Critical Review Of Cocaine
Focus on the pharmacology of the Psychoactive drug Marijuana known as COCAINE. Do not focus on the social or addictive aspects and impact
A minimum of three peer-reviewed articles published within the last five years on COCAINE. Analyze and explain the pharmacological aspects of the drug as they relate to the following:
- neurotransmitters affected and receptors,
- route of administration, half-life, doses,
- side effects, drug interactions,
- contraindications, and other important facets of the drug. Explain these aspects of the drug in terms of the psychiatric disorders indicated for the drug and the issue(s) associated with that use. If there is no accepted therapeutic use for the drug, evaluate and describe the actions of the drug with regard to the abuse process.
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.
