this trend is set to continue.Data from 10 countries that accounted for about 55% of the world population of 6079 million in the year 2000 provide an overview of this significant shift in demography.Table 1 summarizes the projections for the next 25 years.Hitherto, increases in life expectancy have been most obvious in the affluent countries; however, improvements in public health and disease control are also leading to increases in life expectancy in the less affluent countries.As a result of relatively larger increases in life expectancy at birth, significant shifts in demography are also expected in countries that are at present economically less affluent.The number of elderly people in the world is therefore expected to continue to increase for some considerable time.Interestingly, the most dramatic increases in the proportion of the population who are elderly are anticipated in countries where total populations are projected to decrease (such as Japan, Germany and Italy).The 2001 population census of the UK revealed that since the census of 1951, the proportion of elderly population above 65 years and 85 years has increased from 16% and 0.4% respectively to 21% and 1.9%, respectively.These changes in demography will have significant effects on the economics generally as well as on the provisions for healthcare.Cardiovascular and neurological diseases and cancers are the most prevalent in the elderly.These three groups of diseases account for about 54% of the total burden of disease in Europe in terms of disability adjusted life years.Of the total gross Hospital and Community Health Services expenditure of £31.9 billion in the year 2001-2002 in the UK, 13% was expended on people aged 65-74 years, 16% on those aged 75-84 years and 10% for people aged 85 years or more.Furthermore, about 55% of the community prescriptions during 2001 in the UK were dispensed for the elderly.Cardiovascular and psychoactive drugs accounted for more than 40% of these prescriptions.In view of many age-related changes in the pharmacokinetics and pharmacodynamics of a drug, the safe and effective prescribing of medicines in the elderly will continue to present a major challenge.This review provides an overview of the issues relevant to development and clinical use of drugs in the elderly population, with particular reference to determining the right dosage and dose regimen and the regulatory requirements that facilitate this process.It also examines whether, as a result of advancing age per se, the dosing regimens in the elderly and the frail elderly might be different from those in the nonelderly.Drug development and the elderly population

Celecoxib Plus Aspirin Versus Naproxen and Lansoprazole Plus Aspirin: A Randomized, Double-Blind, Endoscopic Trial

NSAIDs, Risks, and Gastroprotective Strategies: Current Status and Future

Aspirin and the prevention of colorectal neoplasia

The Relationship Between Nonsteroidal Anti-inflammatory Drug Use and Age-related Macular Degeneration

Objective: The aim of the study was to analyze the prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and to identify the commonly used NSAIDs and their drug-related problems (DRPs). Methods: A prospective and cross-sectional study on prescription pattern analysis of NSAIDs was conducted for the period of 6 months. Results: Prescriptions of 150 patients containing at least one NSAIDs were analyzed. About 56% of the prescription were prescribed for males and 44% prescription were female. NSAIDs were more prescribed for below 60-year age group (47%) but were most frequently used by 61–70-year age group (21%). Subjects were regularly prescribed with acetaminophen (95%) and diclofenac (22%). Among all the prescriptions, (19%) of the prescriptions contained NSAIDs in the form of fixed dose combinations (FDCs). About 37% of prescriptions had other analgesic coprescribed along with NSAIDs amid which tramadol was in majority (22%). Prescription was also coprescribed with antibiotic (90%) and gastroprotective agents (GPAs) (97%) that consisted of pantoprazole belonging to the class of proton pump inhibitors which was the persistently prescribed GPA (86%). Due to coprescription, (3%) suspected drug-drug interactions (DDIs) were observed. Conclusion: The goal of studying prescribing patterns was to monitor, assess, and, if required, advise changes in medical practitioners’ prescribing behavior to offer quality medical treatment and reasonable drug use. The prescribing pattern was rational and in accordance with national list of essential medicine (NLEM-2015) but was not in accordance with the World Health Organization (WHO) model list of essential medicines.

Few, if any, nurses have conducted a career in health care without being asked for advice about self-treatment of minor health problems and the use of nonprescription drugs. However, nursing education curricula rarely specifically address the issue of self-medication with over-the-counter (OTC) drugs. How well are nurses meeting the needs of the public in this regard? The use of prescription drugs appears to be declining and the practice of selfmedication to be increasing (Dolusio, 1983; OTC Update, 1982). This may be the result of polarization and compartmentalization of attitudes toward the use of drugs. Following the popularization of psychoactive drugs (medicinal and nonmedicinal) in the 50s and 60s, concern arose that society was relying unduly on the use of chemical agents. In overreaction to the pill for every ill philosophy, many people began to oppose the use of any drugs. The issue has become charged with emotion and highly polarized, making objective judgments very difficult. In addition, a given individual may express conflicting opinions, such as opposition to the use of certain substances (illegal drugs, psychotropic medications), while relying heavily on the use of others (vitamins, caffeine, alcohol). There is a tendency for consumers to discount the use of over-the-counter medications because they do not consider them to be drugs. Few studies have been conducted to investigate the use of nonprescription (overthe-counter) drugs. One retrospective study carried out in the United States in 1983 indicated that most people report that they experience self-treatable health problems and that a majority of these are treated with nonprescription drugs (Robinson, 1984). Because the study was sponsored by the Proprietary Association, the national organization of OTC drug manufacturers, these data may be slanted. However, it is undeniable that OTC drugs sell well and are presumably widely used. What can nurses do to make use of these medications safer and more effective?

Objective:The prevalence of non-steroidal anti-inflammatory drug (NSAID) and concurrent gastroprotective agent (GPA) use in the US is not known. As such, the prevalence of GPA use among arthritis patients taking NSAIDs was examined.Methods:Men and women aged ≥40 with self-reported arthritis and members of a web-based community panel were invited via e-mail to participate in a web survey. Interested panelists consented and completed the survey. Participants using NSAIDs in the last 30 days were eligible. Questions regarding NSAID and GPA use were asked, likewise adherence to GPA (Morisky scale), comorbid conditions, gastrointestinal (GI) history, and other risk factors. Descriptive analyses and logistic regressions were performed to assess associations with GPA use and adherence.Results:Invitations were sent to 7605 adults; 4108 (54%) responded; 2208 completed. Final sample was 1525 (76%) with osteoarthritis (OA), 354 (18%) with rheumatoid arthritis (RA), and 121 (6%) with both OA and RA. Mean age was 62.0; 64% were female; 83% white; 25% worked full-time, and 39% were retired. Mean duration with arthritis was 13.0 years; 47% and 19% experienced arthritis symptoms ‘daily’ and ‘almost always’, respectively. Nearly 43% reported using a GPA and 39% of daily NSAID users reported taking a GPA. Fifty-eight participants (2.9%) were classified as low GI risk, 342 (17.1%) were moderate risk, and 1600 (80.0%) were high risk. Variables significantly associated with GPA use included older age; male gender; being white (vs. Hispanic); taking an NSAID at least daily; taking fewer NSAIDs; taking a Cox-2 inhibitor or prescription NSAID; history of GI conditions; prescription antiplatelet use; and having GI symptoms. Similar variables were associated with GPA adherence.Conclusion:Less than half of adult men and women in the US taking a daily NSAID used GPAs and only 37% of high-risk participants were taking GPAs.

Clinical trial data have prompted questions about the degree to which patients and their physicians should consider an increased risk of cardiovascular or cerebrovascular events when selecting medications for pain relief. Since the 2005 publication of a Science Advisory on the use of nonsteroidal antiinflammatory drugs (NSAIDs) by the American Heart Association,1 several important events have occurred that have served as the catalyst for this update for clinicians. (1) Additional data from randomized controlled trials of cyclooxygenase (COX)-2–selective agents have been reported and summarized in meta-analyses, which has reinforced the concern about cardiovascular events with COX-2 inhibitors (coxibs; Figure 1). (2) Several reports have appeared that have identified an increased risk of cardiovascular events even with the nonselective NSAIDs, which has raised concern about the use of those agents as well (Table). (3) Regulatory authorities in several regions of the world have introduced warning statements and advisories to both healthcare professionals and the lay public about the use of various NSAIDs (Figures 2 and 3⇓). Figure 1. Comparison of effects of different selective COX-2 inhibitors vs placebo on myocardial infarction. Event numbers and person-years of exposure, with corresponding mean annual event rates in parentheses, are presented for patients allocated to selective COX-2 inhibitor or placebo. Event rate ratios for pooled data with 95% CIs are indicated by a diamond; rate ratios for individual selective COX-2 inhibitors, with 99% CIs, are indicated by a square and horizontal line. Diamonds to the right of the solid line indicate hazard with a selective COX-2 inhibitor compared with placebo. As noted, there was a significant increase in the rate ratio for myocardial infarction with COX-2 inhibitors compared with placebo. Similar analyses (data not shown) include rate ratios of 1.42 (1.13 to 1.78; P =0.003) for vascular events, 1.02 (0.71 to 1.47; P …

Nonsteroidal Anti-Inflammatory Drug-Induced Enteropathy: Case Discussion and Review of the Literature