Nsaids: Salicylates

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in behavior (along with nausea and vomiting) may be an early sign of Reye’s syndrome; patients should be instructed to contact their healthcare provider if these occur” ("Aspirin," 2016, para. 7).

As for pregnancy it is classified as D. It indicates that the drug has positive evidence of human fetal risk. It should be strictly avoided during the third trimester of pregnancy. UpToDate has highlighted that “salicylates have been noted to cross the placenta and enter fetal circulation. Adverse effects reported in the fetus include mortality, intrauterine growth retardation, salicylate intoxication, bleeding abnormalities, and neonatal acidosis” ("," n.d., para. 35). In the same manner that is possibly unsafe for lactation because of evidence-based literatures demonstrating potential or actual adverse effects to infant and or breast milk production. It is therefore necessary to consider possible alternatives if taking the said medication ("Aspirin," 2016).

In cases of individuals undergoing surgical procedures, Salicylates should be avoided for at least a week or two prior to the scheduled surgery to decrease the possibility of hemorrhage with exception to individuals with cardiac stents that have not completed their “full course of dual antiplatelet therapy [aspirin, clopidogrel]” ("Aspirin," 2016, para. 7);

Drug Interactions

Salicylates are contraindicated with dichlorphenamide as it may contribute to salicylate toxicity and increases the risk of CNS toxicity. If taken with live influenza nasal vaccine and live varicella vaccine, the combination would increase the risk of Reye’s syndrome. Ketorolac is also contraindicated due to its additive effects and risk of GI bleeding.

There is a rather lengthy list of drug interactions with Salicylates and alternatives should be used. I will just name a few, such as ACE inhibitors as it diminishes its therapeutic effect if used alongside with the drug. With alcohol (ethyl), it would enhance the toxic effect of the drug, in fact it interferes with the controlled release mechanism of extended release aspirin. Hence, monitoring should be provided for individuals who take 3 or more alcoholic drinks a day otherwise therapy modification should be considered. It increases the risk for bleeding with SSRIs and Rivaroxaban among others ("Aspirin," 2016, para. 8).

Food Interactions

It has been emphasized in UpToDate that if Salicylates is taken with food, it would decrease the rate but will not cause extensive effect on oral consumption. Benedictine liqueur, prunes, raisins, tea, and gherkins have a potential to cause salicylate accumulation ("," n.d., para. 38). Consumption of fresh fruits that contain vitamin C “may displace the drug from binding sites, resulting in increased urinary excretion of aspirin” ("," n.d., para. 38). Spices such as that of “curry powder, paprika, licorice; may cause salicylate accumulation” ("," n.d., para. 38).

It is therefore necessary that if the medicine is prescribed, it is suggested that food should be taken. A large amount of water and milk can ease any GI upset. Furthermore, use of spices as aforementioned should be limited ("," n.d.).

Conclusion: NSAIDs and Rehabilitation

It is expected in our profession that an extensive rehabilitation program plan is designed for a patient. In the course of the drawing the plan, it is the responsibility of the physical therapist to understand the pharmacology, pharmacokinetics and pharmacodynamics of the drugs that has been prescribed for the patients as well as the over the counter medicines. One should be aware that the prevalence of NSAIDs is very substantial for rehab professionals in the clinical practice. Patients with mild to moderate pain such as a soft tissue injury, arthritis, gout and rheumatoid arthritis are usually given NSAIDs as the first line drug of choice to address their concerns. However, despite its benefits there are known risks that would bring about a significant effect on the rehabilitation outcome. Thereby, the rehab professional should be vigilant with regards to the effects and should be able to evaluate the benefits over potential risks especially when planning and discussing the treatment of the patient. In fact, in an article written by P.G. Conaghan describes that “all NSAIDs are associated with some varying degree of gastrointestinal and cardiovascular risk” (Conaghan, 2012, p. 1491). With that, understanding the clinical pharmacology will be a huge advantage in the profession especially to the patients we are providing care with.

Currently, it is outside of the scope of our profession to prescribe with the exception of those working in the military environment, but it does not undermine our responsibility by educating the patients and make known to them the risks of prolonged usage of NSAIDs especially with over the counter medicines. Apart from that, we have the tools such as the appropriate use of modalities, therapeutic exercises and manual therapy so I believe there would not be a downside to verbalise our concerns to the patients. It would also help establish trust making it more comfortable for the patients to communicate his or her concerns about the medication and what not. This would help identify any potential risk and adverse reactions that needed to be collaborated with their physician to target and provide resolution to their concerns especially when the patient does not respond to the rehabilitation as expected.

References

Aspirin: Patient drug information. (n.d.). In UpToDate version (99.0). Retrieved March 20, 2016, from http://www.uptodate.com/contents/aspirin

Ciccone, C. D. (2016). Pharmacology in Rehabilitation (5th ed.). Retrieved from http://www.amazon.com

Conaghan, P. G. (2012, December 23). A turbulent decade for NSAIDs: update on current conceptsof classification, epidemiology, comparative efficacy, and toxicity. Rheumatology International, 32, 1491–1502. http://dx.doi.org/10.1007/s00296-011-2263-6

Connelly, D. (2014). A history of aspirin. Retrieved from http://www.pharmaceutical-journal.com/publications/previous-issues/cp-september-2014/a-history-of-aspirin/

Salicylates. (2016). In Epocrates Plus version (14.1). Retrieved from http://www.epocrates.com/mobile/iphone/essentials

Salicylates. (n.d.). Retrieved from http://reference.medscape.com/drug/

Sinha, M., Gautam, L., Shukla, P. K., Kaur, P., Sharma, S., & Singh,