NSAID

Can you identify this plant?

Do you know what medicine we derive from it?  Do you know what class of medicines are derived from this medicine?

The plant is the  Willow Tree the genus is, Salix.  The Salix Alba is known medicinally for its bark from which we obtain Salicin .  The medicine that we derive from it is Aspirin and the class of drugs that is derived from Aspirin is the NSAIDS Class.  Do you know the effects of aspirin?  If not, you should really watch my powerpoint.  Here is the link:

http://www.authorstream.com/Presentation/APhTI-2367837-aspirinpowerfinal/

____________________________________________________________________________________Well this is the month that many people start an exercise program.  While we must be careful not to over do it, sometimes we look to over the counter or prescription medications in order to manage pain and inflammation.  There is a class of drugs called the NSAIDS ( non steroidal anti inflammatory drugs) that are used for such a purpose.

But, there is no drug that is side effect free.  These drugs should be used with caution in people with existing stomach diseases ( this problem can be minimized by using an Enteric Coated form).  They also should not be taken by those who are on anticoagulant therapy because the NSAIDS have an action on the platelets and cause them to become less sticky. 

Why is this important?  Well, the platelets are the bodies in our blood that cause it to clot.  The ability of our blood to clot is what prevents us from losing significant amounts of blood due to an injury such as a cut.  When a person is on anticoagulant therapy, these agents also cause the platelets to not function normally.  This is the reason why a person on these drugs will bruise easily.  We know that bruising is blood pooling underneath the skin.

What compounds the problem is that we also have plasma proteins in our blood and drugs that are acidic in nature tend to be highly bound to these proteins.  What I mean is that there is an intense attraction between the drug and the protein.  If the drug is bound, it is not active-- the activity comes from the free drug.  When there are two drugs that have equal attraction (affinity) for the same thing whether it be a protein, receptor, etc., the percentage of bound drug fluctuates and if the percentage of bound drug fluctuates, the percentage of free drug fluctuates as well.  Since it is the free drug that has all of the activity herein lies the issue.  Let me explain:

If a drug is 98% bound to protein it is 2% free.  If something happens to bring that drug down to 96% bound, that's a big problem.  You may say that there is not much difference between the numbers 98 and 96, so what's the issue.  The issue is with the comparison of the free drug and not the bound drug.  If a drug goes from being 2% free to 4% free, this is a doubling of the available free drug and is like the person has taken twice the dose and this is very serious!

There is so much more to say about therapy with NSAIDS and who should take them with caution and who shouldn't take them at all.  I am limited by time and space here.  If you would like to know more, perhaps I could put together a webinar on the topic.  Let me know what you think.  You can email me at vw@aphti.com.

There are a few things that I can draw from this:

Consult your physician before embarking on an exercise program.  Start slowly and increase over time.  Give your body time to adjust and give your mind the time to develop a new habit.  It is better to be wise when it comes to self medicating.  What I am saying is this, we want to prevent the things that are preventable and an injury due to being overzealous is preventable.

Know your medications and your conditions.  When you are not sure, reach out to a qualified medical professional.

I found a good article about over the counter pain relievers, click on the link,

http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/pain-relievers-understanding-your-otc-options.html

Here is another article if you want more information on this topic:

http://abcnews.go.com/Health/Wellness/counter-painkillers-choose/story?id=12932012

There are some drugs that are NSAIDS but are not over the counter.  See this FDA list for approved NSAIDS

http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM106241.pdf

This is why Pharmacists are very important, your Pharmacist knows these things!  This is why Pharmacists need good technicians!  A good technician knows how to do necessary tasks that free the Pharmacist's hands so that they can concentrate on drug management and therapy.

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