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Pharmacology > 24. Anti-inflammatories > Flashcards

24. Anti-inflammatories Flashcards

1
Q

Name 3 prototypes of NSAIDs

A
  • salicylates (Aspirin or ASA)
  • propionic acid derivatives (Ibuprofen)
  • selective COX-2 inhibitors (Celecoxib)
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2
Q

Name 1 prototype of immune modulators

A

Infliximab

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3
Q

Name 1 prototype of uric acid biosynthesis inhibitors

A

Allopurinol

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4
Q

Name 3 chemical mediators released after tissue injury

A
  • histamines
  • kinins
  • prostaglandins
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5
Q

5 Cardinal Signs of inflammation

A
  • erythema (vasodilation)
  • edema (increased membrane permeability)
  • heat (vasodilation)
  • pain (stretching of pain receptors and chemical mediators)
  • loss of function (due to pain and swelling)
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6
Q

enzyme responsible for converting arachidonic acid into prostaglandins

A

cyclooxygenase (COX)

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7
Q

COX-1 vs COX-2 enzymes

A
  • COX-1: protects stomach lining, decreases fever, promotes clotting
  • COX-2: triggers pain and inflammation
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8
Q

What is caused by Aspirin and NSAIDs when they inhibit both COX-1 and COX-2 enzymes?

A
  • inhibit COX-1: loss of stomach lining -> ulcers; prevent clotting
  • inhibit COX-2: reduces pain and inflammation
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9
Q

What is the function of 2nd generation NSAIDs?

A
  • inhibit COX-2: reduces pain and inflammation

- does NOT inhibit COX-1: protects stomach lining and promotes clotting

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10
Q

list 4 general uses for anti-inflammatories

A
  • inflammation
  • pain
  • fever
  • anticoagulant (anti-platelet)
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11
Q

How is Aspirin used differently than other NSAIDs?

A
  • used as an anti-platelet in cardiac/CVA patients
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12
Q

T/F: ASA can be taken with other NSAIDs

A

False; ASA and NSAIDs reduce each others effects

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13
Q

What form does ASA come in?

A
  • enteric-coated pills -> absorbed later in GI system to prevent stomach ulcers
  • can come in regular tablets for those who can’t take full pills (can be crushed)
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14
Q

MOA of Aspirin (ASA)

A
  • inhibition of prostaglandin synthesis

- inhibition of hypothalamic heat-regulator

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15
Q

Uses for Aspirin

A
  • reduce pain/inflammation/fever
  • inhibit platelet aggregation
  • osteoarthritis
  • RA
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16
Q

Adverse reactions for Aspirin

A
  • tinnitus
  • GI bleed/hemolytic anemia
  • agranulocytosis
  • thrombocytopenia
  • hepatotoxicity
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17
Q

syndrome linked to viral illness in children (ex. chickenpox/influenza) and administration of Aspirin

A

Reye’s syndrome

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18
Q

Sxs of Reye’s syndrome

A
  • vomiting
  • lethargy
  • delirium
  • coma
19
Q

How are Ibuprofen and Naproxen different from older NSAIDs?

A
  • stronger than ASA but less GI irritation

- highly protein bound (risk for drug interactions)

20
Q

MOA of Ibuprofen

A
  • inhibition of prostaglandin synthesis -> relieving pain and inflammation
21
Q

Uses for Ibuprofen

A
  • reduce inflammatory process
  • relieve pain
  • reduce fever
  • arthritic conditions
22
Q

Adverse reactions for Ibuprofen

A
  • hearing loss/tinnitus
  • anemia (LT)
  • neutropenia (LT)
  • thrombocytopenia (LT)
  • nephrotoxicity (LT)
  • anaphylaxis (LT)
23
Q

1 contraindication for Ibuprofen

A

CABG (increased risk of another MI due to effect in another area of the clotting system)

24
Q

What is the only selective COX-2 inhibitor (2nd generation NSAID) and what is it the drug of choice for?

A
  • Celecoxib

- used for severe arthritis

25
Q

MOA of Celecoxib

A
  • inhibits COX-2 -> inhibits prostaglandin synthesis and inflammation
  • does not inhibit COX-1
26
Q

Uses of Celecoxib

A
  • osteoarthritis
  • RA
  • moderate/severe pain
  • ankylosing spondylitis
27
Q

Adverse reactions for Celecoxib

A
  • peripheral edema
  • bleeding
  • HTN
  • CVA (LT)
28
Q

What are DMARDs and what are they used for?

A
  • disease modifying anti-rheumatic drugs
  • include immunosuppressives, immunomodulators, and antimalarials
  • used to control immune-mediated pain when NSAIDs don’t work
29
Q

MOA of Infliximab

A
  • binds to TNF and blocks it from attaching to receptors on synovial cell surface
  • reduces infiltration of inflammatory cells and delays inflammatory process
30
Q

Uses for Infliximab

A
  • RA
  • psoriatic arthritis
  • spondylitis
  • ulcerative colitis
  • Crohn’s disease
  • psoriasis
31
Q

Adverse reactions for Infliximab

A
  • severe infections
  • BP changes
  • seizures
  • elevated liver enzymes
  • Steven-Johnson syndrome
  • anemia
32
Q

Contraindication for Infliximab

A

heart failure

33
Q

What should be considered before starting a pt on Infliximab?

A
  • medication is an immune suppressant (can lead to infection)
  • review pt’s infection risk
  • make sure they are up to date on all immunizations (especially attenuated virus vaccines before starting)
34
Q

serious disorder (usually dug induced) that causes flu symptoms and a painful rash that spread and blisters on the skin and mucous membranes

A

Steven-Johnson syndrome (SJS)

35
Q

more severe form of SJS that causes damage to more than 30% of the skin surface and mucous membranes

A

toxic epidermal necrolysis (TEN)

36
Q

What should be done to help during a gout attack?

A
  • increase fluid intake

- avoid foods high in purines (organ meats, liver, gravy, and beer)

37
Q

MOA of Allopurinol

A

inhibits final step of uric acid synthesis -> lowers serum uric acid levels

38
Q

Uses of Allopurinol

A
  • prophylactic for gout
  • chronic tophaceous gout
  • NOT used for acute gout attack
39
Q

Adverse reactions for Allopurinol

A
  • hepatic impairment
  • angioedema
  • hyperglycemia
  • hyperlipidemia
40
Q

Side effects of Aspirin hypersensitivity or overdose

A
  • tinnitus
  • dizziness
  • bronchospasm
  • flushing/sweating
  • headache
41
Q

Pt teaching for Aspirin

A
  • do NOT give ASA to children w/ flu-like sxs (Reye’s)

- take ASA w/ food or fluids (prevents GI distress)

42
Q

Pt teaching for Ibuprofen

A
  • do NOT take ASA w/ Ibuprofen or other NSAIDs
  • pregnant women should not take NSAIDs (may cause congenital defects)
  • take NSAIDs w/ food or fluids (prevents GI distress)
43
Q

Pt teaching for Inflixmab

A

advise pt not to receive live vaccines while taking Infliximab

44
Q

Normal therapeutic range of ASA

A

15-30 mg/dL

Pharmacology (22 decks)

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