Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ketorolac tromethamine is a pyrrolo-pyrrole nonsteroidal antiinflammatory drug (NSAID) with potent analgesic effects when administered intramuscularly for the treatment of acute pain. Ketorolac is well absorbed and has a rapid onset of action. Maximum plasma concentrations are achieved in 45-50 minutes and peak analgesic effects in about one to two hours following intramuscular injection. Ketorolac is more than 99 percent bound to plasma proteins and has a mean apparent volume of distribution of 0.11-0.25 L/kg. About 91 percent of a dose is excreted in urine, mostly as inactive metabolites, and approximately 6 percent is eliminated in feces. The elimination half-life, approximately four to six hours, increases in elderly patients and those with renal impairment. Its analgesic effectiveness was similar or superior to that of morphine, meperidine, or pentazocine in single-dose studies of patients with postoperative pain or renal colic and greater than that of placebo in patients with chronic cancer pain. The adverse effects are generally mild to moderate, self-limiting, and similar to those seen with other prostaglandin inhibitors. Ketorolac has a reversible inhibitory effect on platelet aggregation. It can cause dose-related gastric ulcerations, even when administered parenterally. Ketorolac is a promising parenteral alternative to oral NSAIDs and a nonnarcotic alternative to opioid analgesics. Additional multiple-dose studies are needed to more clearly define its place in therapy.
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PMID:Ketorolac: a parenteral nonsteroidal antiinflammatory drug. 227 36

The mineral density of bone (MDB) was measured by dualphoton absorptiometry in the lumbar vertebrae of 23 healthy volunteers who consumed large amounts of a mineral water with high fluoride content (8.5 mg/l). The subjects studied had ingested a minimum of 0.75 litre of this water each day for 5 years or more. None of them had a history of pain in the bones or spontaneous fracture. MDB was found to be significantly higher in these subjects than in age - and sex-matched controls, and particularly high in those who were older than 60 years. There was positive correlation (r = 0.61, p less than 0.02) between MDB and mineral water consumption index. Serum levels of osteocalcin - a marker of bone formation - and urinary fluoride levels were significantly higher in drinkers of St-Yorre water than in controls. These data suggest that prolonged consumption of this mineral water by subjects without renal impairment might protect against the risk, increasing with age, of vertebral osteoporosis.
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PMID:[Increase of vertebral bone density in heavy drinkers of mineral water with a high fluoride content]. 252 22

Autosomal dominant polycystic kidney disease is the third cause of end-stage chronic renal failure (CRF) requiring dialysis and transplantation. Over a 5-year period we collected 21 cases of that disease. The patients' mean age at the time of diagnosis was 48 years and the sex ratio 1.1. Pain was the most frequent signal symptom, being present in 43 p. 100 of the patients. Varying degrees of renal impairment were found in 61 p. 100 of the cases, and arterial hypertension in 38 p. 100. The diagnosis, suspected on clinical grounds, was confirmed by ultrasonography in 95 p. 100 of the patients. Beside CRF and hypertension, the main complications were microscopic haematuria (38 p. 100) and urinary tract infection (24 p. 100). In two patients the disease was associated with hepatic polycystosis. Treatment was symptomatic for CRF (4 patients were put on periodical haemodialysis) and for the other complications. On the basis of this series, we discuss the profile and prognosis of polycystic kidney disease in our environment, and notably its effects on renal function, and we underline the usefulness of familial investigations and the need for genetic counselling.
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PMID:[Dominant renal polycystic disease]. 252 23

Fourteen osteoporotic women who had been under treatment with fluoride (23 mg/day of fluorine ions) for 12 months on average developed periarticular pain in the lower limbs or pelvis, corresponding to 21 fractures due to bone insufficiency. Six of these fractures were revealed only by radionuclide uptake in the painful areas, whereas the remaining 15 fractures, including 2 of the sacrum, were visible at radiography. Four patients had a past history of hyperthyroidism or were in a state of active hyperthyroidism detected by hormonal assays and iliac bone biopsy when the fractures were diagnosed. The decalcification associated with hyperthyroidism facilitates the occurrence of bone insufficiency fractures, as do treatments with high doses of fluoride, inadequate calcium supplement intake (observed in 5 cases) or the presence before treatment of renal impairment or disorders of bone mineralization, sometimes detected only by iliac bone biopsy. Repeated measurements of blood and urinary fluoride levels during treatment make it possible to adjust fluoride dosage, and lower doses (14 mg/day of fluorine ions) might reduce the incidence of the adverse effects of fluoride on bone.
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PMID:[Bone complications during the treatment of osteoporosis with fluor]. 274 Jun 60

Naproxen sodium is a drug characterized by rapid and complete absorption after oral administration, highly protein-bound distribution, relatively simple metabolism, and renal excretion. Its pharmacokinetics are little affected by food, by dosage levels (within wide limits), or by mild renal impairment. The main mechanism of naproxen sodium action, inhibition of prostaglandin synthesis, makes the drug effective in combating pain and inflammation, while its relatively long half-life permits a two times daily dosing. The drug is well tolerated by most patients.
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PMID:Pharmacokinetics of naproxen sodium. 309 34

The evaluation of a 10-day 3 x 800 mg dosage regimen was equivalent for bacampicillin to oral ampicillin therapy (using 3 or 4 g respectively per day) in patients with primary UTI (n = 50) in clinical and bacteriological respect. The cure rate amounted to 69 and 68,4% respectively 2 days after therapy. No differences could be assessed after a 2-, 4- and 6-week period. Frequency of diarrhoea was 3 times as high in the ampicillin group as in the bacampicillin group. The rate of exanthema was also 2,5 times as high. No differences existed between eosinophilia and pain complaints in the upper gastrointestinal tract. 10 patients with liver function disturbances and renal impairment respectively tolerated well bacampicillin treatment. Only in the patients with impaired liver function rise of BUN and urea was found in 3 cases, not related to rise of creatinine.
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PMID:[Bacampicillin in urinary tract infections tolerance in patients with impaired kidney and liver function]. 639 71

In a four week double-blind crossover study, flurbiprofen 200mg daily was compared with naproxen 750mg daily in the management of 30 patients with ankylosing spondylitis. Both treatments were found to be very effective in alleviating pain and stiffness. No significant difference in efficacy was discernible between the two drugs. Side-effects were more frequent with flurbiprofen. A small, but significant, increase in renal excretion of beta-n-acetyl glucosaminidase occurred during treatment with both naproxen and flurbiprofen. Although previous surveys have not shown evidence of renal damage, further surveillance of renal function in patients receiving long term treatment with these preparations to exclude possible renal impairment would be prudent.
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PMID:A comparison of flurbiprofen with naproxen in ankylosing spondylitis. 700 49

We report on 10 kidney transplant patients with acute hemorrhagic cystitis caused by adenovirus, accompanied by the deterioration of kidney function. They developed macrohematuria with urgency, frequency and micturition pain for more than 7 days within 1 year after transplantation. Adenovirus type 11 was isolated from the urine of 6 patients, and complement-fixing antibody became positive in 9 patients. Hematuria and irritative voiding symptoms disappeared without any specific treatment; however, serum creatinine rapidly increased. The histological findings of the biopsy specimens indicated that renal impairment was attributed to acute rejection in some cases and virus-associated nephropathy in other cases. Acute hemorrhagic cystitis caused by adenovirus is an interesting complication after kidney transplantation, especially with regard to kidney impairment and treatment.
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PMID:Acute hemorrhagic cystitis caused by adenovirus after kidney transplantation. 760 55

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of agents with similar actions but diverse chemical structures. Aspirin (acetylsalicylic acid) and sodium salicylate were the first drugs of this type to be used clinically. However, over the past 3 decades there has been a dramatic increase in the number of NSAIDs available for the treatment of postoperative pain. Tissue injury, such as occurs with surgical intervention, is associated with the release of numerous inflammatory mediators including prostaglandins. Prostaglandins derived from the arachidonic acid cascade are implicated in the production of inflammatory pain, and in sensitising nociceptors to the actions of other mediators. They are synthesised from arachidonic acid via the endoperoxide biosynthesis pathway, the initial step of which is catalysed by the enzyme cyclo-oxygenase. Two forms of the cyclo-oxygenase enzyme (COX-1 and COX-2) have been characterised. COX-1 is important in circumstances where prostaglandins have a protective effect such as gastric mucus production and renal blood flow maintenance. NSAIDs inhibit the synthesis of prostaglandins at 1 or more points in the endoperoxide pathway. Three mechanisms of inhibition of the biosynthetic enzymes have been proposed: (i) rapid, reversible competitive inhibition; (ii) irreversible, time-dependent inhibition; and (iii) rapid, reversible noncompetitive (free radical trapping) inhibition. In addition, there is evidence that NSAIDs have a central antinociceptive mechanism of action that augments the peripheral effect. This may involve inhibition of central nervous system prostaglandins or inhibition of excitatory amino acids or bradykinins. There is considerable variability in the pain relief obtained from NSAIDs. Such variability in drug response may be explained in terms of differences between agents with respect to either pharmacodynamic actions or pharmacokinetic parameters or a combination of both. Stereoisomerism, where preparations exist as racemic mixtures and where only 1 enantiomer is active, may also be important. However, chiral inversion from inactive to active enantiomer may occur and may be rapid or slow. NSAIDs have numerous adverse effects. Gastrointestinal disturbances including ulceration are the commonest adverse responses to NSAIDs and carry the greatest risk of death. Also significant are renal impairment and an increased risk of postoperative haemorrhage. Asthma and allergic reactions are uncommon.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Nonsteroidal anti-inflammatory drugs in perisurgical pain management. Mechanisms of action and rationale for optimum use. 770 16

Nonsteroidal anti-inflammatory drugs (NSAIDs) are important therapeutic agents in the management of rheumatologic disorders and other pain syndromes. Over the counter availability of the drugs has expanded the usage of the drugs. This article reviews the nephrotoxicity of these drugs, with some emphasis on NSAID-related proteinuria. Although reversibility of renal involvement upon drug discontinuance is the rule, progression to end-stage renal disease has occurred. A proposed guideline for monitoring renal impairment in low- and high-risk patients is also presented.
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PMID:Nephrotoxicity of nonsteroidal anti-inflammatory drugs. 784 21


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