The Perceived Effects of Paracetamol plus Ibuprofen among

Men Ages 25 to 45 In Hilltop Mansion

Subdivision

Group 4- BSN 3G
 CHAPTER I
THE PROBLEM AND ITS BACKGROUND

Background of the Study

A drug, broadly speaking, is any chemical substance that, when absorbed into

the body of a living organism, alters normal bodily function.1 While kidneys are complex

organs that are responsible for the elimination of waste products of body metabolism,

the liver breaks down toxic substances and most medicinal products. These two organs

interact with a process called anaphylactic metabolism or drug metabolism.

Kidney plays a primary role in a process of drug metabolism, as the kidney is

more exposed to dangers of anaphylactic toxicity. As the drug is first filtered in the liver

and mixes with blood, the blood enters the kidney through renal artery in the renal sinus

and filtration will take place through the glomeruli of nephrons. After filtration occurs the

blood moves through a small network of venules, the filtered products along will blood

will pass along nephron’s tubules which will secrete substances such as drugs into the

urine. There is a kidney injury called Analgesic nephropathy which is caused by

analgesic medications such as Paracetamol and Ibuprofen or just by using any

combined drugs or from any single analgesic medication. Over dosage or overuse of this

drug results to this kind of damage. Paracetamol is the major metabolite of phenacetin,

one of the first synthetic fever reducers , and may contribute to kidney injury through

specific mechanism such as conversion of Paracetamol into N-acetyl-p-

benzoquinoneimine (NAPQI).
 Several times a week a person is not always to stay at home and as a person

who has basic needs, he or she needs to work thus is exposed to several environmental

hazards as the body’s immune system is at risk. As a result of encountering

environmental hazards people seek medications to alleviate sores. Paracetamol is a

drug of choice for pains especially febrile and Ibuprofen is the common choice for pain

relief, these two are the most widely used drugs and two of the most effective drug for

minor pains and febrile. Men are more prone to strenuous activities than women with

tons of heavier workloads (eg. machine-operated jobs) further leading in accumulation of

muscle pains and tensions which will lead to immunity declination. In most cases men

that fall into reproductive ages (ages between 16 and 45) are more exposed in having

these criteria. In order to relieve consequences of daily heavy working, which are

headaches, migraines, muscle pains and even fever, available OTC drugs are being

used and one of which is common is taking Paracetamol and Ibuprofen together. In this

case while two of the most leading anti-pyretic and pain reliever drugs are now

formulated and combined as one, it is now widely acceptable and used and their effects

said to have much more efficacy than taken alone.

Studies have been conducted in taking Paracetamol plus Ibuprofen drug into

children as the sample group and thus concluded that taking the combined drug is much

effective but with more hazardous effects. Nevertheless if the combined drug has shown

effectiveness and toxicity among children, much more will be the effect to teens, young

adults, adults and older group. Research studies also show that environmental factors

play a major role in our body towards drug tolerance.

Objectives
The primary cause this thesis was formed is to know the underlying effects of

Paracetamol plus Ibuprofen drug among men ages between 25 and45. Knowing the

effects of the said combined drugs can lead in finding out how Ibuprofen and

Paracetamol together can affect body systems and further pointing out which body

systems are affected. The most important agenda of the researchers is to learn how the

body can control the underlying effects of Paracetamol plus Ibuprofen.

Statement of the Problem:

1) What is the profile of the respondents in terms of:

A. Age

B. Gender

2) What are the systemic effects of Paracetamol plus Ibuprofen among the respondents?

3) Is there a relationship between age and the perceived effects of Paracetamol plus

Ibuprofen?

4) Is there a relationship between gender and the perceived effects of Paracetamol plus

Ibuprofen?

Hypotheses
Null
 Ha: There is no significant relationship between the profiles of Paracetamol and

Ibuprofen users and the perceived effects of the drug.

Alternative

Ho: There is a significant relationship between the profiles of Paracetamol and

Ibuprofen users and the perceived effects of the drug.

Significance

Drugs to relieve pain are readily obtainable in most countries and are used on a

regular basis by many persons not knowing the effects many people use OTC drugs in

relieving their body pains. Paracetamol plus Ibuprfoen is one of the common used drugs

as well as Paracetamol and Ibuprofen alone. Unrelieved pain compromised their ability

to work and fulfil their role in the family and community.

This research will provide knowledge whether combining the two drugs will

worsen or lessen the body pains

Scope and Limitation

 CHAPTER II
REVIEW OF RELATED LITERATURE AND STUDIES

Related Literature

Two characteristics are common to definitions of dependence and addiction: a

compulsion to take the drug with a loss of control in limiting intake and a withdrawal

syndrome that results in physical as well as motivational signs of discomfort when the

drug is removed. The concept of reinforcement or motivation is a crucial part of both of

these characteristics. A reinforcer can be defined operationally as "any event that

increases the probability of a response." This definition can also be used to signify a

definition for reward, and the two words are often used interchangeably. However,

reward often connotes some additional emotional value such as pleasure. Multiple

sources of reinforcement can be identified during the course of drug dependence. Based

on Wikler's extensive work with opiate drugs and his innovative conceptualizations

about dependence, the primary pharmacological effect of a drug was hypothesized to

produce a direct effect through positive or negative reinforcement as a process (e.g.,

self-medication) and/or can produce an indirect motivational effect through drug-

engendered dependence (relief from aversive abstinence signs). The secondary

pharmacological effects of the drug can also have motivating properties. Again, direct

effects can be obtained through conditioned reinforcement (e.g., pairing of previously

neutral stimuli with acute reinforcing effects of drugs) or indirect effects through removal

of the conditioned negative reinforcing effects of conditioned abstinence. Recently,

attempts have been made to explore the neurobiological bases for both the acute

positive reinforcing effects of drugs and also the negative reinforcing effects imparted by

the dependent state. The effectiveness of the ibuprofen+paracetamol combination

 (Maxigesic) in comparison to the actives alone, as reflected in VAS score comparison, is

clearly seen. This enhanced pain relief effect over the first dose interval is unexpected

and offers advantages in pain relief management to the user. The observed increase in

effective pain relief of the combination over the first pain interval, at reduced ibuprofen

amounts, offers pain management options for users when treating intermittent pain with

a single dose administration. The enhanced effect reinforces the results observed for the

daily administration (4 times a day for maximum OTC administration) and shows that, at

the ratios of actives used in the treatment (i.e., between about 47.5 to 12.5 to about 50

to 15; preferably about 50 to 15; paracetamol to ibuprofen), a synergistic pain relief

effect is occurring.

Related Studies

The Urinary System and the Neurologic System are the two of the most affected

systems due to the underlying effects of Paracetamol plus Ibuprofen. Related studies

show how the body can tolerate drug effects and, how the body prepares for it.

TOLERANCE DEVELOPMENT TO DRUGS

Fig. 1 shows a simulation with the mathematical

model. A hypothetical drug is administered over

Figure 1
20days, once a day. Whereas in Fig. 2 the drug

dose was the same in every administration, in

Figure 2 this simulation the dose is increased every day

such that the decrease in the drug effect due to tolerance development is compensated,

keeping the drug effect more or less constant. This is how drugs are usually

administered over longer periods.

 The figure shows that a rise in the drug effect is followed by a drop to below the

base line, representing the rebound mechanism. These negative reactions increase

when tolerance to the drug increases. In the simulations, the change in the sensor

output caused by the presence of the drug is assumed to be the drug effect. While a

negative reaction can cause a reversal of the symptoms which generally is unpleasant or

undesired, a positive reaction is of the same nature as the drug effect. Furthermore,

many drugs know an upper limit of acting: pain medication, for instance, alleviates the

pain and cannot go beyond no pain.

ASPIRIN AND NSAIDS

Proper kidney function depends upon adequate blood flow to the kidney. Kidney

blood flow is a complex, tightly regulated process that relies on a number of hormones

and other small molecules, such as prostaglandins. Under normal circumstances,

prostaglandin E2 (PGE2) produced by the kidney is necessary to support adequate

blood flow to the kidney. Like all prostaglandins, PGE2 synthesis depends upon the

cyclooxygenases. Aspirin and other NSAIDs are inhibitors of the cyclooxygenases. In the

kidney, this inhibition results in decreased PGE2 concentration causing a reduction in

blood flow. Because blood flow to the kidney first reaches the renal cortex (outside) and

then the renal medulla (inside), the deeper structures of the kidney are most sensitive to

decreased blood flow. Thus the innermost structures of the kidney, called the renal

papillae, are especially dependent on prostaglandin synthesis to maintain adequate

blood flow. Inhibition of cyclooxygenases therefore rather selectively damages the renal

papillae, increasing the risk of renal papillary necrosis.[2]

Most healthy kidneys contain enough physiologic reserve to compensate for this

NSAID-induced decrease in blood flow. However, those subjected to additional injury

from phenacetin or paracetamol may progress to analgesic nephropathy.

Theoretical Framework

There are theories involving the control techniques of the body in drug effects.

PERCEPTUAL CONTROL THEORY says that the body is known to house numerous control

mechanisms that help to maintain them within the narrow limits required for efficient

operation and survival. Behavior, then, is a means by which humans (and other animals)

defend their intrinsic variables against disturbance (Powers, William). The basic type of

behavior that has been utilized in research on the behavioral effects of drugs

is RESPONDENT OR REFLEXIVE BEHAVIOUR (Pavlov). This type of behavior is elicited by specific

stimuli and usually involves no specific training or conditioning in that the responses are

typically part of the behavioral repertoire of the species and are expressed under

suitable environmental conditions. Although factors responsible for the occurrence of

these behaviors presumably lie in the organism's distant evolutionary past, certain

unconditioned responses, called reflexes, can be brought under more direct and

immediate experimental control through the use of procedures first discovered and

systematically explored by Pavlov. Such procedures consist of expanding the range of

stimuli capable of producing or eliciting a response.

Several learning processes appear to play key roles in the acquisition,

expression, or retention of tolerance to behavioral effects of drugs from numerous

pharmacological classes. A number of terms have been used to describe behavioral

influences, including associative tolerance, behavioral tolerance, behaviorally

augmented tolerance, conditioned tolerance, contingent tolerance, environment-

dependent tolerance, and learned tolerance. Although these multiple terms highlight

situations in which different learning processes may operate to regulate tolerance, they

also impede recognition of situations in which common processes operate. As with

 biochemical and cellular influences on tolerance the learning processes that are likely to

operate in a particular situation are those that normally govern the behaviors affected by

a drug. In the case of complex learned behaviors, these learning processes are involved

in their acquisition, maintenance, or adaptability.

I. RESEARCH PARADIGM

II. DEFINITION OF TERMS

Research Design

In this study the researchers use the survey research as the research design. This

research design is a descriptive method used to study a representative characteristic of a

population. In the survey research, the researchers used a paper-pen questionnaire that

enlists choices of two therapeutic effects and four symptoms of the bad effects of taking

Paracetamol plus Ibuprofen which will be answered by the respondents.

Research Instrumentation

The researchers used one research design and it is the Rating Scale. The

researchers used this to assess attributes. In the rating scale the male respondents ages

25-45 will indicate their age and rate themselves on what underlying effects they perceived

in accordance on what type of effects they encountered. They will rate it as four(4) which

signifies highly affected and one (1) which means unaffected/ no effect. The data collected

will be used as to determine if there is a relationship between the profiles of users and the

perceived effects of Paracetamol plus Ibuprofen.