NSAIDs - Indications and Preferred Drug for Each

ls /home/daytona/workspace/ 2>/dev/null && echo "---" && ls /home/daytona/worksp…

mkdir -p /home/daytona/workspace/nsaids-pdf

~/nsaids-pdf/generate_nsaids_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY

OUTPUT = "/home/daytona/workspace/nsaids-pdf/NSAIDs_Indications_KDT.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    "CustomTitle",
    parent=styles["Title"],
    fontSize=18,
    textColor=colors.HexColor("#1a3a5c"),
    spaceAfter=4,
    alignment=TA_CENTER,
    fontName="Helvetica-Bold"
)
subtitle_style = ParagraphStyle(
    "Subtitle",
    parent=styles["Normal"],
    fontSize=10,
    textColor=colors.HexColor("#4a6fa5"),
    spaceAfter=2,
    alignment=TA_CENTER,
    fontName="Helvetica-Oblique"
)
section_heading = ParagraphStyle(
    "SectionHeading",
    parent=styles["Heading1"],
    fontSize=12,
    textColor=colors.HexColor("#1a3a5c"),
    spaceBefore=12,
    spaceAfter=4,
    fontName="Helvetica-Bold",
    borderPad=3,
)
body = ParagraphStyle(
    "Body",
    parent=styles["Normal"],
    fontSize=8.5,
    leading=13,
    textColor=colors.HexColor("#1a1a1a"),
    spaceAfter=4,
    alignment=TA_JUSTIFY
)
note_style = ParagraphStyle(
    "Note",
    parent=styles["Normal"],
    fontSize=8,
    leading=11,
    textColor=colors.HexColor("#555555"),
    spaceAfter=3,
    leftIndent=10,
    fontName="Helvetica-Oblique"
)
bullet_style = ParagraphStyle(
    "Bullet",
    parent=styles["Normal"],
    fontSize=8.5,
    leading=13,
    leftIndent=14,
    bulletIndent=4,
    spaceAfter=2,
    textColor=colors.HexColor("#1a1a1a"),
)

# Header colour
HEADER_BG = colors.HexColor("#1a3a5c")
HEADER_FG = colors.white
ROW_ALT   = colors.HexColor("#eaf0fb")
ROW_NORM  = colors.white
BORDER    = colors.HexColor("#b0c4de")
ACCENT    = colors.HexColor("#e8a000")

def header_para(text):
    return Paragraph(f"<b><font color='white'>{text}</font></b>",
                     ParagraphStyle("th", parent=styles["Normal"],
                                    fontSize=8, fontName="Helvetica-Bold",
                                    textColor=colors.white, alignment=TA_CENTER))

def cell(text, bold=False, center=False, color="#1a1a1a"):
    align = TA_CENTER if center else TA_LEFT
    fname = "Helvetica-Bold" if bold else "Helvetica"
    return Paragraph(f'<font color="{color}">{text}</font>',
                     ParagraphStyle("td", parent=styles["Normal"],
                                    fontSize=7.8, fontName=fname,
                                    leading=11, alignment=align,
                                    textColor=colors.HexColor(color)))

def make_table(headers, rows, col_widths):
    data = [[header_para(h) for h in headers]]
    for i, row in enumerate(rows):
        data.append([cell(c) for c in row])

    ts = TableStyle([
        ("BACKGROUND", (0,0), (-1,0), HEADER_BG),
        ("TEXTCOLOR",  (0,0), (-1,0), HEADER_FG),
        ("ALIGN",      (0,0), (-1,-1), "LEFT"),
        ("VALIGN",     (0,0), (-1,-1), "TOP"),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [ROW_NORM, ROW_ALT]),
        ("GRID",       (0,0), (-1,-1), 0.4, BORDER),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("RIGHTPADDING",  (0,0), (-1,-1), 5),
    ])
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(ts)
    return t

# ── BUILD CONTENT ─────────────────────────────────────────────────────────────
story = []

# Title block
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("NSAIDs — Indications & Preferred Drug for Each", title_style))
story.append(Paragraph("Reference: KD Tripathi | Katzung | Goodman &amp; Gilman | Lippincott Pharmacology", subtitle_style))
story.append(HRFlowable(width="100%", thickness=2, color=ACCENT, spaceAfter=10))

# ── Section 1: Mechanism ──────────────────────────────────────────────────────
story.append(Paragraph("1. Mechanism of Action (Brief)", section_heading))
story.append(Paragraph(
    "NSAIDs inhibit <b>cyclooxygenase (COX-1 and/or COX-2)</b> enzymes, reducing the "
    "synthesis of prostaglandins, thromboxanes, and prostacyclin. This produces three shared "
    "pharmacological effects: <b>Analgesia · Antipyresis · Anti-inflammation</b>.",
    body
))

# ── Section 2: General Indications ───────────────────────────────────────────
story.append(Paragraph("2. General Indications of NSAIDs", section_heading))

gen_headers = ["#", "Indication", "Examples / Notes"]
gen_rows = [
    ["1",  "Mild-to-moderate pain (somatic)",         "Headache, dental, musculoskeletal, postoperative pain"],
    ["2",  "Fever (antipyresis)",                      "Second-line to paracetamol in some settings"],
    ["3",  "Inflammatory arthritis",                   "Rheumatoid arthritis (RA), ankylosing spondylitis (AS)"],
    ["4",  "Osteoarthritis (OA)",                      "Symptom relief; not disease-modifying"],
    ["5",  "Primary dysmenorrhea",                     "Inhibit uterine prostaglandin synthesis"],
    ["6",  "Acute gout",                               "Short-course NSAID therapy for acute flares"],
    ["7",  "Bursitis / Tendinitis",                    "Periarticular inflammation"],
    ["8",  "Migraine (acute)",                         "Especially naproxen (also combined with sumatriptan)"],
    ["9",  "Patent ductus arteriosus (PDA)",           "Indomethacin / Ibuprofen IV in neonates"],
    ["10", "Pericarditis",                             "Aspirin first-choice; ibuprofen second-line"],
    ["11", "Bartter syndrome",                         "Indomethacin reduces prostaglandin-driven renin overactivation"],
    ["12", "Antiplatelet / Cardioprotection",          "Low-dose aspirin (75-150 mg/day) only"],
    ["13", "Rheumatic fever",                          "High-dose aspirin (75-100 mg/kg/day)"],
    ["14", "Kawasaki disease",                         "High-dose aspirin acute phase → low-dose antiplatelet"],
    ["15", "Colorectal cancer / FAP prophylaxis",      "Aspirin (chemoprevention); sulindac / celecoxib (FAP)"],
    ["16", "Ophthalmic (post-op / seasonal allergy)",  "Ketorolac ophthalmic 0.5% drops"],
    ["17", "Juvenile idiopathic arthritis (JIA)",      "Naproxen, meloxicam, celecoxib"],
]
story.append(make_table(gen_headers, gen_rows, [0.6*cm, 5.5*cm, 8.5*cm]))

# ── Section 3: Preferred NSAID per Indication ─────────────────────────────────
story.append(Paragraph("3. Preferred NSAID for Each Indication", section_heading))

pref_headers = ["Indication", "Preferred NSAID", "Reason / Key Points"]
pref_rows = [
    ["Rheumatic fever",
     "Aspirin (high-dose 75-100 mg/kg/day)",
     "Only NSAID approved; anti-inflammatory + antipyretic"],

    ["Kawasaki disease",
     "Aspirin (30-100 mg/kg/day acute, then low-dose)",
     "Reduces coronary artery aneurysm risk"],

    ["Antiplatelet / Cardioprotection",
     "Aspirin (75-150 mg/day)",
     "Irreversible COX-1 inhibition → TXA2 suppression; unique to aspirin"],

    ["Pericarditis",
     "Aspirin (1st line); Ibuprofen (2nd line)",
     "Aspirin preferred esp. post-MI; ibuprofen for non-cardiac causes"],

    ["Primary dysmenorrhea",
     "Mefenamic acid (KDT preferred) / Naproxen",
     "Mefenamic acid blocks both PG synthesis AND PG receptors; also reduces menorrhagia"],

    ["Acute gout",
     "Indomethacin (traditional) / Naproxen",
     "Indomethacin most potent; naproxen equally effective, better tolerated"],

    ["Patent ductus arteriosus (PDA)",
     "Indomethacin IV (classical) / Ibuprofen IV",
     "Ibuprofen preferred due to fewer renal side effects in neonates"],

    ["Bartter syndrome",
     "Indomethacin",
     "Reduces prostaglandin-mediated renin-angiotensin overdrive in renal tubule"],

    ["Ankylosing spondylitis (AS)",
     "Indomethacin / Diclofenac / Celecoxib",
     "Indomethacin historically most effective; diclofenac / celecoxib for better tolerability"],

    ["Osteoarthritis (OA)",
     "Diclofenac topical or oral / Naproxen / Meloxicam",
     "Topical diclofenac for local OA (knee); celecoxib if high GI risk"],

    ["Rheumatoid arthritis (RA)",
     "Naproxen / Diclofenac / Celecoxib",
     "Symptom relief only; DMARDs used concurrently for disease modification"],

    ["Postoperative / Acute severe pain",
     "Ketorolac (IM / IV)",
     "Only parenteral NSAID for acute pain; opioid-sparing; max 5 days use"],

    ["Migraine (acute)",
     "Naproxen sodium / Aspirin",
     "Naproxen + sumatriptan combo available; aspirin effective in mild migraine"],

    ["Fever in children",
     "Ibuprofen",
     "Aspirin avoided in children (Reye syndrome risk); ibuprofen is drug of choice"],

    ["GI-risk patients needing NSAID",
     "Celecoxib (COX-2 selective)",
     "Significantly lower risk of GI ulcers/bleeding vs non-selective NSAIDs"],

    ["Juvenile idiopathic arthritis (JIA)",
     "Naproxen / Meloxicam / Celecoxib",
     "Well-studied in paediatric populations; naproxen most widely used"],

    ["Familial adenomatous polyposis (FAP)",
     "Celecoxib (FDA-approved adjunct) / Sulindac",
     "Sulindac causes polyp regression; celecoxib approved as adjunct to surgery"],

    ["Ophthalmic inflammation / Allergy",
     "Ketorolac 0.5% ophthalmic",
     "Post-cataract inflammation; seasonal allergic conjunctivitis"],
]
story.append(make_table(pref_headers, pref_rows, [4.5*cm, 4.5*cm, 5.6*cm]))

# ── Section 4: KDT Quick Reference Table ─────────────────────────────────────
story.append(Paragraph("4. KDT-Style Quick Reference — Individual NSAIDs", section_heading))

qr_headers = ["NSAID", "Class", "Unique / Preferred Indications"]
qr_rows = [
    ["Aspirin",         "Salicylate",                    "Antiplatelet, Rheumatic fever, Kawasaki disease, Pericarditis, low-dose TIA prophylaxis"],
    ["Indomethacin",    "Indole acetic acid",            "Acute gout, PDA closure (neonates), Bartter syndrome, AS"],
    ["Diclofenac",      "Phenylacetic acid",             "OA (topical/oral), RA, post-op pain, biliary/renal colic"],
    ["Mefenamic acid",  "Fenamate",                      "Dysmenorrhea (preferred in KDT), menorrhagia — blocks PG synthesis AND receptors"],
    ["Meclofenamate",   "Fenamate",                      "Dysmenorrhea, menorrhagia; rarely used now"],
    ["Ketorolac",       "Pyrrolizine carboxylic acid",   "Acute moderate-severe pain (IM/IV); post-op pain; ophthalmic drops — NOT for chronic use"],
    ["Ibuprofen",       "Propionic acid",                "Fever in children, OA, RA, mild-moderate pain; IV form for PDA"],
    ["Naproxen",        "Propionic acid",                "RA, OA, JIA, gout, migraine, AS; best cardiovascular safety profile among NSAIDs"],
    ["Celecoxib",       "Diaryl heterocycle (COX-2)",    "GI-high-risk patients, RA, OA, AS, FAP adjunct; avoid in sulfonamide allergy"],
    ["Sulindac",        "Indene acetic acid (prodrug)",  "FAP (polyp regression), OA, RA; spares renal prostaglandins more than others"],
    ["Piroxicam",       "Oxicam (enolic acid)",          "OA, RA; long t½ ~57 h → once-daily dosing; higher GI risk at >20 mg/day"],
    ["Meloxicam",       "Oxicam (partial COX-2)",        "OA, RA, JIA; once-daily; lower GI risk than indomethacin; t½ 15-20 h"],
    ["Etodolac",        "Pyranocarboxylic acid",         "OA, RA; some COX-2 selectivity; lower GI side effects"],
    ["Nabumetone",      "Non-acidic prodrug",            "OA, RA; converted to active acid in liver; lower GI ulcerogenicity"],
]
story.append(make_table(qr_headers, qr_rows, [3.2*cm, 3.8*cm, 7.6*cm]))

# ── Section 5: Special Points ─────────────────────────────────────────────────
story.append(Paragraph("5. Key Points to Remember (KDT Emphasis)", section_heading))

points = [
    "<b>Aspirin is the ONLY NSAID used as an antiplatelet agent</b> — irreversible COX-1 inhibition prevents TXA2 synthesis in platelets. All other NSAIDs are reversible inhibitors.",
    "<b>Indomethacin</b> is the most potent non-selective NSAID but has the worst CNS/GI side-effect profile (headache in ~25-50% patients, GI ulcers).",
    "<b>Mefenamic acid</b> is KDT's preferred drug for primary dysmenorrhea because it inhibits both prostaglandin synthesis AND prostaglandin receptor action.",
    "<b>Ketorolac</b> is the most potent NSAID analgesic available parenterally. Use is restricted to max 5 days (IM/IV) due to GI/renal toxicity.",
    "<b>Celecoxib (COX-2 selective)</b> has significantly lower GI ulcer risk but carries increased cardiovascular (MI) risk — use with caution in cardiac patients.",
    "<b>Naproxen</b> has the most favourable cardiovascular safety profile among all NSAIDs.",
    "<b>Aspirin in children</b> is contraindicated (Reye syndrome) EXCEPT in Kawasaki disease and Rheumatic fever.",
    "<b>Sulindac</b> is a prodrug — converted to active sulfide metabolite in liver; relatively spares renal prostaglandins (useful in mild renal impairment).",
    "<b>Fenamates (mefenamic acid, meclofenamate)</b> are unique in also blocking PG receptors — not just inhibiting synthesis.",
    "<b>COX-2 selective NSAIDs</b> (celecoxib) do NOT affect platelet TXA2 (only in platelets via COX-1), hence no antiplatelet effect.",
]

for p in points:
    story.append(Paragraph(f"• {p}", bullet_style))
    story.append(Spacer(1, 2))

story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="100%", thickness=1, color=BORDER))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "<i>Sources: KD Tripathi — Essentials of Medical Pharmacology (reference standard) | "
    "Katzung Basic &amp; Clinical Pharmacology 16th Ed. | "
    "Goodman &amp; Gilman's Pharmacological Basis of Therapeutics | "
    "Lippincott Illustrated Reviews Pharmacology</i>",
    note_style
))

doc.build(story)
print(f"PDF created: {OUTPUT}")

python /home/daytona/workspace/nsaids-pdf/generate_nsaids_pdf.py