Stroke code
Rahul Jandial, Danielle D. Jandial in Code Blue, 2014
Intravenous thrombolytic therapy should be considered for patients with ischemic stroke, those for whom the duration of symptoms is ≤3 hours, and those with no contraindications. Angiographic intraarterial thrombolytic therapy appears to be beneficial if given within 6 hours, particularly with documented occlusion of middle cerebral or basilar artery. Clinical deterioration after thrombolysis should be presumed to represent intracerebral bleeding until proven otherwise—stop tPA infusion immediately (and heparin, if used), and obtain a noncontrast CT scan of the head immediately. Neurosurgical decompression may be indicated for large cerebellar or intracerebral hemorrhage, especially if there is associated hydrocephalus or a deteriorating level of consciousness. Ventriculostomy is indicated for basal ganglia hemorrhage associated with hydrocephalus. Maintaining normothermia with antipyretics or cooling blankets may improve outcome after stroke.
Fever and sepsis
Gina Johnson, Ian Hill-Smith, Chirag Bakhai in The Minor Illness Manual, 2018
Fever is usually present, but the very young, old or frail patients may have a normal temperature. Sepsis is ‘life-threatening organ dysfunction due to a dysregulated host response to infection’. It is underrecognised in primary care and it has a high mortality. Sometimes fever alone is the presenting problem. In UK primary care, this is more likely to be due to viral than bacterial infection. Many of the ‘red flags’ for different conditions indicate a risk of sepsis. Fever itself does not cause any harm, and may aid recovery. It is important to make parents and patients aware that the fever caused by an infection is not dangerous but is ‘a sign that the immune system is busy’. Antipyretic medicine is sometimes given to children by clinicians as a test, because a good response is thought to exclude serious illness.
The non-steroidal anti-inflammatory drugs (NSAIDs), including the ‘COXIB’ NSAIDs
Hugh Mcgavock in Pitfalls in Prescribing and How to Avoid Them, 2017
If amiodarone is the riskiest drug prescribed in primary care (on specialist recommendation), then the NSAIDs come a close second. Fortunately, the causes of NSAID-induced adverse drug reactions (ADRs) and adverse drug interactions (ADIs) are relatively easy to explain and understand. NSAIDs block the synthesis within tissue cells of the pros-tanoid family of chemical messengers – the prostaglandins, prostacyclins and thromboxanes. The NSAIDs’ analgesic and antipyretic effects are due to blocking of neuronal prostaglandin synthesis, which sensitises peripheral pain receptors and spinal pain pathways, and synthesis of the prostaglandin in the temperature regulator of the hypothalamus, which initiates fever. Unfortunately, the NSAIDs block the synthesis of most of these essential regulators and so seriously disrupt organ function in a large proportion of patients, particularly the elderly and those with failing organs. NSAIDs also interact with several commonly prescribed maintenance regimes, either by reducing their efficacy or by adding to their unwanted side-effects.
Effect of antipyretic analgesics on immune responses to vaccination
Published in Human Vaccines & Immunotherapeutics, 2016
Ezzeldin Saleh, M. Anthony Moody, Emmanuel B. Walter
While antipyretic analgesics are widely used to ameliorate vaccine adverse reactions, their use has been associated with blunted vaccine immune responses. Our objective was to review literature evaluating the effect of antipyretic analgesics on vaccine immune responses and to highlight potential underlying mechanisms. Observational studies reporting on antipyretic use around the time of immunization concluded that their use did not affect antibody responses. Only few randomized clinical trials demonstrated blunted antibody response of unknown clinical significance. This effect has only been noted following primary vaccination with novel antigens and disappears following booster immunization. The mechanism by which antipyretic analgesics reduce antibody response remains unclear and not fully explained by COX enzyme inhibition. Recent work has focused on the involvement of nuclear and subcellular signaling pathways. More detailed immunological investigations and a systems biology approach are needed to precisely define the impact and mechanism of antipyretic effects on vaccine immune responses.
Severe acute malnutrition and infection
Published in Paediatrics and International Child Health, 2014
Kelsey D. J. Jones, James A. Berkley
Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice.
Pirfenidone for the treatment of idiopathic pulmonary fibrosis
Published in Expert Review of Clinical Pharmacology, 2017
Introduction: Idiopathic pulmonary fibrosis (IPF) is a diffuse parenchymal lung disease with no cure. Up until recently, no treatment had been proven to alter its natural history as judged by rate of lung function decline. In 2014 however, the emergence of two novel anti-fibrotic agents, Pirfenidone and Nintedanib revolutionized the management of this condition. Both have demonstrated the ability to deliver a major reduction in the rate of chronic IPF progression. Areas Covered: This review article focuses on Pirfenidone – a pyridone derivative initially designed as an analgesic and anti-pyretic agent. Here we describe the history of the drug from its inception through to exploratory pre-clinical in-vitro and in-vivo studies where its anti-fibrotic potential was identified, and eventually to large multicenter randomized controlled trials. Expert Commentary: This article also summarizes some of the difficulties surrounding clinical end-point selection in IPF trials and addresses some of the challenges facing the IPF community over the coming years.
Related Knowledge Centers
- Fever
- Pharmacological Actions Category
- Ibuprofen
- Drug
- Hypothalamus
- 8-Hour Bayer
- Analgesic