Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs and their widespread use is associated with increased gastro-intestinal toxic effects such as ulceration, haemorrhage, perforation and death. They result in these complications mainly by reducing cytoprotective prostaglandins (PGE2 and PGI2) in the stomach, through the inhibition of cyclo-oxygenase (COX) enzyme. The increased morbidity and mortality, in addition to enormous cost, associated with NSAID-associated side effects, necessitates a need for safer GI-friendly NSAID. Various approaches have been used to counteract NSAID associated side effects with varying degrees of success and acceptance. These include the use of alternative analgesia, anti-acid secretory agents like proton pump inhibitors, sucralfate and prostaglandin analogues. In addition, new types of NSAIDs are being developed, based on new understanding of their mechanism of action and the pathogenesis of inflammation. These include a new class of NSAIDs called "selective Cox-2 inhibitors". These agents preserve the COX-1 that is responsible for the production of cytoprotective prostaglandins in the stomach and selectively inhibit COX-2 induced at the sites of inflammation. Selective COX-2 inhibitors exert the same analgesic and anti-inflammatory effects as the existing NSAIDs but may be less toxic to the stomach. In this review the background development and well-structured clinical trials on this new generation NSAIDs are discussed.
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PMID:Non-steroidal anti-inflammatory drugs (NSAIDs) and gastro-intestinal toxicity: current issues. 1062 61

Coxibs can be regarded as an effective way of postoperative pain treatment with proven analgesic and opioid-saving effects. When comparing the opioid-saving effect after the large surgical interventions, COX-2 inhibitors are not inferior to NSAIDs and surpass paracetamol. The combination of coxibs and opiate receptors antagonists, as well as epidural analgesia is effective in the frames of multimodal analgesia. The reasonability of coxibs and paracetamol combination is questionable. In patients at risk of gastrointestinal complications development, but with none cardiovascular risk, COX-2 inhibitors are more safe, than the combination of NSAIDs and proton pump inhibitors. Due to no cross-reactivity with aspirin and NSAIDs, coxibs can be recommended to patients with aspirin asthma and related diseases. Specific COX-2 inhibitors prescription is able to inhibit comissure formation after laparotomy, suppressing blood vessels proliferation. It is assumed that the COX-2 inhibitors may inhibit vascular endothelial growth factor of the tumor and so inhibit angiogenesis of solitary tumors and metastases, without affecting the normal endothelium. Thus, today coxibs are not inferior in eficiency to certain opioid analgesics and have improved safety profile compared with traditional NSAIDs. These qualities allow to consider them as a group of non-opioid analgesics for postoperative analgesia.
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PMID:[Coxibs for postoperative analgesia]. 2400 Jun 61

Many pregnant women take over-the-counter (OTC) medications despite the absence of randomized controlled trials to guide their use during pregnancy. Most data come from case-control and cohort studies. In 1979, the U.S. Food and Drug Administration began reviewing all prescription and OTC medications to develop risk categories for use in pregnancy. Most OTC medications taken during pregnancy are for allergy, respiratory, gastrointestinal, or skin conditions, as well as for general analgesia. Acetaminophen, which is used by about 65% of pregnant women, is generally considered safe during any trimester. Cold medications are also commonly used and are considered safe for short-term use outside of the first trimester. Many gastrointestinal medications are now available OTC. Histamine H2 blockers and proton pump inhibitors have not demonstrated significant fetal effects. Nonsteroidal anti-inflammatory drugs are generally not recommended in pregnancy, especially during organogenesis and in the third trimester. There are even fewer data regarding use of individual herbal supplements. Ginger is considered safe and effective for treating nausea in pregnancy. Topical creams are considered safe based on small studies and previous practice. All OTC medication use should be discussed with patients, and the effects of the symptoms should be balanced with the risks and benefits of each medication. Because of the expanding OTC market, formalized studies are warranted for patients to make a safe and informed decision about OTC medication use during pregnancy.
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PMID:Over-the-Counter Medications in Pregnancy. 2637 62

To prevent perioperative aspiration pneumonitis, it is necessary to reduce the volume and acidity of gastric content. The guideline for preoperative fasting published by Japanese Society of Anesthesiologists recommends fasting from intake of clear fluids, breast milk and nonhuman milk at least 2h, 4h and 6h, respectively, before elective procedures requiring general anesthesia, regional anesthesia or sedation/analgesia. Gastrointestinal stimulants, histamine-2 receptor antagonists, proton pump inhibitors, antacids, antiemetics, anticholinergics are effective for reduction of the volume or acidity of gastric content. However, the routine preoperative use of these drugs to reduce the risk of pulmonary aspiration in patients who have no apparent increased risk for pulmonary aspiration is not recommended.
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PMID:[Prevention of Perioperative Aspiration Pneumonitis]. 2700 83