NSAIDs: Nonsteroidal Anti-Inflammatory Pain Medications

Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs (pronounced en-sayds), are some of the most commonly prescribed medications, especially for patients with orthopedic problems such as arthritis, bursitis, and tendonitis. These medications are available over-the-counter (e.g. Ibuprofen, Motrin, Aleve) or as a prescription (e.g. Celebrex, DayPro, Relafen). NSAIDs are effective at pain relief (analgesia), and to reduce swelling (anti-inflammatory).

How do NSAIDs work?
Medications that work to reduce inflammation come in two major categories:

* Steroids (e.g. Cortisone)

* Non-Steroidal Anti-Inflammatory Medications (NSAIDs)

Steroid drugs are a derivative of a natural hormone produced by the body. These medications can be given orally, systemically, or as a localized injections, as is commonly used in orthopedics.

NSAIDs work to block the effect of an enzyme called cyclooxygenase. This enzyme is critical in your body's production of prostaglandins. It is prostaglandins that cause swelling and pain in a condition such as arthritis or bursitis. Therefore by interfering with cyclooxygenase, you decrease the production of prostaglandins, and decrease pain and swelling associated with these conditions.

Simple, right?

Well, there's more to it. Prostaglandins also have other important functions in the body. One type of prostaglandin (there are many varieties) helps line the stomach with a protective fluid (called gastric mucosa). When the production of this protective fluid is diminished, some people are at risk for developing stomach ulcers.

H1N1 Swine Flu 2009 Frequently Asked Questions

With so much in the news about swine flu, also called H1N1, it's wise to know what it is, what you can expect, and how to protect yourself and your loved ones. Empowered patients can use this knowledge to reduce their fear of swine flu.

What is swine flu?

The swine flu is a strain of virus that pigs contract and transmit. The swine flu of interest in 2009 is the H1N1 strain, which can be passed from pigs to human beings. It was first identified in pigs in 1930. Now it is causing illness in humans, with the potential of reaching pandemic levels.

What does H1N1 Influenza A mean?

The official, scientific name for swine flu, its serologic classification, is H1N1 Influenza A. The H means hemagglutinin and the N means neuraminidase and the 1s refer to their antibody type. Influenza A is a genus of the Orthomyxoviridae family of viruses, and refers to the fact that the virus is first identified in an animal, usually a pig or a bird. When put together, they describe the 2009 swine flu virus.

Why is this flu different from other flus?

There are thousands of different kinds of viruses that can cause the flu. New strains develop frequently and each one is different from the one before it. The seasonal flu is actually comprised of several different strains of flu. Swine flu is a new, different strain, as described above.

What are the swine flu stages I keep hearing about?

The World Health Organization, WHO, developed a plan to respond to health emergencies, like swine flu, which have the potential to become pandemic. Each stage represents a different level of response. For example, Stage 4 means that the disease can no longer be contained inside any specific country, therefore governments must take steps to handle community spread of the disease. If we get there, Stages 5-6 will indicate the swine flu has become pandemic. You can follow WHO swine flu staging for changes and updates.

What exactly is a pandemic?

WHO defines a pandemic along those stages mentioned above. They describe the prevalence of the disease, across populations and countries. There is a difference between a pandemic and an epidemic.

I keep hearing "swine flu" and "avian flu" in the same sentence.
What's that all about?

Avian flu is another name for bird flu. This pairing is heard as "swine, avian, human" and refers to the fact that this flu strain seems to be a combination of all three.

How is the swine flu transmitted?

The swine flu is transmitted just the way any viral disease is transmitted -- person-to-person contact, by touching something someone with a virus has already touched, or from droplets in the air which come from a sneeze or a cough of a person who has the swine flu.

What are the symptoms of swine flu?

Symptoms of swine flu are the same as typical flu symptoms. Fever, cough, sore throat, body aches, headache, chills and fatigue are the most prevalent symptoms. Some patients report diarrhea and vomiting, too.

Do people die from swine flu?

People can die, but most do not.


Is there a swine flu vaccine like seasonal flu vaccine?

No. The CDC and WHO report there is no vaccine available for this strain of swine flu. A vaccine may be developed, but if so, it will not be available until Fall 2009.

There are many spam emails circulating that claim a vaccine is available. Since this strain, the H1N1 strain, is only weeks old, it would be impossible for a vaccine to have been developed. Any claims to the contrary would likely be counterfeit.

New Drug That Raises HDL Levels

An article published recently in the New England Journal of Medicine addresses the discovery of a new drug, torcetrapib, that elevates HDL levels. This drug acts by inhibiting the cholesteryl ester transfer protein, which regulates the size of cholesterol particles and aids in the development of atherosclerosis. Although other drugs, including torcetrapib, lower LDL levels, this is the first drug developed that specifically raises HDL levels and does so through a route different from other drugs.

Yukon Gold Potatoes and Health

The more intense yellow color of the flesh, the higher the vitamin A levels, which promotes good vision, healthy skin, and improved immune system. The peel stores goodly amounts of potassium, helping to reduce risk of stroke, as well as vitamin A. So scrub them gently and leave on the peels when cooking.

Potatoes also contain glutathione, an antioxidant that may help protect against cancer.

New Anti-Psychotic Drugs work better than Old

A new study has shown that people diagnosed with their first episode of schizophrenia fare much better when treated with newer anti-psychotic drugs than with traditional medications. The double bind study was conducted in China by American and Chinese scientists. It is the first study to directly compare treatment with clozapine (Clozaril), an 'atypical' anti-psychotic medication, with chlorpromazine (Thorazine) in people who had an episode of schizophrenia for the first time.

200 patients diagnosed with first-episode schizophrenia were randomized to receive one drug or the other. Neither they nor the scientists knew who received which drug until all the data had been collected. The findings strongly suggest that clozapine works better than chlorpromazine in early schizophrenia.

The findings of this study were presented December 11, 2000 to the 39th Annual Meeting of the American College of Neuropsychopharmacology. Jeffrey A. Lieberman, M.D. of the University of North Carolina summarized the study this way: "We found that clozapine acts faster and produced fewer patients who drop out or stop treatment because of side effects. This is the first time a study's ever been done comparing the prototype of this new class of drugs with the old group in a large sample of patients."

Clozapine is the second most widely used medication for schizophrenia in China, but its use is restricted in the United States. The FDA approved clozapine as a 2nd- or 3rd-line of treatment for people who were unresponsive to other medications because early studies showed it suppressed the immune system's white cells in one percent of people who took it for more than six weeks . The authors conducted the study in China where these restrictions do not exist.

Based on the study's results Lieberman sees a wider role for the newer medications. "We think using these new drugs as first-line medications increases the likelihood of recovering from the illness and reduces the likelihood of a second episode when they remain in treatment. Patients who are at the beginning of their illness are extremely sensitive to treatment. That sensitivity makes them very responsive to the therapeutic effects of anti-psychotic drugs. They respond to all treatment including the newer and better treatments. However, they're also more sensitive to side effects and this can become a real problem in terms of their willingness to continue their medication and the likelihood of them stopping."

In a footnote, the study also found that patients in the study whose blood tests showed signs of exposure to the parasite toxoplasmosis had a poor response to treatment. Toxoplasmosis is a parasite borne by cats and some other domestic animals. Lieberman speculated on this result: "There's a theory that an infectious agent, a parasite or some other microorganism, can cause schizophrenia - and toxoplasmosis has an affinity for the nervous system, where it can lie dormant for a long time in its migration to the brain." Lieberman suggested that schizophrenic patients in a population with a high risk for toxoplasmosis should be given standard anti-psychotic medication along with one of the drugs typically used against the parasite.

Clozapine was the very first of the new 'atypical antipsychotic' medications. Other medications in this class seem to have some of the benefits without the infrequent dangerous side-effect. This study suggests that physicians should at least consider a medication in this class for patients newly diagnosed with schizophrenia. Is there still a role for older anti-psychotics? Maybe - but their role continues to shrink.

Tramadol - 10 Things You Should Know

TRAMADOL, the generic version of Ultram, is a synthetic analgesic medication. The exact mode of action of tramadol is unknown but it is said to work like morphine. Tramadol binds to opioid receptors in the brain -- receptors that transmit the sensation of pain throughout the body. Here are 10 things you should know about tramadol to ensure its safe use.

1 - Tramadol is prescribed to treat moderate to moderately severe pain.

Tramadol belongs to the class of drugs known as opiate agonists. Primarily, tramadol works by changing the way the body senses pain. Some people mistakenly believe that tramadol is an NSAID (nonsteroidal anti-inflammatory drug), but it is not.

2 - Tramadol is available in immediate release and extended release formulations.

Tramadol may be prescribed as an immediate release tablet (50 mg.) or as an extended release tablet (100, 200, or 300 mg.). The extended release tablets are usually reserved for patients with chronic pain who require continuous, long-term treatment. Your doctor will determine the appropriate dosage schedule for you.

3 - Tramadol extended release tablets must be taken whole, not split, chewed or crushed.

It is important to take tramadol properly and to follow prescribing instructions. If taken improperly or in a way that is not recommended, serious side effects and even death can result.

4 - Tramadol can be habit-forming for some people.

Do not take more tramadol than has been prescribed for you. Taking more tramadol or taking it more often can cause dependency on it. You should also not stop taking tramadol without first consulting your doctor. You may experience withdrawal symptoms if you stopped it suddenly. You doctor will likely decrease your dose of tramadol gradually.

5 - Drug interactions are possible with tramadol.

Be aware of the following possible drug interactions:

* Carbamazepine reduces the effect of tramadol
* Quinidine increases the concentration of tramadol by 50% to 60%
* Combining tramadol with an MAO (monoamine oxidase inhibitor) inhibitor or SSRI (selective serotonin reuptake inhibitors) can lead to seizures or other serious side effects.

Be sure to tell your doctor about all medications you are taking.

6 - Tramadol, when combined with certain other substances, can increase central nervous system and respiratory depression.

In other words, breathing may be affected or even stop if tramadol is combined with alcohol, narcotic drugs, anesthetics, tranquilizers, or sedatives.

7 - The use of tramadol during pregnancy should be avoided.

Because the safety of tramadol use during pregnancy has not been established, the medication should not be used during pregnancy. The safe use of tramadol in nursing mothers has also not been established.

8 - Tramadol is usually well-tolerated. Any side effects are usually temporary.

Some of the common side effects associated with tramadol include:

* nausea
* constipation
* dizziness
* headache
* drowsiness
* vomiting

Less common side effects include: itching, sweating, diarrhea, rash, dry mouth, and vertigo. There have been patients who developed seizures after taking tramadol.

9 - A Cochrane Review of tramadol to treat osteoarthritis revealed some small benefit.

The Cochrane Review stated that when tramadol is taken for up to 3 months, there may be decreased pain, improvements in function and stiffness and overall well-being. However, tramadol can cause side effects that are significant enough to require that the patient must stop taking the medication. Risks outweigh benefits for many people who have tried tramadol.

10 - If an overdose of tramadol has occurred, call your local poison control center, or call 911 if it appears to be an emergency situation.

Symptoms of an overdose include decreased pupil size, difficulty breathing or staying awake, unconscious, coma, heart attack, or seizure. Call for help, even if you are unsure about what to do.

Acetaminophen: 10 Things You Should Know

Tylenol (acetaminophen) is a widely used drug which is considered safe when used appropriately. Tylenol safety decreases the chance for undesirable side effects. Safety warnings about Tylenol should be respected. To enhance patient safety, Tylenol must be taken according to directions. If you take Tylenol or may take it in the future, here are 10 things you should know.
1 - Tylenol is a medication prescribed for pain relief and fever reduction.

Tylenol belongs to a class of drugs known as analgesics and antipyretics. Acetaminophen, the generic equivalent of Tylenol, is the most commonly prescribed and widely used analgesic (pain reliever) and antipyretic agent (fever reducer) in the world. Tylenol (acetaminophen) does not have anti-inflammatory properties though. Tylenol is prescribed for many health problems, one of which is arthritis pain.

2 - Acetaminophen, the active ingredient in Tylenol, is contained in more than 100 different products and combination products.

Acetaminophen is contained in countless pain formulations, cold products, sinus preparations, and more (e.g. Sinutab, Midol, Ultracet, Dristan). The wide availability of acetaminophen, sold over-the-counter and in prescription products, make it one of the most common drugs associated with intentional or accidental poisoning. Taking multiple products which contain acetaminophen and exceeding the maximum allowable daily dose can cause serious side effects and can have potentially fatal consequences.

3 - The maximum allowable daily dose of Tylenol (acetaminophen) is 4 grams (or 4000 mg) in adults and 90 mg/kg in children.

Tylenol (acetaminophen) is available as a tablet, chewable tablet, capsule, caplet, geltab, gelcap, extended-release tablet, or liquid suspension to be taken by mouth with or without food. It is also available as a suppository. Regular strength Tylenol is 325 mg per pill. Extra strength Tylenol is 500 mg per pill. For adults, 8 extra strength Tylenol tablets is the maximum allowed per day. If you exceed that amount, you risk serious consequences.

4 - You must be aware of the cumulative effect of taking various products which contain acetaminophen.

As previously explained, many products contain acetaminophen. It is your responsibility to add up the amount of acetaminophen you are ingesting daily, even if from more than one product, to be sure you are not exceeding the daily dose which is allowed. For example, if you take two Darvocets per day, that is equal to 1300 mg acetaminophen since one Darvocet contains 650 mg. acetaminophen. Darvocet contains propoxyphene and acetaminophen. If, in addition, to Darvocet for pain, you also take cold or sinus medication which contains acetaminophen, you must add the total amount ingested (e.g. add up the acetaminophen in both Darvocet and the cold medication) in order to be aware of the cumulative effect. The label on Tylenol recommends that you not take more than one product at a time which contains acetaminophen to ensure that you won't exceed maximum allowable dosages.

5 - Drinking alcoholic beverages while taking acetaminophen is not advised.

If you drink three or more alcoholic beverages every day or have had alcoholic liver disease, ask your doctor if you should take acetaminophen. The combination of alcohol and acetaminophen can be seriously damaging to the liver, with possibly fatal outcomes.

6 - Acetaminophen side effects can be serious. Know when you should call your doctor instead of assuming the problem will disappear.

Certain side effects can be signs of an allergic reaction or a situation which requires immediate medical attention, such as:

* Rash
* Hives
* Itching
* Swelling
* Hoarseness
* Difficulty breathing
* Difficulty swallowing

7 - Symptoms associated with acetaminophen overdose can be serious too, and require immediate medical attention.

The symptoms can occur whether the overdose is accidental or not:

* Nausea
* Vomiting
* Loss of appetite
* Confusion
* Sweating
* Extreme fatigue
* Unusual bleeding or bruising
* Pain in stomach (especially upper right portion)
* Yellowish skin or eyes
* Flu-like symptoms
* Diarrhea
* Irregular heartbeat

8 - There are recommendations and guidelines for how long you should take Tylenol (acetaminophen) if you are self-treating.

Current recommendations suggest that you may take acetaminophen for up to 3 days when treating a fever, and for up to 10 days when treating pain. If symptoms persist beyond that time frame, consult with a doctor to see if you should continue with acetaminophen or change your treatment plan.

9 - Acetaminophen is classified as FDA Pregnancy Category B, meaning, it is unlikely the drug would harm an unborn baby.

If you are pregnant, do not take acetaminophen without discussing it with your doctor. Acetaminophen passes into breast milk. Though it is considered safe to use during breastfeeding, discuss it with your doctor.

10 - When used as directed, Tylenol (acetaminophen) is considered generally safe. That's the bottom line.

When taken according to directions, side effects from acetaminophen are rare. The most serious side effect is liver damage. Kidney toxicity is also a possibility. The risk of liver damage increases with:

* Large doses of acetaminophen
* Chronic use of acetaminophen
* Concomitant use of acetaminophen with alcohol (i.e. taken together) or with other drugs that can also potentially cause liver damage