Ofirmev article had 4 arms. From this, 22

 

 

 

 

 

 

 

Ofirmev THESIS AND ANTITHESIS

 

Abstract

Ofirmev also known as Intravenous Tylenol or acetaminophen
has been employed in pain management as well as Postoperative nausea and
vomiting initialized as PONV.

THESIS: Ofirmev is useful in controlling
pain and decreasing PONV in the post-operational  patients likened to patients that Ofirmev is
not used.

Macario, A., & Royal, M. A. (2011). A literature
review of randomized clinical trials of intravenous acetaminophen (paracetamol)
for acute postoperative pain. Pain Practice, 11(3), 290-296.

This article entails a
study conducted with the aim of assessing analgesic outcomes of Orfimev for
acute postoperative pain in adults. The method of the study involved searching
Medline and the Cochrane library of IV acetaminophen versus placebo. The
results obtained were as follows:

Sixteen
articles published in the period 2005-2010 from 9 countries were sampled having
met the inclusion criteria. These had a total of 1,464 patients. .
it’s also important to note that  the use
of (IV) acetaminophen in pain management is allowed in approximately 80
countries , This article also highlights the median sample. The median sample
size included 54 patients in the range of 25-165. According to Macario and
Royal, out of the 16 articles, four had three arms in the study. An article had
4 arms. From this, 22 study comparisons were analyzed- IV acetaminophen to
placebo as well as IV acetaminophen to an active comparator. The RCTs had a
jaded median score of 5. In 7 of the 8 active comparators, IV acetaminophen
shared similar analgesic outcomes to the active comparator. Out of the 14
placebo studies, 12 found that IV acetaminophen patients had improved
analgesia. 8 studies, 3 showed that the mean opioid consumption in IV
acetaminophen patients significantly went down.

However,
the article also provides crucial information that attention must be paid
before prescription to take care of patients at risk for hepatotoxicity. This
does not downplay the benefits obtained from IV acetaminophen.

The article also mentions that in
the 14 placebo-controlled studies, 2 had no pain improvement nor decreased opioid
use after administration of IV acetaminophen. One case was in patients
undergoing lumbar. This indicates that, though minimal, IV acetaminophen may
not be effective in some patients and alternatives may be applied.

The article also points
out the case patients undergoing breast resection who received one-gram of IV
acetaminophen dose 20 minutes prior to the conclusion of surgery. Among this
unabated pain followed for the next 24 hours. 
A difference was observed in morphine administration. 42 percent of IV
acetaminophen patients did not receive any morphine while only 4 percent in the
placebo group did not receive morphine. Significantly 2 of the 13 patients
undergoing extensive surgical procedures having received IV acetaminophen did
not request for morphine in the first 24 hours postoperatively unlike the
placebo patients. Comparatively, the patients administered with IV
acetaminophen had less pain at the one-hour measurement compared with placebo,
but from 2 to 24 hours postoperatively, the average pain ratings fell below 2.5
in both groups without any significant difference.

This article places the
use of Orfimev (IV acetaminophen), in pain management, across a variety of
surgical procedures at an acceptable percentage. It upholds the thesis by showing
that using IV acetaminophen in perioperative areas is helpful to the patient
for efficient pain management

Yeh, Y. C., & Reddy, P. (2012). Clinical and
economic evidence for intravenous acetaminophen. Pharmacotherapy: The
Journal of Human Pharmacology and Drug Therapy, 32(6), 559-579.

Yeh and Reddy in their
text, delves in the description of economic and clinical evidence for
intravenous acetaminophen (Orfimev). This article underscores the inability of Orfimev
to consistently decrease the occurrence of opioid-related adverse effects such
as vomiting and postoperative nausea in post operational cases. Nevertheless it
is useful in pain reprieve.it also gives economic insights in the
administration of acetaminophen
intravenously, orally or rectally. In this respect, it shows that intravenous
administration is costly compared to the other two modes of administration.

Intravenous administration of acetaminophen requires much
time, 15 minutes as stated by the article. Some patients may not be willing to
take that long receiving a drug due to time constraint or injection phobia.
It’s mode of packaging also poses a great challenge to safety as it is packed
in glass which are prone to breakage. Being single dose consumption and its
high cost, IV acetaminophen creates a
heavy burden on the purchase ability of patients. Patients may way out either
to take a costly single dose or go for cheaper cost effective methods.

In those patients with
fluid restriction the usage of IV
acetaminophen has a lot of challenge. Its formulation requires , of 1g per
100ml of solution, may lead to addition of much fluid above the optimal level
into the patient’s system and pose other risks.

This clinical and
economic evidence shows that despite its usefulness in pain management, IV acetaminophen usage should be limited to
patients who cannot receive drugs orally or rectally and to whom other
antipyretic agents or parenteral nonopioid analgesic cannot be applied.

The article was closely
related to the thesis, and I found it helpful in answering the question raised
by the thesis- “Is Orfimev helpful in pain relief and in the management of  postoperative nausea and vomiting (PONV) in
the postoperative patients ?.” Based on the arguments in the article,
Ofirmev is useful in decreasing postoperative nausea and vomiting in post-op
patients. However, it has adverse effects. As a result, it can be considered in
a restricted number of patients

Torabi,
S. A. (2015). Implementing Recommended Perioperative Pain Practice Guidelines
byincorporating Intravenous Acetaminophen.

This is an article on
the optimization of peri-operative management of pain and presents its
importance in pain management. The article also presents recommendations  for 
the perioperative surgical practices on patients  through the incorporation of intravenous
acetaminophen as analgesia. The article adopts the application of Lewis’ theory
of change to drive its point home, a theory that gives strategies for attainment
of the changes in perioperative pain guidelines.

Based on the painless nature of the
medication as presented in the article, Acetaminophen
is found to be appropriate for pain management in perioperative surgeries.

Turkoski, B.
J. (2015). Acetaminophen by infusion. Topics in Pain Management, 30(12),
1-5.

Turkoski (2015), the author of the CME
article titled “Topics in Pain Management,” describes the
pharmacokinetics of Acetaminophen and the history of the development
Acetaminophen. Furthermore, the author of the article proceeds by identifying
guidelines, benefits, and cautions of the administration against the use of
Acetaminophen

The article addresses the nonsalicylate
analgesic, antipyretic and nonsteroidal properties of Acetaminophen in Pain management.
It also notes that Acetaminophen is available various forms including oral
drugs, rectally administer forms and recently (2010) in the IV Acetaminophen
form.

The author classifies Acetaminophen as
being among the leading agents of pain and fever relief among adults and
children due to its effectiveness and safety.

Antithesis

 

Antithesis:
Ofirmev

Mischkowski,
D., Crocker, J., & Way, B. M. (2016). From painkiller to empathy killer:
acetaminophen (paracetamol) reduces empathy for pain. Social cognitive
and affective neuroscience, 11(9), 1345-1353.

The article is based on a research that was conducted to ascertain if
acetaminophen can reduce empathy for someone in pain

In placebo-controlled experiments, the participants empathized in
response to reading cases of people under pain, witnessing either in
dramatization or seeing another study participant subjected to some painful
noise blasts.

Those who received acetaminophen did not empathize in these
scenarios.

The ability to empathize with others is key to good leadership and
daily social encounters with family and friends. Empathy is a key social
experience and being such should not be altered.

The authors, in proposing consequences of using acetaminophen,
deliberates on the impact of acetaminophen to the society. They suggest that it
has a general effect on compassionate actions. they also probe into the effects
of acetaminophen to the general good of the society given that millions of
people use it on a regular basis. Its effect could be far more costly. This is
the first study to research that has shown that the acetaminophen can reduce
empathy to other people’s pain. It interrupts the capacity to relate to other
people’s painful experiences.

From this point of
view, this article supports the antithesis that acetaminophen as a pain
reliever causes other pains.

Michaut,
A., Moreau, C., Robin, M. A., & Fromenty, B. (2014). Acetaminophen?induced liver injury in obesity and nonalcoholic fatty liver
disease. Liver International, 34(7).

This
article is based on clinical and experimental findings involving diabetic
rodents.

The
article recognizes that Acetaminophen is a widely prescribed drug for pain
management.  It also indicates that
Acetaminophen’s mode of action is not yet fully understood and is still under
investigation. This should be questioned by health practitioners. In its mode
of action the drug may be causing other unknown side effects that may affect
the patient adversely. Someone may be suffering from a condition that is wholly
caused by acetaminophen yet unknown to them. The counter effect may be more
pain. The findings have illustrated that acetaminophen can induce liver injury
even in normal persons even with the recommended dosage. The possibility of
liver injury, resulting from the breakdown of acetaminophen, even with a
recommended dosage makes acetaminophen a risk factor in the life of a patient.

It is
also important to note that long-term ingestion of acetaminophen can induce
chronic liver injury which is a painful experience. And this is the common drug
used by majority of people(Kaufman et al., 2002) there
is possibility that many people could be suffering from slow liver damage that
ultimately affects their life span.

The
views presented in this article make it unavoidable to look at the painful
results of using acetaminophen as a pain relieving agent.

Emmett,
M. (2014). Acetaminophen toxicity and 5-oxoproline (pyroglutamic acid): a tale
of two cycles, one an ATP-depleting futile cycle and the other a useful
cycle. Clinical Journal of the American Society of Nephrology, 9(1),
191-200.

This
article looks into acetaminophen as a factor that induces 5-oxoproline
metabolic acidosis. It has been associated with chronic ingestion of
acetaminophen.

It
points out that many cases of 5-oxoproline metabolic acidosis go unrecognized
because an assay for 5-oxoproline test is not widely accessible. This presents
a question that “how many people could be suffering from this condition unknown
to them?”  Unavailability of the assay
may lead to misdiagnosis and eventual loss of life.

The
5-oxoproline cycle has been identified to deplete energy in
acetaminophen-related syndromes. It is important to remember that energy is key
in growth, development and repair of worn out tissues. Repeated use of
acetaminophen may have adverse effect on these roles thus impairing the normal
functioning of the body.

Kato,
H., Fujigaki, Y., Inoue, R., Asakawa, S., Shin, S., Shima, T., … &
Hoshimoto, K. (2014). Therapeutic dose of acetaminophen as a possible risk
factor for acute kidney injury: learning from two healthy young adult
cases. Internal Medicine, 53(14), 1531-1534.

This article presents the case of two normal
young adults. It goes on to substantiate the ability of Acetaminophen to cause
kidney disorders in normal persons that is someone who had normal kidneys prior
to over-does of Acetaminophen.

It also gives important information that an
overdose of Acetaminophen can lead to severe kidney and liver failure. The two
young adults were diagnosed with renal biopsy and who were -proven to have
acute tubular necrosis after medication with acetaminophen.

One patient had slight reversible renal
insufficiency, while the other had an increased serum-creatinine level with
inflamed kidneys . Administration of other antibiotics may have heightened the
renal dysfunction demanding a temporal hemodialysis.

The article advices Physicians to be aware of
the risks posted by usage of acetaminophen and its potential to cause AKI and
use alternatives

McBride,
J. T. (2011). The association of acetaminophen and asthma prevalence and
severity. Pediatrics, 128(6), 1181-1185.

An important clinical observation is drawn from this article
relating the intake of acetaminophen and asthma prevalence and severity among
children and adults. It draws a suggestion from related sources which indicate
that that the use of acetaminophen has played a role in recent increase in
asthma prevalence in children.

 

It draws a conclusion that the use of acetaminophen, among
children with or at risk of asthma, should be avoided until the safety of
acetaminophen is documented by future studies.

Guggenheimer, J., & Moore, P. A. (2011). The therapeutic
applications of and risks associated with acetaminophen use: a review and
update. The Journal of the American Dental Association, 142(1),
38-44.

This article is published in response to the warning label
placed on acetaminophen (OTC) products by in April 2010 by U.S. Food and Drug
Administration. It reviews acetaminophen’s potentiality to cause liver
toxicity.

It is based on literature
reviews of documents on acetaminophen and liver toxicity in the United States.

It shows that there exists a
minimal margin of safety lying between the therapeutic dose of acetaminophen
and toxic doses.

The research also reveals that
rise in acute liver toxicity cases in the United States has been due to intake
of acetaminophen.

Being a component of other
prescriptions, chances are that an overdose of acetaminophen may occur.

 

 

 

Conclusion

The adverse effects of acetaminophen as analyzed in the above
articles ranging from reduced empathy, kidney and liver disorders, increased
asthma cases and 5-oxoproline metabolic acidosis disorder are in support of the antithesis stating
that

References

 

Emmett,
M. (2014). Acetaminophen toxicity and 5-oxoproline (pyroglutamic acid): a tale
of two cycles, one an ATP-depleting futile cycle and the other a useful
cycle. Clinical Journal of the American Society of Nephrology, 9(1),
191-200.

Guggenheimer,
J., & Moore, P. A. (2011). The therapeutic applications of and risks
associated with acetaminophen use: a review and update. The Journal of
the American Dental Association, 142(1), 38-44.

Kato,
H., Fujigaki, Y., Inoue, R., Asakawa, S., Shin, S., Shima, T. … &
Hoshimoto, K. (2014). Therapeutic dose of acetaminophen as a possible risk
factor for acute kidney injury: learning from two healthy young adult cases. Internal
Medicine, 53(14), 1531-1534.

Macario,
A., & Royal, M. A. (2011). A literature review of randomized clinical
trials of intravenous acetaminophen (paracetamol) for acute postoperative
pain. Pain Practice, 11(3), 290-296.

McBride,
J. T. (2011). The association of acetaminophen and asthma prevalence and
severity. Pediatrics, 128(6), 1181-1185.

Michaut,
A., Moreau, C., Robin, M. A., & Fromenty, B. (2014). Acetaminophen?induced liver injury in obesity and nonalcoholic fatty liver
disease. Liver International, 34(7).

Mischkowski,
D., Crocker, J., & Way, B. M. (2016). From painkiller to empathy killer:
acetaminophen (paracetamol) reduces empathy for pain. Social cognitive
and affective neuroscience, 11(9), 1345-1353.

Torabi,
S. A. (2015). Implementing Recommended Perioperative Pain Practice Guidelines
by Incorporating Intravenous Acetaminophen.

Turkoski,
B. J. (2015). Acetaminophen by Infusion. Topics in Pain Management, 30(12),
1-5.

Yeh,
Y. C., & Reddy, P. (2012). Clinical and economic evidence for intravenous
acetaminophen. Pharmacotherapy: The Journal of Human Pharmacology and
Drug Therapy, 32(6), 559-579.