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NSAIDs Pharmacology Lecture Notes Tissue Injury & Inflammatory Response Initial vasoconstriction occurs immediately after injury to minimize blood loss (temporary reaction) Chemical mediators released: histamines, kinins, and prostaglandins - crucial for inflammatory response Vasodilation follows - blood vessels widen, increasing blood flow to injured area Classic inflammatory symptoms: redness (erythema), swelling (edema), pain from nerve stimulation, fever/heat NSAIDs Classification & Examples Propionic derivatives: ibuprofen, naproxen Phenomates: mefenamic acid Available OTC: salicylates, propionic acid derivatives Prescription required: COX2 inhibitors, acetic acid derivatives, oxicams, phenomates Mechanism of Action COX enzymes: cyclooxygenase (COX1 & COX2) convert arachidonic acid to prostaglandins COX1: Always active, protects stomach lining, helps platelet aggregation COX2: Activated only during tissue injury, causes inflammation and pain NSAIDs inhibit COX enzymes, preventing prostaglandin production (prostaglandin inhibitors) Primary Effects Antipyretic: reduces fever Analgesic: pain relief Anticoagulant: prevents blood clots (especially aspirin) Specific Drug Categories Salicylates (aspirin): pain, inflammation, fever, anticoagulant effects Propionic acid derivatives: mild to moderate pain (1-6 on pain scale), inflammation, fever Acetic acid derivatives: more effective for inflammation but significant GI side effects COX2 inhibitors: second generation NSAIDs with better safety profile, target COX2 specifically Oxicams: long-term use for osteoarthritis/rheumatoid arthritis, longer half-life (once daily) Phenomates: especially effective for menstrual pain Major Side Effects Gastrointestinal Dyspepsia: heartburn, indigestion, abdominal pain, nausea Long-term risks: stomach lining damage, GI bleeding, perforation (holes in stomach/intestines) Bleeding signs to monitor: dark tarry stools, bleeding gums, petechiae, ecchymosis, purpura Higher risk patients: older adults, smokers, alcohol users, pre-existing ulcers Prevention: proton pump inhibitors or H2 receptor antagonists to reduce stomach acid Kidney Effects Impaired function: reduced urine output, fluid retention, weight gain, edema Monitor: BUN and creatinine levels for kidney function Mechanism: NSAIDs reduce blood flow to kidneys, worsening function and increasing kidney disease risk Cardiovascular Risk Non-aspirin NSAIDs increase heart attack and stroke risk Prescribe at smallest effective dose Special Considerations Menstrual Pain (Dysmenorrhea) Avoid aspirin for painful menstruation with heavy bleeding Use acetaminophen 2 days before and during first 2 days of menstrual period Aspirin-Specific Risks Salicylism/Aspirin toxicity: early symptoms from overdose, can progress to electrolyte imbalances, coma, respiratory depression Serum salicylate levels: >30 mg/dL mild toxicity, >50 mg/dL severe toxicity Treatment: activated charcoal, possible hemodialysis Reye's syndrome: rare but serious condition causing liver/brain swelling in children/adolescents recovering from viral infections (flu, chickenpox) Reye's syndrome symptoms: persistent vomiting, lethargy, confusion → irritability, aggression, disorientation, seizures, loss of consciousness Avoid aspirin in children/adolescents with viral infections Drug Interactions & Precautions Glucocorticoids: amplify stomach bleeding risk Alcohol: increases stomach bleeding - limit/avoid consumption Other NSAIDs: can negate heart protective effects of aspirin - space dosing apart Herbal supplements: garlic and ginseng enhance bleeding risk High-risk populations: older adults, smokers, certain health conditions (H7
Updated 15d ago
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Infant Development (chapter 2) Alcohol Favorite toy as a transitional Baby’s wants and needs are the same thing Non-emotion induced tears- see two things water and salt. Emotion induced tears- water, salt,endorphins, and endoxified protiens. Toxins and endorphins reduce stress. Prolactin and oxytocin (frequency, duration, intensity) Egotistical response Bioevolutionary speaking crying is a survival instinct. Babies absorb about 10 times radiation than adults. Closer chromosomes with female chimp than a human male. culture dictates how much time we spend with our babies. Bowlby said that culture is so powerful that it can override instincts. Behaviorism theory can say that instinct do not exist in humans. About 77% of infants (12 m) 40 or more hours a week. About 8 of our babies are not raised with their parents. It matters how we raise our kids, because they will grow up and make choices for us. About 75%-80% of women said they were working for personal fulfillment. Women would rather be at work than be with their children at home. Snowball effect- To be able to read those cues, it takes times. so when you don’t spend time with them you wont pick up their cues. Quality time involves quantity. Having kid at work can also be counted as quality because they can still ask questions and make memories. It’s just about the amount of time you spend. They have the highest turnover rates than any other job Cultural feminist- belief that women are superior than men because they will never do things that women could. Feminism-men and women should be treated equally. Formula is digestible and allows you to sleep longer but when awake stomach hurts Ferberize a baby to make them sleep longer. Works for any age, put in crib, pat their back (3 time) and turn off lights and leave room Come back 20 minutes and pat back again and leave without turning light on. Next night 21, 22, 23, and increase each night. Can leave baby alone because they are starving and also since they don’t have a sense of time (they think you leave forever) We spoil babies (holding too much, pick up when crying) 1912 We spoil babies the exact why we spoil fruit, (leave them alone) Anecetipmen is also to ADHD, brain is not receiving signals Day 2 Relational play- understanding what goes with what. Stranger anxiety- you like people you don’t know at all (8-9 months) Categorical anxiety- they don’t like glasses etc. Visual cliff- she was born knowing not to go off cliff. Strange situation test- You can not measure attachment Other countries when given money for having a baby only have one baby. ( Sweden) Independence cannot be taught. Our need for sleep that drives what happens to our babies 80% world’s co-sleeping because everyone sleeps better. Moms slept with babies in the past. Needs have never changed for babies from very first baby to the ones present. According Erickson the first year is where we determine if the word is a safe place. Emotional needs for babies are as important as their physical needs. Letting a child cry it out is perceived as child abuse in other countries. You can be taken to jail and/or ticketed. (Other cultures) Formula feeding is super convenient 88% of white educated American pediatricians In American in curbs where SIDS occurred the most Royal rode to the unconscious - you will deal with the hard stuff when you are awake. Boy and girls develop differently All around the world, all babies start using words at 12 months If not start using words 12 months then might check hearing. Nouns are the first words Chomsky ( are speaking is innate) Talking to us or someone to talk for us The more you’re talked to the more you are verbal fluently The word no Bali is a country where babies that are perceived to be devine Refuse to babies on the ground up until the first 6 months 6 months ceremony 6 months can crawl, and sit up Breastfeeding, staying close proximity, co-sleeping Wearing your baby much more likely to read their cues Make them scared of the whole world Developmentally appropriate More child is held the happier they are, more nursed she will be happier (oxytocin, prolactin) We call this an ancient physiological interdependence. Advanced motor skill, more vertigo Baby is learning through the mothers experience Instinct Less crying ( more time together) Non-medicated births, baby-led breastfeeding, co-sleeping Colic can be withdrawal- formula fed - stomach issues - co-sleeping— miss mom Motor skills- body doing everything the mother is doing Lower vertigo, because you get a workout Separated from their mothers they cry Higher self esteem, they are more self -reliant- lower rates of anxiety and depression Strong sense of self Mesozoic era Two types of mammals -caching hide their young to protect them while they go look for food. Their babies can remain silent for long periods of time Their milk is very very high is protein very high is fat Caring mammals- their young are born helpless, they can’t regulate body temperature, they need constant contact with their mom for protection, their milk is low in fat and low in protein designed for continuous and on demand feeding Humans are caring mammals Monkeys, apes, Pigmies - long term breastfeeding 4-5 years Learn from experiences Babies worn long term !Kung- very very tall people They breastfeed 4-5 years Not having babies often Very sexual people Master gland- nursing often, gland stays silent Breastfeeding becomes spaced not they can have a child Not having periods Sleep 4-7 hours, period comes Baby nursing almost all the time It’s nutritional and its medicinal, and attachment formation More the baby suckle the more milk you make What kind of birth control pill- cannot breastfeed on birth control About 200 years ago the crib was introduced According to John bowlby separation form attachment figure can be physiological damaging Bowlbys primary attachment theory Tears and constant waiting for mom to return Very sad, no affect, low affect Deattachment- know she’s not going to come back Can be long term, Can impair child’s ability to form loving relationships Internal working model is our prototype for all later relationship Bowlby hypothesized in the 1940s that separation from mother can leave to chronic anxiety and depression It is impossible to measure neurotransmitters of a brain of a living human The number one cause of disability is depression Babies don’t have a concept to time Existential sense of self Dichotomy of the public and private sphere Is where you nurture and raise children Family was a man and a women and their children Three types of women Those that have to be mothers They love kids, they want take them back to their parents She doesn’t want kids, doesn’t like them Bought a house 10.5 years after they got married 600 and 25 ft 28 years old car Few months after marriage Car is no 20 years old It is not 600 and 25 ft If we breastfed for 12 months and you save 7,
Updated 20d ago
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