\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{happyfeet2020}
\pdfinfo{
  /Title (nsaid-pharmacology.pdf)
  /Creator (Cheatography)
  /Author (happyfeet2020)
  /Subject (NSAID Pharmacology Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{F2C01B}
\definecolor{LightBackground}{HTML}{FEFBF0}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{NSAID Pharmacology Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{happyfeet2020} via \textcolor{DarkBackground}{\uline{cheatography.com/144934/cs/31540/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}happyfeet2020 \\
  \uline{cheatography.com/happyfeet2020} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 13th April, 2022.\\
   Updated 12th April, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{How Do NSAIDs Work?}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{NSAIDs have anti-inflammatory, antipyretic, analgesic and anti-platelet properties.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Goal is to inhibit the cox-mediated generation of pro-inflammatory eicosanoids and to limit extent of inflammation, pain and fever.} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{They do this by blocking the site in cyclooxygenase enzyme in which substrate arachidonic acid binds to} \tn 
% Row Count 8 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Most NSAIDs are metabolized in the liver by oxidation and conjugation to inactive metabolites which are typically excreted in urine \newline *patient sensitive to one NSAID may be sensitive to any other NSAID. Studies show that meloxicam can be a good option for NSAID intolerant patients}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{COX-1 Function}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Contributes to homeostasis} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Ongoing constitutive physiologic "house keeping", vascular homeostasis, maintenance of renal, myocardial and GI blood flow, platelet function, intestinal mucosal proliferation, antithrombogenesis} \tn 
% Row Count 5 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{COX-1 Inhibition}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Decreases mucosal defense} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Increase GI acid, and decreases GI mucus} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Decreases HCO2 secretion} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Decreases mucosal blood flow} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Special Consideration for NSAIDs}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{1. Both ibuprofen and naproxen may reduce the effects of furosemide (diuretic) and may reduct the effectiveness of several antihypertensive agents} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{2. Indomethacin is the NSAID most likely to cause nephrotoxicity} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{COX 2 Inhibitors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Due to sometimes severe GI adverse effects associated with long-term NSAID therapy, selective cox 2 inhibitors are used} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Inhibition of the chemical mediators responsible for inflammation while maintaining the cytoprotective effects of the products of COX-1 activity} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Meloxicam} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Inhibition of COX-2 may generate some problems in wound healing, angiogenesis and the resolution of inflammation} \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lower GI and renal problems} \tn 
% Row Count 11 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Cox 2 may induce hypertension, renal failure and cardiac failure} \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Naproxen has some cardioprotective properties} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.18988 cm} x{2.78712 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Contraindication for NSAIDs}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Reye's Syndone}} & For patients under 18 years old \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{5.377cm}}{{\bf{ Pregnancy }}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{Compromised Renal Function}} & NSAIDs reduce renal blood flow and therefore may further reduce renal function which may have an impact on the effects of concurrent meds and elimination of the NSAID and other meds and toxins \tn 
% Row Count 12 (+ 9)
% Row 3
\SetRowColor{white}
{\bf{ Compromised Liver Function}} & Most NSAIDs are metabolised in liver \tn 
% Row Count 14 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{Hypersensitivity}} & Happens more in asthmatics \tn 
% Row Count 16 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{COX 2 Function}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Works at the site of pain and inflammation} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Source of prostacyclin- platelet stability/dilate blood vessels} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{COX 2 Inhibition}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Decrease pain and inflammation} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Increases CV risk as it shifts the balance between platelet production TxA2 and PGI2, predisposing to platelet aggregation, thrombus formation  and vasoconstriction} \tn 
% Row Count 5 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Salicylates}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Includes Aspirin which acts in an irreversible manner by acetylating the active site serine residue in both COX-1 and COX-2} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Daily low dose aspirin is used as an anti-thrombogenic agent for prophylaxis and post event management of MI and stroke} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Aspirin is antithrombogenic because of its irreversible inhibition of COX, which prevents platelets from biosynthesizing TxA2} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Within an hour of aspirin, the effects of COX-1 activity on newly formed platelets is irreversibly destroyed (acetylated) therefore TXA2 cannot be produced} \tn 
% Row Count 13 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{A single administration of aspirin decreases for several days the amount of thromboxane that can be generated, shifting the vascular TxA2-PGI2 balance toward PGI2 mediated vasodilation, platelet inhibition, and antithrombogenesis} \tn 
% Row Count 18 (+ 5)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Long term use of aspirin can lead to GI ulceration and hemorrhage, nephrotoxicity and hepatic injury} \tn 
% Row Count 20 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Two unique toxicities of aspirin: induced airway hyperactivity in asthmatics and reye's syndrome} \tn 
% Row Count 22 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{NSAID Drug to Drug Interaction}}  \tn
% Row 0
\SetRowColor{LightBackground}
Wendy's LAMP & mnemonic for remembering drug interactions \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Warfarin}} & May increase risk of bleeding- Monitor PT and INR \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Lithium}} & May increase lithium plasma levels and decrease its clearance renally- need to monitor \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
{\bf{ACE Inhibitors}} & may decrease antihypertensiuve effects so need to monitor BP and CV function \tn 
% Row Count 11 (+ 3)
% Row 4
\SetRowColor{LightBackground}
 & NSAIDs increase BP and decrease affects of diuretics, ACE inhibitors and ARB which all relax blood vessels as NSAIDs inhibit cox-2 in kidneys which decreases sodium excretion due to a decrease in prostaglandins \tn 
% Row Count 19 (+ 8)
% Row 5
\SetRowColor{white}
 & NSAIDs may increase fluid retention and decrease blood flow to the kidneys as they block prostaglandins which dilate blood vessels and allow O2 to reach kidneys \tn 
% Row Count 25 (+ 6)
% Row 6
\SetRowColor{LightBackground}
{\bf{Methotrexate}} & May lead to an increase in methotrexate toxicity- don't administer within 10 days of high dose methotrexate \tn 
% Row Count 29 (+ 4)
% Row 7
\SetRowColor{white}
{\bf{Probenecid}} & May lead to reversal or uricosuric effects \tn 
% Row Count 31 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Non-Selective COX 1 and COX 2 Inhibition}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{GI irritation due to decreased protection of gastric mucosa.- N\&V, GI ulcer, diarrhea} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Skin reactions - mild rash, hives, photosensitivity} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Inhibition of platelet function- increase risk of bleeding} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Decreased renal blood flow- decreases GFR can cause renal ischemia- look out for pts w/ renal disease} \tn 
% Row Count 9 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{CVD risk} \tn 
% Row Count 10 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Respiratory- bronchospasm- look out for asthmatic pts} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Risk Factors for GI complications}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Over 60 in age} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{history of peptic ulcer} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{use of anti coagulants or corticosteroids} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{History of pylori infection} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{High NSAID dose or use of two NSAIDs} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Severe illness} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.9908 cm} x{2.9862 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Reducing GI risks}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Misoprostol}} & Synthetic prostaglandin- Protects gastric mucosa from irritation \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Protein Pump Inhibitors}} & Long lasting reduction of gastric acid production \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & Drugs end in -"prazole" \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{H2 Receptor Antagonists}} & Blocks the action of histamine on parietal cells in the stomach decreasing the production of acid by these cells \tn 
% Row Count 12 (+ 5)
% Row 4
\SetRowColor{LightBackground}
 & Drugs end in -"dine" \tn 
% Row Count 13 (+ 1)
% Row 5
\SetRowColor{white}
 & Not enough evidence that these alone will work in reducing GI issues \tn 
% Row Count 16 (+ 3)
% Row 6
\SetRowColor{LightBackground}
{\bf{COX-2 Inhibitor}} & Allow continued protective COX-1 function \tn 
% Row Count 18 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Acetaminophen}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Not an NSAID} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Has analgesic and antipyretic effects similar to aspirin} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{anti-inflammatory effects are insignificant because of its weak inhibition of COX} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{May be a third functional COX isoform (COX-3)} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{MOA believed to involve the prostaglandin pathways within the CNS with little influence on peripheral prostaglandin synthesis} \tn 
% Row Count 9 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Adverse effect= hepatotoxicity as it is metabolized by hepatic cytochrome p450 enyzmes which produces a reactive molecule which is normally detoxified by conjugation with glutathione. An overdose of acetaminophen can overwhelm glutathione stores, leading to cellular and oxidative damage and in severe cases to acute hepatic necrosis} \tn 
% Row Count 16 (+ 7)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{4000mg daily limit for adults. For those who are alcoholics or multiple medication patients and patients with liver disorders, even doses within the therapeutic range may be hepatotoxic} \tn 
% Row Count 20 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}