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Indeed, when the lipoxin pathway is activated in the presence of COX-1 inhibitors, acetylation of the COX-2 enzyme occurs to inhibit further production of prostanoids through arachidonic acid metabolism while inducing the synthesis of 15-R-hyroxy-(p)-eicosatetraenoic acid that is transformed to 5( )-epoxytetraene and then into15-epi-lipoxins or into aspirin-triggered 15-epi-lipoxins (ATLs).
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Within the first 90 minutes of a complete ureteral obstruction, afferent preglomerular arteriolar vasodilation occurs, which temporarily increases renal blood flow.
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Prostaglandins serve to dilate the afferent arteriole; by blocking this prostaglandin-mediated effect, particularly in renal failure, NSAIDs cause unopposed constriction of the afferent arteriole and decreased RPF (renal perfusion pressure).
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Intermittent vaso-occlusive crises may be superimposed, or chronic low-level pain may be the only expression of the disease.
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Others require frequent doses of opiod analgesics.
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Also, know what your hospital's policy is for administration of all of the medications listed above.
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In all of these, when using an NSAID alone, even when dosed prior to surgery, outcomes are not as impressive as one would hope (Table 1).
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