Psychology 630 Rapid Review Paper

Note to student: This is a worked example paper for the “Rapid Review” assignments in Weeks Three, Four, and Five of PSY630: Psychopharmacology. Your paper does not need to (and probably should not) look just like this example paper. Depending on the drug you chose, your paper may be more complicated, involve more subsections, and cover different topics with more or less depth. This example paper is meant to give you a general idea of what to include and what depth of detail to use. Ask your instructor if you have any concerns.

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Ibuprofen

General Description

Ibuprofen belongs to the larger class of drugs referred to as the non-steroidal anti

inflammatory drugs (NSAIDs) and also includes naproxen, aspirin, indomethacin and celecoxib,

among others. Ibuprofen was chosen as a paper topic because of its’ widespread over-the

counter (OTC) use. Ibuprofen has, as the name NSAID suggests, anti-inflammatory effects

making it useful in a wide variety of disorders where the inflammatory response needs to be

suppressed. Relatedly, it is also an analgesic, partly due to its’ anti-inflammatory effect which is

central to many disorders and injuries which cause pain, but also to a separate secondary

mechanism which is poorly understood. It is also an anti-pyretic and useful for treating fever.

Steroids also reduce inflammation; however they have a large number of broad side effects

including immune-suppression which make NSAIDS like ibuprofen a better choice for many

conditions. Ibuprofen and many other NSAIDs are also superior to aspirin in people allergic to

aspirin and other salicylates (Atchinson, Herndon, & Rusie, 2013; Roda, Bagán, Soriano, &

Romero, 2007).

Specific indications include: general relief of mild to moderate pain, menstrual pain, fever,

rheumatoid arthritis, osteoarthritis, headache, migraine, dental pain. It sees use across a wide

variety of medical conditions and procedures.

Mechanism of Action

Ibuprofen and the other NSAIDs reduce the production of prostaglandins. These

substances are produced by injured tissues or tissues inflamed by some type of immune response.

Specifically, ibuprofen inhibits the enzyme cyclooxygenase (COX). However, COX has more

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than one form and is directly or indirectly involved in the activity of other biological processes

producing a variety of side effects (Roda et al., 2007).

Dosage, Administration, Absorption, and Metabolism

Ibuprofen is administered by mouth, although rectal suppositories are available for those

unable to swallow. The dose for an adult is 200-400mg three times daily for OTC use. Under

medical supervision doses up to 800mg four times a day may be given. It is typically taken with

food to avoid stomach upset. After being taken ibuprofen enters the bloodstream in about 30

minutes reaching its peak in 1-2 hours. It has a half-life of around 2 hours. After first pass

metabolism it has a bio-availability of 80% and is 99% plasma bound. Its two inactive

metabolites are excreted by the kidneys (Blondell, Azadfard & Wisniewski, 2013; Roda et al.,

2007), making health kidney function very important to use this drug safely.

Side Effects and Contraindications

Because ibuprofen inhibits the COX enzyme it also interferes with blood clotting and

functions of the gastrointestinal tract. The primary side effects of ibuprofen are gastric upset

occasionally leading to ulcer with long term use. There is some risk of bleeding, especially for

those with a history of bleeding disorders or about to undergo a surgical procedure. Kidney

damage has also been reported. As with many drugs these side effects are linked to the dosage

involved and the length of use (Blondell, Azadfard & Wisniewski, 2013; Conaghan, 2012; Roda

et al., 2007).

Other reported but fairly rare side effects include: headache, dizziness, sleepiness,

fatigue, ringing in the ears, changes in vision, rash, sun sensitivity, sweating, dry mouth,

constipation, diarrhea, flatulence, painful urination, increased menstrual bleeding, altered blood

count, bone marrow depression, shortness of breath, coughing blood, runny nose, hypertension,

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stroke and heart attack. There is some indication that ibuprofen may be implicated in

miscarriages, rhabdomyolysis, and erectile dysfunction (Atchinson, Herndon, Rusie, 2013;

Blondell, Azadfard & Wisniewski, 2013; Conaghan, 2012; Roda et al., 2007).

This drug should be used with care in the elderly or very young, people with bleeding

disorders or a history of ulcers. The drug should not be taken with other NSAIDs or with

steroids. Drug interactions include: lithium, some diuretics, beta-blockers, and selective

serotonin reuptake inhibitors. The patient should also avoid alcohol because of the risk of

stomach irritation as well as steroids due to the risk of stomach ulcers. People with a previous

sensitivity to any NSAID should avoid ibuprofen. Ibuprofen does cross the placental barrier and

enters breast milk and should be used by pregnant or nursing mothers only under medical advice

(Blondell, Azadfard & Wisniewski, 2013; Conaghan, 2012; Roda et al., 2007).

Overdose

Since being introduced as an OTC drug overdose has become more common.

Occasionally this is due to intent, however, it typically appears to be more often the result of

casual use or inadvertent overdose by combining several OTC products with the patient being

unaware that they all contained ibuprofen. Symptoms of overdose typically include: abdominal

pain, nausea, vomiting, headache, tinnitus and drowsiness. In more severe cases gastrointestinal

bleeding, seizures, low blood pressure, acidosis, irregular heartbeat, coma, kidney failure and

respiratory depression can occur. Treatment for overdose includes emptying the stomach,

intestinal irrigation, IV fluids and monitoring. Overdose is occasionally fatal and intensive care

may be needed (Conaghan, 2012).

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Other Notes

Ibuprofen is often combined with other analgesics that do not fall into the NSAID class

such as acetaminophen. It is sometimes used in conjunction with opiate drugs like codeine to

reduce the amount of opiate needed to relieve pain (Blondell, Azadfard, & Wisniewski, 2013).

Consumers need to check OTC medication labels and avoid combining ibuprofen with other

OTC medications because ibuprofen or other NSAIDs are found in many OTC preparations.

Concluding Remarks

Despite the extensive list of side effects and contraindications ibuprofen is a popular and

safe medication for the everyday aches, pains, and injuries of life. However, like all

medications, it needs to be used wisely. In particular knowing the medical history of the patient,

avoiding other interacting drugs and limiting the dose and length of use will prevent the vast

majority of issues.

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References

Atchinson, J. W., Herndon, C. M., & Rusie, E. (2013). NSAIDs for musculoskeletal pain

management: Current perspectives and novel strategies to improve safety [Supplemental

material]. Journal of Managed Care & Specialty Pharmacy, 19(9), S3-S19.

Blondell, R. D., Azadfard, M., & Wisniewski, A. M. (2013, June 1). Pharmacologic therapy for

acute pain. American Family Physician, 87(11), 766-772.

Conaghan, P. G. (2012). A turbulent decade for NSAIDs: Update on current concepts of

classification, epidemiology, comparative efficacy, and toxicity. Rheumatology

International, 32(6), 1491-1502. doi: 10.1007/s00296-011-2263-6

Roda, R. P., Bagán, J. V., Soriano, Y. J., & Romero, L. G. (2007). Use of non-steroidal anti

inflammatory drugs in dental practice. A review (English). Medicina Oral, Patologia

Oral, Cirugia Bucal, 12, E10-18.