Anti-Inflamatory Flashcards
Anitinflamatory drug classes
Corticosteroids
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Aspirin and nonacetylated salicylates
Cortisol Actions (5 items)
Level of awareness and sleep pattern Labile emotions Stimulates gluconeogenesis Stimulates protein catabolism Decreases proliferation of fibroblasts, leading to poor wound healing
Think of cortisol as a
stress hormone
Glucocorticosteroid inhibits
Inhibits immune and inflammatory systems
Depresses proliferation of T lymphocytes, decreases natural killer cell activity, reverses macrophage activity
Glucocorticosteroid
Increases circulating
erythrocytes
and appetite
Glucocorticosteroid promotes
Promotes fat deposits in the face and cervical areas
Promotes lipolysis in the extremities
Glucocorticoid increases
uric acid excretion
Glucocorticosteroid decreases
serum calcium levels
Glucocorticosteroid promotes gastric
Promotes gastric acid secretion
Glucocorticosteroid supresses
Suppresses secretion and synthesis of adrenocorticotropic hormone (ACTH)
Suppresses prostaglandin E production of growth hormone secretion
Glucocorticosteroid causes skeletl
Causes skeletal wasting
Glucocorticosteroid potentiates the
Potentiates the effects of catecholamines, thyroid hormone, and growth hormone on adipose tissue
Mineralcorticoids (Aldosterone) Actions
Retain sodium and water
Excrete potassium
Corticosteroids well absorbed
from the GI tract
Corticosteroids metabolized in and excreted by
Metabolized by the liver
Metabolites are active.
Cortisone is converted to hydrocortisone.
Prednisone is converted to prednisolone.
Excreted by the kidneys
Corticosteroids contraindications
Contraindicated in patients with active untreated infections
Corticosteroids Cautious use in Patients with
hypertension and cardiovascular disorders
Corticosteroids may elevate
blood pressure, salt and water retention, and increased excretion of potassium
Corticosteroids cautious use
in postmenopausal women and others at risk for osteoporosis
lot less risk in ___ compared to ___ for corticosteroids
short term use
long term use
Corticoseroids patients with diabetes
may have problems with glycemic control. (eleveted glucose)
corticosteroids patients with ulcerative colitis
or peptic ulcer disease may have increased risk of gastrointestinal (GI) bleed and perforation.
Corticosteroids: Adverse Drug Reactions (ADRs) - Muscle and skin
Atrophy and thinning, striae, hirsutism, poor healing
Muscle atrophy, truncal obesity, buffalo hump, moon facies
Corticosteroids: Adverse Drug Reactions (ADRs) - Skeletal Tissues
Osteoporosis (up to 20% of patients)
10% of persons on long-term therapy diagnosed with a fracture
Corticostroids can cause side effects that mirror what condition
cushing syndrome
Corticosteroids: Adverse Drug Reactions (ADRs) - eyes
Cataracts, glaucoma, ocular infections
Corticosteroids: Adverse Drug Reactions (ADRs) (continued) - GI
Peptic ulcer disease
Corticosteroids: Adverse Drug Reactions (ADRs) (continued) - Cardiovascular
Hypertension
Fluid and electrolyte disturbance
Corticosteroids: Adverse Drug Reactions (continued) - CNS
Delirium, agitation, insomnia, mood swings, and severe depression
Corticosteroids: Adverse Drug Reactions (continued) - Endocrine
Adrenal suppression
Withdrawal syndrome if abruptly stopped
Affects glucose metabolism
You do not have to taper corticosteroids if you are using them
less than 10 days
Adrenal insufficiency drugs of choice
hydrocortisone, cortisone, and prednisone
Give corticosteroids
in the morning before lunch, maybe before 0900
Inflammation drugs of choice
Methylprednisolone, prednisone, and triamcinolone or dexamethasone can be used.
Immune suppression drugs of choice
Prednisone is used because of its short half-life.
Different strength tablets make dosing and tapering easier
Rheumatoid arthritis (RA) first and second line drug
First-line therapy is NSAIDs.
Low-dose prednisone (less than 7.5 mg/day) can be used.
Corticosteroid Prophylaxis with a bisphosphonate and calcium/vitamin D will
will lower risk of osteoporosis.
Corticosteroids: Principles of Prescribing
To best match the natural body rhythm, daily doses are best taken in the morning before 9 a.m (earlier in the day, preferable in the morning with food) Body releases naturally occuring corticosteroids at this time
The initial dose depends on the specific disease being treated. Maintain or adjust the dose until an acceptable response is achieved
Corticosteroids: Principles of Prescribing - 3 and 4
After an acceptable response is achieved, determine the maintenance dose by tapering until the lowest dosage that maintains an adequate clinical response is reached.
If, after long-term therapy or because of spontaneous remission, the drug is to be stopped, taper off to prevent an adrenal insufficiency crisis. Tapering is generally not necessary after short-term therapy.
Corticosteroids: Principles of Prescribing - 5 and 6
Most conditions that require chronic corticosteroid therapy can be well controlled on alternate-day therapy. Twice the daily dose is given every other morning before 9 a.m.
Unlike a tapering schedule, alternate-day scheduling retains the same total steroid dose.
Corticosteroids
Short-acting agents are less likely to produce hypothalamic-pituitary-adrenal (HPA) axis suppression.
hypothalamic-pituitary-adrenal (HPA) axis suppression.
Long-acting agents are preferred if the effects of high doses must be sustained.
Corticosteroids Long-acting agents are preferred if
if the effects of high doses must be sustained.
Corticosteroids: Monitoring
Baseline and ongoing
Weight, electrolytes, glucose, and complete blood count (CBC) for all
Long-term or high-dose therapy require monitoring for GI bleeding
Lipids
Eye examination for cataracts and glaucoma in long-term therapy
Corticosteroids - Adminsitration
Administration
Instruct patient to take exactly as prescribed.
Explain alternate-day or tapered dosing.
Drug should not be abruptly discontinued.
Corticosteroids - Lifesytle
Need to wear medic alert bracelet
Diet high in potassium and calcium and low in sodium and carbohydrates
Caloric management
NSAIDs MOI
Inhibit cyclooxygenase (COX-1 and COX-2) activity, thus inhibiting prostaglandin synthesis
COX-1 is present in all
tissues and cells, especially platelets; endothelial cells; the GI tract; and renal microvasculature, glomeruli, and collecting ducts.
COX-2 is an
inducible” enzyme that is synthesized mainly in response to pain and inflammation.
NSAIDs are primarily used for ___ but also
pain and their anti-inflammatory activity.
Also effective antipyretic
