Anti-gout and anti inflammatory Flashcards
Inflammation
Protective response stimulated by injury to tissues
NSAID properties
Analgesic
Anti-inflammatory
Antipyretic
Aspirin caused platelet inhibition (only in aspirin
Uses of NSAIDs
Relief of mild to moderate headaches
Relief of myalgia
Relief of neuralgia
Relief of arthralgia
Relief of postoperative pain
Relief of pain associated with arthritic disorders such as rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, and osteoarthritis
Treatment of gout and hyperuricemia
Salicylates
Aspirin
Acetic acid derivatives
- Diclofenac Sodium
- Indomethacin sulindac
- Ketorolac
Cyclo-oxygenase (COX-2) inhibitors
Celecoxib
Propionic acid dereviatives
Ibuprofen and naproxen
Types of NSAIDs
Salicylates
Acetic acid derivatives
Cyclo-oxygenase (COX)-2 inhibitors
Enolic acid derivatives
Propionic acid derivatives
What is aspirin used for (heart)
Reduce cardiac death after MI, given at the first sign of an MI
NSAID MOA
Stops the leukotriene pathway, prostaglandin pathway or both. Blocking the chemical activity of the COX enzyme
What does COX-1 enzyme
Maintains the GI mucosa
What does COX2 do
Promotes synthesis of prostaglandins involved in the inflammatory process
MOA of aspirin
Irreversible inhibitor of COX-1 receptors in the platelets causing antiplatelet activates.
Which NSAID has antiplatelet activities
Aspirin is the only one
Contraindications of NSAIDS
Drug allergies and conditions that place the patient at risk for bleeding (rhinitis, vit k deficiency, peptic ulcer disease)
NSAID adverse effects
Heartburn to severe GI bleeding
Acute kidney injury
Noncardiogenic pulmonary edema
Altered hemostasis
Hepatotoxicity
Skin eruption, sensitivity reaction
Tinnitus, hearing loss
What is misoprostol
helps reduce adverse effects of NSAIDs (inactivation of prostaglandins).
- Helps prevent GI bleeds
- Inhibits gastric acid secretion and has a cytoprotective component
-CI in pregnancy
How does NSAID affect kidney function
- Through the disruption of prostaglandins causing kidney injury/failure
- Kidney toxicity can occur with patients with dehydration, heart failure, or liver dysfunction, or with the use of diuretics or angiotensin-converting enzyme inhibitors
Salicylates forms
- acetylsalicylic acid (aspirin) the most common
- Oral (tablets, capsules), topical cream (Aspercreme®), oral liquids, rectal suppositories
- aspirin–antacid combinations (Alka-Seltzer®)
- Enteric-coated aspirin (Praxis ASA EC®)
What can aspirin cause
Reye’s syndrome
Dosage of aspirin
81-325 mg and both effectively prevent thrombotic events
What is aspirin used for (not heart)
Headache, neuralgia, myalgia, and arthralgia
Pain syndromes resulting from inflammation: arthritis, pleurisy, and pericarditis
Systemic lupus erythematosus: antirheumatic effects
Antipyretic action
Why does aspirin help systemic lupus erythematosus
Because of its antirheumatic effects
How does reye’s syndrome occur
Triggered by viral illnesses and when one takes salicylate with the presences of a viral illness
What is reye’s syndrome
Progressive neurological deficits that can lead to coma and may involve live damage. May cause permanent neurological damage
Salicylate toxicity aka…
- salicylism
Increased heart rate
Tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, drowsiness
Nausea, vomiting, diarrhea
Sweating, thirst, hyperventilation, hypoglycemia or hyperglycemia
Indomethacin properties
Analgesic, anti inflammatory, antirheumatic and antipyretic properties that
Uses of indomethacine
RA, osteoarthritis, acute bursitis or tendonitis
Ketorolac tromethamine
- Some anti-inflammatory properties
- Mostly an analgesic
Indication of Ketorolac tromethamine
Used for short term use (up to 5-7 days) to manage pain
Adverse effects of ketorolac tromethamine
kidney impairment, edema, GI pain, dyspepsia, and nausea
Propionic acid derivatives Ibuprofen uses
Uses: analgesic, management of RA, osteoarthritis, dysmenorrhea, dental pain, MSK disorder and antipyretic
Propionic acid derivatives Naproxen uses
- A little better than adverse effects of ibuprofen
- Few drug interactions of ACE< and hypertension
COX-2 inhibitor:Celecoxib
- Only COX-1 inhibitor, used for osteoathritus, RA, acute pain sympotms, ankylosing spondylitis, and primary dysmenorrhea, little effect on platelet function
- Not to be used in patient siwht a known sulpha allergy
Nabumetone compared to other GI adverse events and some NSAID…
Nabumetone is better
NSAID adverse effects GI
Dyspepsia, heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal pain
GI bleeding*
Mucosal lesions* (erosions or ulcerations)
Misoprostol on NSAID GI adverse effects
Misoprostol can be used to reduce adverse effects.
Misoprostol on NSAID Renal adverse effects
Reduction in creatinine clearance, acute tubular necrosis with acute kidney injury
Misoprostol on NSAID cardiovascular adverse effects
Noncardiogenic pulmonary edema
NSAID interactions
Alcohol
Anticoagulants
acetylsalicylic acid (ASA)
Biphosphonates
Corticosteroids and other ulcerogenic medications
Protein-bound drugs
Diuretics and angiotensin-converting enzyme inhibitors
Other drugs
What is Gout
Underexcretion or overexcretion(hyperuricemia) of uric acid causing uric acid to deposited in tissues, joints causing pain
Antigout drugs
Allopurinol, colchicine, probenecid
Indications of allpurinol
Prevent uric acid production and prevent acute tumour lysis syndrome
Side effects of allopurinol
exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis
Indication ofProbenecid
Inhibits reabsorption of uric acid in the kidneys and thus getting rid of more uric acid
Indications of Colchicine
- Reduces inflammatory response to the deposits of urate crystals in joint tissue
- Also may cause short term leukopenia as it can inhibit mitosis
Dose of colchicine and why
Dose of 0.6mg once or twice a day for prophylaxis of acute attacks
how do you take colchicine
on empty stomach
Herbal products
Glucosamine and chondroitin
Glucosamine and chondroitin use
Treat pain of osteoarthritis
Glucosamine Adverse effects
Gi discomfort, drowsiness, headache, skin reactions
Chondroitin adverse effect:
GI discomfort (normally well tolerated)
Drug interactions of glucosamine and chondroitin
- Enhances effects of warfarin
- Glucosamine may increase insulin resistance
Why shouldn’t one give salicylates to children and teenagers
May risk reye’s syndrome
How long may till occur therapeutic effects
1 week or more
What should patients watch for when on NSAIDs
