how medication works

Sunday, May 3, 2015

Manny Pacquiao lost the fight of the decade but perhaps not the battle of the excuses. ESPN’s quoted the boxer as saying that “he didn’t want to make alibis or complaints or anything…[but] it’s hard to fight one-handed.” The people in his corner asked that he be injected with an anti-inflammatory in the dressing room just before the bell rung, but were denied permission by the Nevada Athletic Commission because the injury was not previously disclosed. Pacquiao’s trainer said that the requested anti-inflammatory had been previously used in training camp and was on the approved list by the US Anti-Doping Agency.

There are two potential injectable anti-inflammatory medications that are used to treat acute or chronic injuries. The first is hydrocortisone or any of the myriads of corticosteroids that are used to decrease inflammation. They are very effective and by decreasing inflammation, the patient’s pain may also be relieved, but it takes 48-72 hours for the medication to have an effect. The second injectable anti-inflammatory is ketorolac (Toradol), which is a nonsteroidal anti-inflammatory, is an effective medication and is often used as a non-narcotic alternative for acute pain management.

For many medications, the presumption is that the injected medication is “better”, working faster and being more potent. Patients are surprised that isn’t necessarily so. If Mr. Pacquiao was interested, almost 20 years of medical research has shown that ibuprofen (Advil, Motrin] taken by mouth works as well as the injectable Toradol. Testing patient pain levels at 0, 15, 30, 60, 90 and 120 minutes found no difference at any time interval. The only benefit to Toradol is that it is injectable, and therefore helpful when people are vomiting or cannot have anything to eat or drink.

Other medications are similar in that their action works quickly when taken by mouth. An allergic reaction may be a true emergency, especially if there is difficulty breathing, shortness of breath, wheezing or difficulty swallowing. These are all potential disasters that can be associated with anaphylactic shock and calling 911 is a reasonable first step. The second step is taking diphenhydramine (Benadryl) by mouth. Surprisingly, its onset of action is relatively quick when taking orally, starting to work within 15-30 minutes. Hopefully, by the time the patient arrives in the ER, the medication is kicking in. For those patients who develop hives as their allergic reaction, the oral Benadryl may be all that they need.

As much as its important to know how quickly a medication work, it’s just as important to know when the effects begin to fade. For pain medication, that allows the prescribing provider to know how often to recommend taking the drug. Take it too quickly and the accumulation of the drug within the blood stream may lead to an overdose; delay too long and there will be gaps in pain control. The same thought process goes into prescribing long term medications for most medical ailments from seizure control, to heart failure to diabetes. Understanding the pharmacokinetics of a drug, how it’s absorbed, how the body metabolizes it and how it’s excreted, is crucial to know when and how much to take.

For Mr. Pacquiao, the shoulder injury may have put him at a disadvantage in the fight. While the Athletic Commission didn’t allow injectable medications, not considering alternatives might have been a difference maker. But when all was said and done, there would be little opportunity to complain when the judges’ scoring was not in his favor.

 

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