By Oluwatise Osinaike
Taiwo was recently rushed to the pharmacy complaining of major pain and swelling on her left leg after a domestic accident. On tracking her medical history, it was discovered that she is on ulcer medications. What drug can Taiwo be given to cure her pains?
In my last edition of You and Drugs, I mentioned that Paracetamol is a good analgesic and antipyretic drug. However, there are cases where Paracetamol might not been the best prescribed drug as in the case study of today. This is because along with the pains, there is skin inflammation. While Paracetamol might be a good analgesic, it has little or no anti-inflammatory effect.
A thorough care
Having to treat pains, especially when it’s swollen, the patient has to be given more thorough care and attention so that the treatment will not backfire. There are many reasons the leg was swollen. It could be a fracture, dislocation, a sign, or a symptom of a major underlying disease, depending on the severity of the incident that happened at home.
But let’s assume it was a minor fall that would require some NSAIDs to treat it. NSAIDS (Nonsteroidal Anti-inflammatory Drugs) are drugs effective for pyresis (fever), algesia (pain), and inflammatory activities.
How do they work?
Generally, NSAIDs act by inhibiting the COX pathway (cyclooxygenase pathway). There are three types. Cox 1, 2, and 3. Cox 1 has a constitutive effect. It’s present in most parts of the body and functions with or without an injury.
Some of the organs Cox 1 are present in, are the uterus, stomach lining, kidney, platelets, etc. Cox 2 has an inducible effect, and it’s only induced once an inflammation occurs. Cox 3 enzyme is responsible for fever and pains in the body (A major reason Paracetamol won’t work for inflammations is that it inhibits only Cox 3 enzyme in the brain and it’s also not an NSAID).
Read also: A study of Paracetamol:https://churchtimesnigeria.net/you-and-drug-a-study-of-paracetamol-and-its-implication/
Cox 1 helps in the production of prostaglandins and thromboxaneA2. Thromboxane A2 helps to promote platelet aggregation but that’s not the focus of today. Let’s look more into prostaglandins. Prostaglandin E2 helps in the protection of the stomach lining (cytoprotection). It helps to maintain the wall of the GIT. So if NSAIDS would generally inhibit the Cox enzyme, whether 1 or 2, it will limit the function of prostaglandin E2 in protecting the wall of the GIT and this is very bad for ulcer patients.
What to prescribe?
We now agree that for Taiwo, giving an NSAID may not be the best treatment since she has a track history of ulcer. An NSAID would worsen the condition, causing bleeding, stomach pain, vomiting, and even death. It is always advisable to ask if the person being treated is an ulcer patient. Of course, this drug would help treat the pains and even reduce swelling but it would cause more harm than good in damaging the GIT (Gastro Intestinal Tract) wall.
So what is usually done is to give a highly selective cox 2 inhibitor, this will take care of the inflammation only and reduce any pain, if a cox 2 selective inhibitor isn’t available, you may want to use a combination therapy. You will administer both an NSAID and an antiulcer drug. The NSAID would do its part by reducing pain, while the antiulcer drug would help to treat the ulcer.
Some examples of NSAIDs are diclofenac, aspirin, piroxicam, etc. A good example of the cox 2 inhibitor is the celecoxibs. As I said earlier, the pain and swelling can result from different things depending on the severity of the incident. If symptoms persist, it’s advisable to meet with medical personnel.
Osinaike studied Pharmacology at the Olabisi Onabanjo University