Dr. Gbemudu received her B.S. in Biochemistry from Nova Southeastern University, her PharmD degree from University of Maryland, and MBA degree from University of Baltimore. She completed a one year post-doctoral fellowship with Rutgers University and Bristol Myers Squibb.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Aspirin, when taken together with an anti-coagulant such as warfarin
(Coumadin) or enoxaparin (Lovenox), can greatly impair the body's ability to
form blood clots, resulting in excessive bleeding spontaneously, from ulcers, or
related to a procedure. Therefore, patients on such combinations must be closely
monitored by a doctor.
Low dose aspirin can raise levels of uric acid in the blood and may need to
be avoided in patients with increased uric acid levels or gout.
Certain NSAIDs, particularly ibuprofen (Motrin, Advil), if taken just before
aspirin or in multiples doses each day, can reduce the
anti-platelet effects of
aspirin treatment and theoretically render aspirin less effective in preventing
heart attacks and ischemic strokes.
Salicylates other than aspirin
Choline salicylate (Arthropan) is available as a liquid. It is absorbed more
quickly, but its onset of action is no different than that of aspirin. Some
people find choline salicylate fishy tasting. Fortunately, it can be mixed with juice or
soda prior to ingestion. It is less effective at reducing fevers in children
than either aspirin or acetaminophen.
Magnesium salicylate (Arthriten; Backache) is as effective as aspirin at
reducing pain. Patients with chronic kidney disease should avoid magnesium
salicylate, since the magnesium may accumulate in the body.
Sodium salicylate (Scot-Tussin Original) and aspirin are equally effective in
the long-term treatment of rheumatoid arthritis, but sodium salicylate is less
effective at reducing pain or fever.
Acetaminophen
Acetaminophen comes in various oral formulations, including different types
(elixirs or syrups) and flavors of liquids, capsules, tablets, caplets, and
suppositories. The capsules contain tasteless granules that can be emptied onto
a teaspoon containing a small amount of drink or soft food, and can then be
swallowed. However, the granules should not be mixed in a glass of liquid since
the granules will stick to glass itself. The amount of acetaminophen that is
absorbed from rectal suppositories is about half that of the oral formulations.
Side effects of acetaminophen
Acetaminophen generally is safe to use, and few people develop
side effects. In high doses, however, it can cause
liver damage and doses of
4000 mg (4 grams) per day should not be exceeded.
Pregnancy/breastfeeding and acetaminophen
Acetaminophen has no known harmful effects on the mother, fetus, or infant
and, therefore, can be used safely during pregnancy and breastfeeding.
Drug interactions and acetaminophen
It has been reported that patients with HIV-related
diseases (such as AIDS) who take AZT (zidovudine; Retrovir) and acetaminophen
are at an increased risk of developing suppression of their bone marrow. Such
patients develop lower white and red blood cell and platelet counts and,
therefore, are more susceptible to infection, anemia, and bleeding.
Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
There are three OTC NSAIDs; ibuprofen,
naproxen sodium, and
ketoprofen. All
have pain relieving (analgesic), fever reducing (antipyretic), and
anti-inflammatory properties. Additionally,
NSAIDs are more effective than
aspirin or acetaminophen for
menstrual cramps.
Preparations of NSAIDs
Ibuprofen is available in tablets as well as in a pediatric
suspension. Naproxen sodium is available in tablets. Ketoprofen is available as
tablets and capelets.
Side effects and NSAIDs
The most frequent side effect of NSAIDs is damage to the lining
of the stomach and duodenum that can lead to abdominal pain, nausea, and loss of
appetite. NSAIDs also can cause ulcers and bleeding from the stomach and
duodenum, but less frequently and less severely than occurs with aspirin use.
NSAIDs, like aspirin, affect platelets and can inhibit the formation of blood
clots, and, therefore, they should be discontinued at least 3 days before
surgery or dental procedures.
Because alcohol intensifies the effect of NSAIDs
on bleeding, alcohol should not be taken with NSAIDs. NSAIDs also can cause
kidney damage, particularly in the elderly or patients with high blood pressure,
diabetes, atherosclerosis, or who take diuretic medications ("water pills").
Patients who are allergic to aspirin should not take NSAIDs since they are
likely to be allergic to NSAIDs as well. NSAIDs may cause fluid retention in
persons with congestive heart failure.
The most serious side effects are kidney
failure, liver failure, ulcers, and prolonged bleeding after an injury or
surgery.
Pregnancy/breastfeeding and NSAIDs
NSAIDs are safe for use during the first or second
trimesters of pregnancy, but should not be taken during the third trimester
because they can:
prolong labor and delay birth,
increase bleeding in the mother
following birth, and
can cause cardiac (heart) and vascular (blood vessels)
complications in the newborn.
Nevertheless, use of NSAIDs during any portion of
pregnancy should be approved by the treating doctor. Ibuprofen and naproxen
sodium also are safe for use by nursing mothers. Due to insufficient data,
ketoprofen is not recommended for use by nursing mothers.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Sinus infection (sinusitis) signs and symptoms include headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
Menstrual cramps (pain in the belly and pelvic area) are experienced by women as a result of menses. Menstrual cramps are not the same as premenstrual syndrome (PMS). Menstrual cramps are common, and may be accompanied by headache, nausea, vomiting, constipation, or diarrhea. Severity of menstrual cramp pain varies from woman to woman. Treatment includes OTC or prescription pain relief medication.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Drug-induced liver diseases are diseases of the liver that are caused by physician-prescribed medications, OTC medications, vitamins, hormones, herbs, illicit (“recreational”) drugs, and environmental toxins. There are three types of liver toxicity; dose-dependent toxicity, idiosyncratic toxicity, and drug allergy. The types of liver disease drugs cause include: mild elevations of blood levels of liver enzymes, hepatitis, necrosis, cholestasis, steatosis, cirrhosis, mixed disease, fulminant hepatitis, and blood clots.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
A broken toe is one of the most common fractures among individuals. There are many causes of a broken toe, whether it is the big toe, middle toes, or little toe (pinky). Common symptoms of a broken toe include pain, swelling, stiffness, and bruising. A broken toe can be treated with buddy taping the toe. There are instances where a physician should be consulted for a broken toe.
A tension headache is a headache previously thought to be caused by contraction of the muscles in the back of the neck, on the scalp, and sometimes in the jaw. The term tension-type headache is now preferred, reflecting the fact that research has shown that these headaches may not be related to muscle tension.
Tylenol liver damage (acetaminophen) can occur from accidentally ingesting too much acetaminophen, or intentionally. Acetaminophen is a drug contained in over 200 OTC and prescription medications from NyQuil to Vicodin. Avoiding unintentional overdoses include reading medication labels, write down the dosages of medications you are taking, do not drink excessive alcohol while taking acetaminophen. In severe cases, a liver transplant may be necessary.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin. The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. Treatments include applying an ice pack and pressure to the area by hand.
Sinus headache is caused by a sinus infection or inflammation of the sinus cavities. The primary symptom of a sinus infection is pain and increasing pressure overlying the area and associated tenderness to the touch. Treatment of a sinus headache depends on the cause.
Cuts, scrapes, and puncture wounds are common, and most people will experience one of these in their lifetime. Evaluating the injury, and thoroughly cleaning the injury is important. Some injuries should be evaluated by a doctor, and a tetanus shot may be necessary. Treatment will depend upon the severity of the injury.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
There are several bones in the foot, and these bones can be broken (fractured) in a variety of ways. Falling from heights, dropping heavy objects on the foot, or stress fractures from running or walking. Treatment of a broken foot depends on what bone in the foot is broken.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Menstrual cramps and premenstrual syndrome (PMS) symptoms include abdominal cramping, bloating, a feeling of fullness, abdominal pain, mood swings, anxiety and more. Treatment for menstrual cramps and premenstrual syndrome (PMS) symptoms include regular sleep, exercise, smoking cessation, diet changes, and OTC or prescription medication depending on the severity of the condition.
The most common cause of a black eye is due to an injury to the face or head. Most black eye injuries are minor and heal on their own, however, some may lead to significant injury. In addition to trauma to the face, cosmetic surgery can cause a black eye(s) as a side effect. People should be aware of the situations in which medical care should be sought immediately for a black eye.
The hand has several bones to include the wrist, palm, and fingers. Fingers are the most commonly injured part of the hand. The most common causes of broken fingers are a traumatic injury to the finger or fingers such as playing sports, injury in the workplace, falls, and accidents. Treatment for a broken finger may be as simple as buddy taping the broken finger to the adjacent finger, or if the fracture is more serious, surgery.
The term cluster headache is a type of headache that recurs over a period of time. There are episodes that last one to three times a day during a period of time, which may last from 2 weeks to 3 months. There are three main types of treatment abortive medications, preventive medications, or surgery which involves blocking the trigeminal nerve.
Reye's syndrome (RS, or Reye syndrome) is a sudden, sometimes fatal, disease of the brain with degeneration of the liver. Reye syndrome occurs in children and comes after the chickenpox or an influenza-type illness, is also associated with taking medications containing aspirin. Symptoms include vomiting, listlessness, irritability or combativeness, confusion, delirium, delusions, convulsions, and loss of consciousness. Treatment depends on early diagnosis and focuses on protecting the brain against irreversible damage by reducing brain swelling, reversing the metabolic injury, preventing complications in the lungs, and anticipating cardiac arrest.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
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