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What does Ibuprofen or medications like it do to the human body?
This is a very common medication that I'm sure many of you have probably used for things
like pain, inflammation, a fever, or maybe even something like period or menstrual cramps
but could this medication cause any harm or potential side effects?
Maybe you've heard it could affect the liver, the stomach, or other organs throughout the
human body.
So, in this video, we're going to take a look at those organs by utilizing the body's behind
me, and of course, talk about how this medication works on you.
So, let's do this.
So, at some point, we're going to need to take this and get it into the various digestive
system structures so that eventually the medication can get absorbed into the body so that it
can take its effect.
But first, what is Ibuprofen?
Ibuprofen commonly known as some other brand names like Advil or Motrin is classified as
a non-steroidal anti-inflammatory drug or an NSAID.
Now, there are some steroidal anti-inflammatories.
Maybe you've heard of things like prednisone or dexamethasone but those steroidal anti-inflammatories
work a little differently and so we'll save those for a different video and focus on these
non-steroidal anti-inflammatory like Ibuprofen.
Now, Ibuprofen has some pretty common uses.
It's commonly used as an analgesic which is a pain reliever and antipyuretic, which is
a fever reducer and obviously as an anti-inflammatory.
Now, is Ibuprofen the only inset out there?
Absolutely not.
Some of you have probably used some others or heard of them.
Things like Aleve, also known as deproxin.
Some of my patients have also used a topical one called Voltaren Gel or Diclofenac gel
that's kind of this generic versus brand name thing and there are variety of prescription
strength insets and for the most part, they all have this similar mechanism of action
or in other words, how they work in the body and so, we'll focus on Ibuprofen as kind of
our baseline inset because it's one of the most commonly used.
So, let's finally get this thing into the body to figure out how it works.
So, I've got my 200 milligram tablet of Ibuprofen which you probably you can't see very well.
So, I'll put it in my tweezers here and we'll trace it into the body.
Here's a sagittal cut of a head.
So, essentially, like so and most of us first put the pill in the mouth or the oral cavity
here.
Now, we often say the oral cavity or the mouth is where digestion begins but this pill isn't
going to spend a lot of time in there.
We pop it in there, put some water in and swallow it quickly down into the pharynx here
and then to the next part of the tube would be the esophagus here.
The esophagus is the food tube or posterior to the windpipe or the trachea here and that
tablet would then move down the esophagus and I can show you on an anterior or a front
view of the esophagus on this dissection, moving down into the stomach here.
Now, many of you have probably heard that Ibuprofen can be harmful to the stomach and
there's definitely truth to that but first, let's get it absorbed into the body and figure
out what it's supposed to do and then we can talk about its potential side effects.
So, in the stomach, it's going to start mixing with the gastric juices.
Those gastric juices essentially include things like the stomach acid, digestive enzymes,
and even some of the stomach mucus.
Now, that's where the pill or the tablet is actually going to start to dissolve and it's
active ingredients are going to be released or to a point where they can start to be absorbed.
Now, some of it can get absorbed into the stomach or through the bloodstream through
that mucosal line that we'll show you later in the video but the majority of it still
going to pass into the small intestine and this is where the majority of the medication
will actually be absorbed.
Small intestine has tons and tons of blood vessels to absorb nutrients or in this case
a medication and this whole timeline of where absorption can start to take place is about
30 to 60 minutes depending on things like the contents of the stomach.
But now that we're in the bloodstream, we essentially can think or say that the medications
going to be distributed to potentially everywhere and now we can talk about how it takes its
effect.
So, Ibuprofen works by inhibiting certain enzymes called Cyclooxygenase 1 in Cyclooxygenase
2 or Cox1 and Cox2.
But what in the world does that mean?
Well these enzymes, cox 1 and cox2 normally get involved in synthesizing other substances
called Prostaglandins.
Prostaglandins are extremely important to this discussion because these prostaglandins
are involved in multiple physiological processes throughout the body.
Some of these include things like inflammation.
Another is they're involved in pain and essentially stimulating certain pain receptors.
You find a lot of Prostaglandins in areas of infection and tissue damage.
They're also involved with interacting with this structure in the central core the brain
called the hypothalamus.
The hypothalamus does a lot of things but one of the things that gets involved in is
body temperature and even the fever response.
We also see Prostaglandins influencing uterine contractions.
Say like during menstrual cramping.
It can cause that smooth muscle in the uterus to contract.
Other things are influencing blood flow into these cool little organs that we call the
kidney.
You can see this artery right here, blood would go in but it really influences some
of these microscopic vessels that you'd find on the cortex or the outer portion of the
kidney here.
And the last thing that I want to mention that the prostaglandins get involved in - if
I take this other dissection of the stomach is the prostaglandins also get involved in
aiding in the mucosal lining of the stomach or the inside lining of the stomach here producing
mucus and also helps to regulate stomach acid.
So, I want you to kind of think about the huge list that we just created of all the
things that the prostaglandins are involved in and if I can take a medication like Ibuprofen
that inhibits Cox1 and Cox2, these enzymes that produce prostaglandins, I'm going to
lower the number of prostaglandins that are circulating throughout the body and so therefore,
I could help potentially reduce inflammation, help reduce pain, help reduce the fever, and
even help reduce like menstrual cramping and a lot of you've probably used these medications
with some level of success with varying degrees depending on the pain levels and what was
actually going on with your body.
But what about the side effects?
Let's discuss those by going to another cadaver.
So, let's talk about some of the potential side effects of Ibuprofen.
Whenever we take a medication, we kind of have to do this pros versus cons, the pros
of the therapeutic benefits of the medication versus the cons or those side effects of the
medication.
So, with Ibuprofen, could it affect the liver, the stomach, or other organs throughout the
human body?
Well, let's start with the liver.
If you take a look at this section here, I've got the diaphragm in my hands here and after
I reflect this diaphragm or this muscle back or upwards, you can see this huge organ that
we call the liver.
The liver is the second largest organ in the human body, second to the skin and it's located
in the right upper quadrant of the abdomen.
Now, the liver does a ton of amazing things for the human body.
One of which is to metabolize a lot of different drugs or medications and what do we mean by
metabolize drugs and medications?
Well, let's think about the Ibuprofen circulating throughout the bloodstream.
Eventually, that Ibuprofen is going to pass through the liver.
And when it passes to the liver, the liver contains certain enzymes that are going to
actually convert the Ibuprofen into more of an inactivated form and what they would refer
to as metabolite and that metabolite, that converted form of Ibuprofen, will then continue
on its merry little way through the bloodstream but eventually make it to the kidneys, get
filtered out and will just pee it out hopefully into the toilet.
But the question is, during that conversion process in the liver, does that cause any
potential harm to the liver?
For the most part, no.
Ibuprofen is relatively safe for the liver.
You can always find cases where there's certain situations where people have had some harm
to the liver from taking Ibuprofen, but again, for the most part, it's relatively safe.
But if we compare that to the potential side effects of the stomach, that might be a little
bit of a different story.
So, let's take a look at this other dissection here.
So, I've actually got two stomachs here.
I've overlaid two thirds of the stomach because we cut it right here as you can see and I
just wanted to kind of give you the comparison of the full stomach but the reason we show
people this stomach is we love to show people the amazing inside lining of the stomach.
This inside lining that I'm touching with my thumbs here is called the tunica mucosa,
called the tunica mucosa because it helps produce mucus.
Now, one of the reasons why our stomach doesn't eat itself alive with its own acid or irritate
itself is because we have that coating or that protective barrier of mucus between the
acid and the actual lining of the stomach So, you think here's the inside lining of
the stomach, mucus, and then we've got that acid but remember our discussion about Prostaglandins
and what they could do earlier.
Prostaglandins also got involved in helping the stomach produce mucus and even regulating
the stomach acid.
So, if I take a medication that reduces the amount of Prostaglandins, Ibuprofen, then
I reduce the potential amount of stomach mucus on that inside lining and so, I could thin
out that protective barrier and make it more risky or at least create a situation where
the acid could irritate the stomach more easily because that mucus being thinner or less produced.
And so, that's essentially how Ibuprofen could affect the stomach or cause stomach irritation.
Now, in general, people who take Ibuprofen every once in a while, even if you take Ibuprofen
for a few days to help with the fever from like the flu or some other illness, for the
most part, you're not going to have major stomach issues.
We're more concerned about those who maybe on Ibuprofen every single day to help manage
a chronic condition say like maybe arthritis or we might be more concerned with patients
who have a history of gastritis which is inflammation of this inside lining or maybe somebody who
has peptic ulcer disease.
But what about other organs like the kidneys?
I mentioned the kidneys a little bit earlier when we talked about the Ibuprofen passing
through the liver, getting converted to a more inactive form that we referred to as
a metabolite and then those metabolites eventually made it to the kidneys and got excreted in
the urine.
Let's talk a little bit more about the details of that process and see if Ibuprofen can have
an effect on the kidneys.
So, here's a really cool dissection that we briefly saw earlier in the video but more
context, this is a frontal cut so we could see the internal anatomy of the kidneys and
the first thing I want to mention is this structure here called the renal artery.
Renal just mean - means kidney and this renal artery is going to take blood into the kidney
and it'll branch multiple times but go back to that story of that metabolite of the Ibuprofen.
Eventually, it's going to enter through this blood vessel and get distributed throughout
the kidneys and like I mentioned, those blood vessels will continue to branch and branch
and branch until the point where when they get into the cortex here, the outer portion
of the kidney, they're microscopic.
Can't see 'em with the naked eye.
So, if we zoomed in and zoomed in to the renal cortex, we'd see these awesome functional
units referred to as a nephron.
A nephron is a combination of urinary tubules as well as some tiny little blood vessels
and this is where we're going to see this filtration process between the cardiovascular
system and the urinary system.
In essence, we're going to create urine here.
So, there's going to be a fluid component from the cardiovascular system that's going
to pass into these urinary tubules and it'll take these waste products including some of
these metabolites into the urinary tubules.
So, we've moved from the cardiovascular system now into the urinary system and if we come
back to this really cool kidney dissection, you can see these areas right here that I'm
highlighting with the probe here and these are referred to as renal pyramids.
Now, these are full of tiny, tiny, little collecting tubules that are collecting essentially
urine and they're going to take them out and funnel them into this process or I should
say this larger tube here called the renal pelvis which then goes and becomes the ureter
down to the bladder and hopefully again out into the toilet.
So, it's a really cool process that's happening 24 hours a day, seven days a week, but does
that process of that metabolite from Ibuprofen passing from the cardiovascular system into
the urinary system cause a problem?
Not so much but there is a potential side effect with the kidneys and Ibuprofen.
It doesn't have to do with the process that I just went through and mentioned, it's weird,
has to do with again what the prostaglandins do.
Last thing, we'll refer to back to the beginning of the video.
Remember the prostaglandins they did have an effect on the kidney, a vasodilator or
in other words, they help the tiny little blood vessels in that renal cortex vasodilate
or stay open a little bit.
And if you take Ibuprofen and suppress Prostaglandins synthesis, you no longer have quite as much
influence to vasodilate those blood vessels and they can start to vasoconstrict.
Now, in what context would that be a problem?
Somebody again, who's taking Ibuprofen every once in a while or for short periods of time,
who's staying well hydrated isn't going to have a much, much of a problem with that kind
of vaso constrictive effect of taking the Ibuprofen, but let's say again, we go back
to that example, somebody who's taking it multiple times a day, every day to help try
to manage arthritis or in a sense - maybe somebody has kidney disease.
If somebody already has kidney disease and uveso constrict those blood vessels, you might
exacerbate that problem even further.
So, when I'm in the clinic and I'm talking about managing people's pain or inflammation
or fevers with Ibuprofen, we often will have a discussion around what their kidney status
is.
Do they have a history of kidney disease?
Sometimes, I'll even pull up their previous labs and see what their kidney function looks
like.
So, those are some considerations that we have to do with say Ibuprofen and if I run
into some of those problems, I may have to consider using some other pain medication
to help manage their pain or their inflammation or their fevers.
So, it's probably enough detail on Ibuprofen and it's potential therapeutic effects versus
its potential side effects.
Now, granted there are some side effects we didn't discuss but we really wanted to focus
on the main or the most common side effects in this video.
Those others we can talk about in a future video.
But I do want to mention one last thing about a really cool phrase that one of my pharmacology
professors mentioned when I was still in medical training and that was in regards to us giving
medications to patients and she would often say this phrase, "start low and go slow".
In other words, start at the lowest therapeutic dose and slowly titrate up till you get the
therapeutic response and then you can stop there.
In other words, you don't necessarily have to say jump like to 800 milligrams of Ibuprofen
if say someone's pain and inflammation could be controlled with 2 to 400 milligrams.
Now, granted everyone situations different, the pain levels, the condition you're treating,
all of that matters when you're picking a medication as well as dosing, but I thought
that was a really cool phrase.
At least that could be used as a general rule for clinicians and even for people who are
going to manage their own health with over-the-counter medications.
Now, in this video, we put so many little puzzle pieces together.
We put the pieces of human physiology and how they would interact with Ibuprofen.
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