Ibuprofen in the current practice of the pharmacist in the community pharmacy

The pharmacist from the community pharmacy plays a key role in the case of patients who seek directly for pathologies related to pain. Being a health specialist, he has the ability to offer pharmaceutical healthcare for drugs that need a medical prescription and also for the ones that are registered as OTC’s. Ibuprofen (IBU) is a part of the drug group called nonsteroidal anti-inflammatory drugs (NSAIDs) being registered in Romania under 17 pharmaceutical formulation by the National Agency of Drugs and Medical Devices. Due to its pharmacological profile which consists of a low risk of gastro intestinal side effects, IBU is an OTC recommended and frequently prescribed for decreasing the low and moderate pain. World Health Organization (WHO) indicates IBU as a drug that can be used to babies aged over three months. Through this paper, we try to analyze the pharmacist’s vision from the community pharmacy in IBU recommendation. In this paper were mentioned some legal aspects that are linked to the pharmacist competences, and also its approach regarding IBU recommendation during pregnancy and breastfeeding and also to children and to a category of patients who have various associated pathologies.


IntroductIon
Millions of people take the threshold of a pharmacy to get their medications available with or without prescription for pain associated pathologies. In civilized countries, people give great attention to self-care under their knowledge, to the information found via the internet in conjunction with the recommendations of a healthcare specialist. This study aims to approach the pharmacist point of view from the community pharmacy as a specialist in healthcare in the ibuprofen recommendation in some painrelated conditions.

PharmaceutIcal healthcare -legal asPects
In Romania, the pharmacist profession is exerted under Law 95/2006 and one of the activities provided in Article 568-point g) is referring to providing information and counseling the patient REVIEWS regarding the drugs prescribed and their appropriate use. Taking into consideration the law mentioned above the pharmacist is defined in Article 903-point f) as a health professional. The pharmacist can offer pharmaceutical healthcare, a fact that implies giving the correct information to the patient regarding the posology, duration of the treatment, some contraindications and cautions including the provision of information regarding the association with beverages and food [1].

PaIn theraPy -PharmacIst aPProacha theoretIcal PersPectIve
The patients that are confronting with different pathologies manifested through pain are addressed many times directly to the pharmacist. Due to its skills, the pharmacist has expertise in pain therapy management and the inflammatory processes. Many patients who present those pathologies do not reach in the first instance to the doctor and prefer to request the pharmacist's advice. By the competences that the pharmacist has, he is perceived by the patients as a specialist of the healthcare capable to offer the fair treatment [2].
The pain is defined by the "International Association for the Study of Pain" IASP as a sensorial and emotional disagreeable experience, given by a potential veritable tissue fluid lesion or a description with terms referring to such lesion [3]. The pain causes are various: injuries, pressure and traction on the nociceptors in case of muscular contractions, vasoconstriction, distensions of the viscera, tumors. Three levels of pain are known for which the specialty literature recommends some medication as a function of the pain severity: • easy pain: in which paracetamol or anti-inflammatory drugs (NSAIDs) are recommended; • moderate pain: in which combinations of opioids with paracetamol or NSAIDs are recommended; • severe pain: in which opioids are recommended given by various administration ways suitable for the patient [4].
Depending on the evolution, pain can be acute or chronic. Acute pain represents a symptom in the case of a disease considered as an important alarm system for the body protection. It responds to a usual antalgic therapy and does not give any physical or mental disease. The chronic pain can persist for six months, and it is often resistant to the usual antalgic therapy. This type of pain can continue even after healing of a primary painful lesion due to the pain reaching the central system, remaining thereby in the "head of the patientˮ [3-6].
There is a varied number of pharmaceutical products used for pain therapy, many of them offered to the patient as OTCs (Over the Counter), which means that they do not require a prescription to be released from the pharmacy [7].
The patients usually come in the pharmacy to request from the pharmacist a product known, but on many occasions they ask pharmaceutical care regarding their pathology. In both cases, the pharmacist plays a key role in choosing the product designed for REVIEWS pain therapy. On many occasions the pharmacist represents the last chain of the health medical system. However, when he must give medications upon request it is recommended to perform a short anamnesis of the patient regarding the other pathologies known or other medication used chronically.
He has to obtain enough information to recommend an optimal treatment in his health issue with which the patient is coming to the pharmacy. Thus, possible interactions can be avoided between the medicine prescribed and the treatment already used. By its easy accessibility, the pharmacist from the community pharmacy is the one that will offer professional counseling, will establish the posology of the recommended drug and the duration of the treatment. The easy pain therapy includes using NSAIDs, and it is usually the first recommendation of the pharmacist. By its skills, the pharmacist can make recommendations in moderate and severe pain when he can give as an adjuvant an NSAID and can direct the patient to a doctor to prescribe an opioid [8].
NSAIDs are substances whose mechanism of action implies the reduction of prostaglandin biosynthesis by blocking COX 1 and COX 2 reversible. From the two isoforms of the COX enzyme, COX 1 is constitutively occurring in all the tissues. It occurs in endoperoxide synthesis with beneficial, protective, properties: PGI 2 prostacyclin (antithrombotic, anti-sclerotic and cytoprotective); TxA 2 and TxB 2 (favors platelet aggregation); prostaglandins PGE 2 (bronchodilators, gastric cytoprotective and natriuretic). As a result, it can be said that COX 1 inhibition determines a side effects mechanism generator. COX 2 is a constitutive isoform only in some tissues such as lungs, kidneys, spinal cord. In the presence of some extern proinflammatory stimuli (macrophage, other cells) COX 2 becomes inducible in all the tissues, and it is involved in the prostaglandins biosynthesis with inflammatory role found in the peripheral level and medullary: PGF 2 , PGF 1α , PGE 1 . As a result, blocking this isoform of cyclooxygenase explains the anti-inflammatory mechanism of action [9][10][11][12]. in which the main medicine is sure and effectively used in the case of children with a maximum age of 12 years, between them IBU being nominated. [24] Following WHO specifications, IBU can be administered just in the case of babies with age higher than three months in the treatment of pain. To newborns, it is administered in special cases and only intravenously, in order to close the arterial channel. As a result of the pharmacological predictable pharmacologic profile, the pharmacist as a specialist in healthcare, recommends IBU to kids for easy to moderate pain such as headache, toothache, throat ache and, earache and also in febrile episodes belonging to colds and also after vaccination [24][25][26].
conclusIons Following the presented data, we can conclude that IBU is one of the surest NSAIDs prescribed and recommended by the specialist in healthcare. Taking into consideration the in-force legislation and including the scientific data presented, the pharmacist by its competences recommends as a unique treatment or as an adjuvant treatment to patients with symptomatology manifested by pain, an NSAID, in most of the cases IBU, especially taking into consideration the lower risk regarding the side effects.