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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
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Study Guide Ch 11,16,37,45  Fill out and maintain accurate and thorough patient records is the most ____for a Medical Assistant important duty Pt medical history and present condition is found where? Medical record also known as charts Patient care management, patient records are used for ? Continuity/Quality of care, communication tool, research, and legal documentation The medical assistant may help _________ about his condition or its management, as requested by ___________. Educate the patient, the physician Pt illness and reason for visit is found in the ___________. History of Present Illness (HPI) Hospital Discharge Summary generally includes? Admission/Discharge dates, HPI, diagnosis, treatment, follow-up care instructions, physician’s signature, complications (if any) The first document found in a pt’s financial record is? Patient Registration Form Initialing imaging reports helps ? To show who is responsible for the entry also to see if practitioner has reviewed them Where should you interview a patient? Private area to have confidentiality You need to distinguish between signs and symptoms. An example of a sign is ________ A fever, rash, or swelling (what other people can tell) You need to distinguish between signs and symptoms. An example of a symptoms is ________ Headache or Nausea (how you feel inside) Signs are External factors that are seen or measured by others Symptoms are Internal factors that are stated by the patient What does each letter of SOAP stands for Subjective, Objective, Assessment, Plan Blue ink is recommended to ensure what? Originality, readability, and fraud prevention Test results should be record ____________ Immediately and accurately Typical time for an CPE is? 30-60 minutes Typical time for f/u appt is? 5-15 minutes The disadvantage of an open-hours scheduling system is? Uneven patient flow (inefficient downtime for office staff) & long wait times What is time-specified scheduling? Where patients arrive at regular, specified intervals, ensuring the practice of a steady stream of patients Wave scheduling is? Several patients seen in the same hour, seen in order they arrived; determined by dividing the hour by the length of the average visit and then giving that number of patients appointments with the doctor at the beginning of each hour Double-booking? 2 or more patients are scheduled at same time slot, assuming both will be seen within the period Advance scheduling is useful in __________ or __________in which a pts are generally booked wks or months in advance. Annual checkups or consultations Advantages of computerized scheduling? Blocks time for emergency or last-minute visits. Lets staff see the schedule from anywhere in the office. Shows which patients cancel or don’t show up often. Helps find and schedule follow-up appointments easily. Makes reports to track how scheduling is going. Uses colors to organize different types of appointments. Lets you search for open days or times quickly
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