Medicines And Drugs Used In Disorders Of The Joints

Ibuprofen (Brufen)

This is a milder anti-inflammatory drug causing less irritation of the stomach and other adverse effects. This drug is available in combination with paracetamol as well as dextropropoxyphene. It is widely used to relieve pain and inflammation of the joints and muscles, mild to moderate pain of menstrual cramps, dental surgery, and athletic injuries as sprains and strains. The recommended daily dosage is 1,200 to 1,600 mg to be given in 3 to 4 divided parts.

Precautions

It should be taken after meals.

Those allergic to aspirin, are likely to be allergic to this drug also.

It should not be taken by patients of peptic ulcer, or liver or kidney disease.

It should be used cautiously by patients of asthma. It has been reported to cause bronchoconstriction. It is also not recommended for those suffering from hypertension or heart disease.

If symptoms of allergic reaction occur, stop the drug and consult the doctor.

Naproxan (Naprogyn, Artragen), Naproxan Sodium (Xenobid)

Naproxan is effective and relatively less toxic. Besides that the duration of its action is longer. The drug can be taken in a dose of 125 to 250 mg, two times a day with meals. The adverse effects of this drug are the same as those of ibuprofen.

Mefenamic Acid (Meftal)

Mefenamic acid has properties like those of aspirin and can cause gastro-intestinal side effects including severe diarrhoea in some cases. Mefenamic acid is taken in a dose of 250 to 500 mg, three times a day.

Ketoprofen (Ostofen, Profenid)

This is a newer drug and supposed to be more effective than ibuprofen, but can cause all the side-effects as ibuprofen. The recommended daily dose of ketoprofen is 50mg, 2 to 3 times a day.

Flurbiprofen (Arflur)

This drug is given in a dose of 100 mg, twice a day. This drug is less irritant to the stomach than the drugs described earlier. The most common adverse effect is a headache. In rare cases it may cause skin rash and bone marrow depression.

Ketorolac Tromethamine (Ketorol)

It is more effective when used for short-term (5 days) management of pain of moderate severe intensity. Its initial dose is 30 to 6Q mg IM (intramuscular), to be followed by 15 to 30 mg every 6 hours.

Diclofenac Sodium (Voveran, Relaxyl, Flexyl, Diclomol)

This is a potent anti-inflammatory drug but has a short duration of action. Its sustained release preparation YOYERAN-SR (100 mg) is given once daily. Its adverse effects OCCur in about 20 per cent of the patients in the form of distress in the stomach. In some patients it may cause gastric ulceration.

Piroxicam (TOLDIN, PIROX)

It has a long duration of action and is given in a dose of 20 mg, once daily. The adverse effects are related to the stomach. It may also cause dizziness, headache, ringing in the ears, and skin rashes.

Note: The use of corticosteroids is discussed in the chapter on ‘Corticosteroids’, for nimesulide (Nimegesic) and other COX-2 inhibitors see chapter on ‘Pain Relievers’.

Combination Drugs

Hundreds of combinations of drugs containing pain-relievers, anti-inflammatory drugs, sedatives, and corticosteroids are available in the market. These combinations are always more expensive and apparently less effective than the individual drugs. In our opinion, a patient should take the appropriate individual drug rather than expose himself to the hazards of several drugs together, and at the same time, avoid unnecessary expense.

Local Pain Relieving Preparations

A number of drugs are now available as local gels, creams, ointments and liniments (need rubbing) for relief of sport injuries, sprains and joints paints. These are given in the table given below.

It is believed that these preparations have local effects and lack significant effects on other body organs. It appears that tall claims are made for their effects by manufacturers. A simple oil of winter green (methyl salicylate), camphor in oil or warm/hot fomentation may also provide comparably equal relief. A slight massage can increase warmth and blood flow that also contribute to relief. Nevertheless they are useful in common joint disorders such as osteoarthritis, sprains, backache and pains arising from soft tissues sue as muscles and tendons. These should never be applied on broken skins, abrasions or tears.

Rheumatoid Arthritis: Role of Disease Modifying Drugs.

Rheumatoid arthritis is a disease in which joints of fingers, wrist and foot are affected. If not treated then crippling deformities and restriction of movements may occur. In order to prevent these complications now a days different kind of drugs are used which attack the underlying root cause of immune disturbances. These drugs modify the course of disease and are called as Disease Modifying Antirheumatic Drugs (DMARDs).

Medicines And Drugs Used In Amoebiasis

Amoebiasis is a worldwide disease, particularly common in tropical countries and places where public hygiene and sanitation are poor. Amoebic infection is caused by an organism, Entamoeba histolytica (EH) which usually spreads through contaminated food and water. Since the causative organism of amoebiasis derives its nutrition from the normal bacterial flora of the large intestine, the latter is the chief site of infection. However, in some cases it may spread to other organs of the body, liver being the most susceptible to infection. Based on the site of the infection, the disease has been divided into intestinal and extra-intestinal amoebiasis.

Intestinal Amoebic Infection: During the acute phase of intestinal amoebiasis the patient may have loose motions, with or without mucus and blood, besides griping pain in the abdomen which may be severe at the time of evacuation. In chronic amoebiasis, a patient may complain of a dull pain in the lower abdomen, alternate constipation and diarrhoea, foul smell in the stools, formation of gases, and loss of appetite. Some people with amoebic infection may remain symptom-free or experience little discomfort but they may pass cysts in their stools (free cyst passers) and are potential carriers of the disease which spread it to others.

Extra-intestinal Infection: This amoebiasis infection is usually associated with a previous history of intestinal amoebiasis. When the liver is involved, the patient ‘may have pain in the right upper abdomen, fever, sweating, loss of weight, and anaemia.

Importance of Diet: Successful treatment of amoebiasis depends both on drugs and on proper diet and good hygiene. For quick recovery it is best to eat a protein-rich, low-roughage and lowcarbohydrate diet. Use of clean drinking water and avoidance of contamination are important.

Drugs for Intestinal Amoebiasis

The drugs used in treating amoebiasis can be divided into three categories according to their effectiveness.

Metronidazole (Flagyl, Metrogyl, Unimezol)

This is a drug of choice in all forms of amoebiasis except in asymptomatic cyst carriers. Since most of it is absorbed in the intestines, another drug which acts in intestinal amoebiasis should be used along with it to avoid relapse and to eradicate the disease. It is given in a dose of 400 to 800 mg, 3 times a day, for 10 days.

Adverse Effects: The incidence of adverse effects is low and include nausea, an unpleasant metallic taste in the mouth, a furry tongue, ulcers in the mouth, loss of appetite, distress, and pain in the abdomen. Sometimes it may affect nerves and may, in rare cases, cause convulsions. Depression of the bone marrow may lead to a short lasting fall in white blood cell count. A relapse can occur if the full course is not taken.

Precautions

Alcohol consumption should be avoided with this drug as it causes a severe reaction leading to vomiting and flushing. Also avoid its use during initial months of pregnancy.

Those suffering from epilepsy or any other nervous system disorder should avoid it.

It depresses the bone marrow. White blood cell count must be monitored by those taking the drug repeatedly.

Medicines And Drugs To Be Avoided During Pregnancy

Cortisone & Prednisolone: These are corticosteroids. If taken during the later part of pregnancy, these may cause deficiency of adrenal hormone on withdrawl of the drug. They delays growth and promote infection.

Cyclizine : The effects are the same as chlorocyclizine.

Cyclophosphamide: This has the same effects busulphan.

Dexamethasone: Its effects are the same as cortisone.

Dexamphetamine : This is used as a slimming drug. It may cause developmental defects of the heart in the foetus, if taken during pregnancy.

Diazepam: An anti-anxiety drug, if taken in a large quantity during late pregnancy, it may cause lowering of the body temperature and muscular weakness in the newborn baby.

Diazoxide: It may lead to abnormal distribution of foetal hair formation and hypoglycaemia in the new born baby.

Dicoumarol: Its effects are the same as bishydroxycoumarin.

Dihydrogesterone: It is likely to produce male characteristics in female babies.

Estrogens: If taken during pregnancy, they may cause vaginal cancer in the female children at a later age and feminization of male offspring.

Ethionamide: This is an anti-tubercular drug. Its use during pregnancy may cause physical defects in the foetus.

Ethisterone: The effect of this drug are similar to dihydrogesterone.

Furosemide: This is a diuretic (increases urine output), it should not be used during pregnancy as it may cause the death of the foetus due to decreased circulation.

Glibenclamide: It may cause prolonged hypoglycaemia in neonates (newborn babies) if taken during late pregnancy.

Hydralazine: It increases the heart rate of newborn babies.

Hydroxy progesterone: The effects are the same as those of dihydrogesteron.

Ibuprofen, Indomethacin & other pain relievers: This drug is sometimes used in rheumatoid arthritis. If used during the early part of the pregnancy, it may cause physical defect (premature closure of ductus) in the foetus.

Iodides: These are ingredients of many cough mixtures and also used in a hyerfunctioning thyroid. Their use during pregnancy may alter thyroid function in the newborn babies. It may also affect their mental functions.

Lithium Carbonate: This is an antidepressant drug. If taken during the first trimester it may cause physical defects in the foetus and poor suckling in the neonate.

Meclizine: Its effects are common to chlorcyclizine.

Melphalan: This has the same effects as busulphan.

Methyldopa: Destruction of red blood cells (hemolytic anaemia) and decreased activity of the intestines occurs.

Morphine: A potent pain reliever, it is an addiction causing drug. The newborn babies of addicted mothers may be premature and exhibit withdrawal symptoms. The chances of death among such babies are very high.

Nitrofurantoin: Commonly used in urinary tract infection its use should be avoided during the last few days of pregnancy as it may cause bursting of red blood cells, specially in individuals who are genetically deficient in certain enzymes:

Norethisterone: The same effects occur as in dihydrogesterone.

Norethynodrel: The same effects occur as in dihydrogesterone.

Opium: The same effects occur as in morphine.

Oral contraceptive: These are used by women for birth control but if by any chance pregnancy occurs, the doctor should be consulted because of the possibility of adverse effects on the foetus.

Pethidine: The same effects occur as with morphine.

Phenobarbitone: The effects are the same as with barbiturates.

Phenytoin: This is an anti-epileptic drug. If taken during the last few days of pregnancy, the newborn baby may suffer from bleeding disorders (hypoprothrombinaemia and haemorrhage). The use of anti-epileptic drugs may cause physical defects in the foetus.

Prednisolone: This produces the same effects as cortisone.

Primaquine: It is an anti-malaria drug. If taken during pregnancy, the newborn baby may suffer from haemolysis and jaundice.

Primidone: The effects are the same as with phenytoin.

Progesterone: The same effects occur as with dihydrogesterone.

Propranolol: This is used in some heart disorders and high blood pressure. Its use should be avoided during pregnancy as it may cause slowing of the heart rate and decrease of blood sugar in neonates.

Propylthiouracil: The same effects occur as with carbimazole.

Purgatives: These are used in constipation. Strong purgatives may cause abortion.

Pyrimethamine: Sometimes used in malaria, its use may cause foetal malformation.

Quinine: Now quinine is used in chloroquine-resistant cases of malaria. Use in early pregnancy may cause abortion. It has been associated with deafness and vision defects in offspring, if taken during pregnancy.

Salbutamol: It increases the heart rate in newborn babies.

Stilboesterol: The same effects occur as with estrogen.

Streptomycin: This is an anti-tubercular drug. It may produce deafness and weakness of the muscles in the newborn baby if taken during pregnancy.

Sulfonamides: These drugs should be avoided during the last few days of pregnancy as they may cause jaundice in newborn babies. These drugs may also combine with the haemoglobin of red blood cells (methaemoglobenaemia) rendering it unable to carry oxygen.

Tetracyclines: These antibiotics, if taken during pregnancy, are deposited in developing bones and lead to discolouration of teeth and impair bone growth of the foetus.

Tolbutamide: The effects are the same as with glibenclamide. It may also cause a decrease in platelets, causing bleeding.

Trimethoprim: This drug is used in certain infections. It may increase blood bilirubin.

Valproic acid: This can cause defects of spinal cord.

Vitamin A & Isotretinoin: Large doses, if taken during pregnancy, may cause developmental defects of head, face, in the urinary and genital system, in the foetus (Isotretinoin never used).

Vitamin D: Very large doses should be avoided during pregnancy. It may cause mental retardation and defects in bones.

Vitamin K : Large doses during pregnancy may produce jaundice in the newborn.

Warfarin : The same effects occur as with bishydroxycoumarin.

Note: Exposure to X-ray radiation must be avoided during pregnancy especially in the first six months as it may cause malformation of the foetus.