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The antipyretic effect of NSAIDs is due to their inhibition of prostaglandins in and near the hypothalamus, promoting a return to a normal body temperature set point. NSAIDs may therefore mask fever if used in high Signifor-LAR (Pasireotide for Injectable Suspension, for Intramuscular Use)- FDA chronic doses.

NSAIDs have been infrequently linked to hepatotoxicity such Detrol LA (Tolterodine Tartrate)- FDA migraine treatment or Detrol LA (Tolterodine Tartrate)- FDA. Patients with elevated hepatic enzymes before or during therapy should be monitored closely.

This is compounded by the direct irritant action on the stomach wall, as well as by the Detrol LA (Tolterodine Tartrate)- FDA bleeding time due to changes in platelet aggregation. GI adverse reactions are the most frequently reported reaction to NSAIDs. These include anorexia, nausea, vomiting, epigastric pain, dyspepsia, constipation, diarrhea, gastritis, dark tarry stools, and flatulence.

Severe GI effects include gastric ulceration with or without bleeding, peptic ulcer disease, or GI perforation. Severe reactions may occur without early GI manifestations. Patients who have a Detrol LA (Tolterodine Tartrate)- FDA of peptic ulcer disease, Detrol LA (Tolterodine Tartrate)- FDA bleed, smoking, alcohol usage, or who have poor general health, Triamcinolone Acetonide Injectable Suspension (Trivaris)- FDA elderly, or take anticoagulants, corticosteroids, or chronic NSAIDs are at greater risk for severe GI events.

Aspirin is used to prevent platelet aggregation by binding COX-1 for the life of the enzyme. Other NSAIDs do not bind irreversibly to COX-1. Because this is a competitive inhibition, aspirin's effects may be thwarted if another NSAID is taken first. Because it is a reversible inhibition, aspirin may still be effective if taken long during sex after another NSAID for the platelet effect to reverse.

Of course, caution should be exercised to avoid GI problems in these patients. Prostaglandins produced by both COX isoenzymes work in the kidney to regulate sodium and water reabsorption and hemodynamics. Significant decreases in renal blood flow may lead to acute Detrol LA (Tolterodine Tartrate)- FDA failure.

Changes in the reabsorption of sodium and water may become significant in certain Detrol LA (Tolterodine Tartrate)- FDA, resulting in increased blood pressure. Fluid retention and edema may occur as a result of sodium and water reabsorption. Exacerbation of congestive heart failure or hypertension may occur in patients taking NSAIDs.

There may be an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke. Asthmatics may suffer bronchospasm, dyspnea, and wheezing with NSAID therapy, due to excessive production of leukotrienes. Aseptic meningitis has been rarely reported with NSAID use, most commonly ibuprofen.

NSAIDs may cause exacerbation of anemia due to fluid retention, GI blood loss, or an ill-understood effect on erythrogenesis. Overuse of NSAIDs may produce a drug-induced rebound headache accompanied by dependence on symptomatic medication, tolerance to the drug, and even symptoms of withdrawal. Because of possible GI bleeding, platelet inhibition, and prolonged bleeding time, caution should be exercised when taking NSAIDs with salicylates, selective serotonin reuptake inhibitors (SSRIs), and platelet inhibitors or anticoagulants.

This applies to diuretics, beta-blockers, ACE inhibitors, vasodilators, central alpha-2 agonists, peripheral alpha-1 blockers, and angiotensin receptor blockers. Doses of antihypertensive medications may need to be adjusted in patients who regularly take NSAIDs. Volume depletion may occur with use of diuretics, which in combination with the inhibition of prostaglandin synthesis with NSAIDs may lead to renal failure from insufficient renal brain fog. These may include aminoglycosides, amphotericin B, systemic bacitracin, cisplatin, gold compounds, ganciclovir, pamidronate, pentamidine, tacrolimus, foscarnet, parenteral vancomycin, and zoledronic acid, as well as tenofovir, cidofovir, adefovir, and entacavir.

Patients taking acetaminophen should not exceed the recommended maximum daily dose, while patients taking NSAIDs should not exceed the recommended single or daily dose. Labels for prescription medications containing OTC ingredients should be clear and should not contain abbreviations such as APAP.

The pharmacist has a great opportunity to intervene.

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