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2020;10(11):1489.[DOI] 201
document indication (Z79.01 prophylactic use) Antibiotics (IV/PO): Piperacillin-tazobactam, vancomycin, clindamycin stump infection
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9 President Trump has rightly described this as global freeloading where inflated prices in the United States fuel global innovation while foreign health systems get a free ride. 10 These harsh realities and trends have been the underlying motivation behind the Trump administrations groundbreaking most favored nation policy on prescription drugsa policy that has already reaped substantial benefits
Key mechanism: Inhibition of COX-1 and COX-2 enzymes Prostaglandin (PGE, PGI) synthesis Afferent arteriolar vasoconstriction Renal blood flow & GFR Sodium and water retention Blood volume Increased peripheral vascular resistance Elevated blood pressure Reduced renal perfusion Acute kidney injury (AKI) in susceptible individuals Patients at higher risk: Chronic kidney disease (CKD) Heart failure Hypertension Elderly patients Volume depletion or dehydration Concomitant use of ACE inhibitors/ARBs and diuretics (Triple Whammy) Clinical takeaway: NSAIDs should be prescribed with caution, especially in patients with cardiovascular or renal risk factors
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