Nonsteroidal anti-inflammatory drug

NDTV reports that NDRA's apex drug regulator, the CDSEO, has issued a public advisory.

They are warning that the prolonged, unprescribed use of common painkillers, specifically NSAIDs and antibiotics, can lead to severe kidney complications and contribute to antimicrobial resistance.

Because these are strictly Schedule H prescription drugs, right?

Yes, meaning they legally require a doctor sign-off, yet they remain widely available over the counter.

Yes.

So we advise against the use of aspirin and NSAIDs, um, due to increased risk of bleeding.

Obviously, this excludes our cardiac population who are on aspirin for other reasons that it's necessary.

Claudia is a girl, so we don't have as much trouble, but our teenage boys, we advise against contact sports, have to break a lot of hearts who are having to miss-

Yes.

So the, the general answer is no, they don't require treatment in terms of anticoagulation.

So warm compresses, NSAIDs, all of the things similar to, you know, a child has a PIV that infiltrates.

Um, however, there are some cases where they are higher risk if they are, I think the cutoff is, like, within five centimeters to the kind of juncture of a deep vein, then you're worried about that propagation and to prevent from them developing a, a deep vein thrombi, then we would offer treatment.

And this profoundly changes your postoperative pain management strategy.

If a patient has a bleeding disorder, or if they are taking therapeutic anticoagulants like warfarin or Eliquis, you must entirely avoid prescribing aspirin and NSAIDs like ibuprofen.

I want to make sure you listening understand the mechanism here because it's not just that NSA is quote unquote thin the blood.

Aspirin irreversibly binds to platelets.

There isn't one cause of increased intestinal permeability.

Chronic intestinal inflammation, infections, celiac disease, alcohol, certain medications such as NSAIDs, changes in the microbiome, metabolic problems, diet, and other forms of intestinal injury can affect the intestinal barrier.

But there's another factor I think many people will find interesting, stress.

Any of you have any stress? Psychological stress doesn't stay only in your mind.

What common things could a high schooler be taking that would cause a major blood pressure spike?

We'll start with NSAIDs, non-steroidal anti-inflammatory drugs.

The most common example is ibuprofen.

Ibuprofen.

How does ibuprofen raise blood pressure?

It comes down to biochemistry.

NSAIDs work by blocking the production of enzymes called cyclooxygenase, which ultimately reduces pain and inflammation.

Right.

So what happens is that people just simply use the term acidity to describe a range of problems.

And the problems can be many, okay? Number one, overuse of those NSAIDs, okay? What those things do is that they disable an enzyme, which is important for you from a painkiller standpoint, by the way.

But it turns out that one of their byproducts, the prostaglandins, are necessary to produce the mucus layer that keeps your stomach from dissolving itself in its own acid.

Think about it.

And then it...

And that mechanical problem could have been caused by age.

It also could have been caused by... you misusing other NSAIDs and other things, etc, etc.

And other postural issues, etc.

Medications are powerful, systemic agents, and polypharmacy often leads to pharmacological crossfire.

The most common offenders, over-the-counter non-steroidal anti-informatory drugs or NSAIDs.

Things like ibuprofen, naproxen, the pills millions of people take every single day for a headache or a tweaked knee.

Yes.

Okay, so prostaglandins keep the kidneys' pipes open.

Right.

But NSAIDs relieve pain specifically by inhibiting the enzymes that produce prostaglandins.

Oh, I see.

And again, it could include a number of different things depending on what the individual clinician thought the individual patient needed.

Medical care included at least two visits with a physician or APC and could include NSAIDs, muscle relaxants, sort of standard care, and or heat, massage, or acupuncture, which are perhaps less standard medical care.

At eight, sorry, 10 to 12 months, which was how long this study lasted, The mean low back pain impact score was 15.3 with self-management and 17.0 with medical care on a scale from 8, which was the best case scenario, to 50, which was the worst case scenario, giving an unfortunately not significantly different change.

They were looking for a pre-specified minimum clinically important difference of 30%.