Anti-inflammatory

Question 1

Rapid onset, short duration, pain, heat, redness, swelling, loss of function, high fever, and innate immune response are typical of what type of inflammation?

Answer 1

Acute

Question 2

Delayed onset, long duration, absence of cardinal inflammatory signs, lymphocyte involvement with low grade fever are typical of which type of inflammation?

Answer 2

Chronic inflammation

*Also associated with a host of disease states

Question 3

What are three classes of therapeutic strategies based on severity and duration of inflammation?

Answer 3

1-Nonsteroidal anti-inflammatory drugs (NSAIDs)
2-Glucocorticoids
3-DMARDs (Disease modifying anti-rheumatic drug)

Question 4

What are 4 goals of anti-inflammatory treatment?

Answer 4

1-Decrease inflammation
2-Decrease pain
3-Arrest tissue damage
4-Maintain function

Question 5

What enzyme do NSAIDs provide non-specific inhibition for?

Answer 5

Cyclooxygenase (COX) enzymes

Question 6

Inhibitors of which enzyme are most often associated with GI upset, and are constitutive (platelets, kidney, GI, lungs)?

Answer 6

COX-1 enzyme

Question 7

Inhibitors of which enzyme do not inhibit platelet aggregation, may increase edema and hypertension and are constitutive in the kidney?

Answer 7

COX-2 enzyme

Question 8

CNS, Cardiovascular, GI, hematologic, hepatic, pulmonary, skin, renal and Reye syndrome are adverse effects common to what?

Answer 8

All NSAIDs

*Reye syndrome is caused by children taking salicylate after viral-induced illness

Question 9

Which drug is a non-selective COX-1 and 2 inhibitor, irreversibly binds COX enzyme, is rarely used as anti-inflammatory medication and is valued more for its anti-platelet aggregation effects?

Answer 9

Aspirin

*anti platelet aggregation effects at either 81 mg/day or 325 mg/every other day

Question 10

Which drug is a derivative of propionic acid, is an analgesic and antipyretic, anti-inflammatory, Interferes with antiplateley effect of low-dose aspirin, and has lesser side effects?

Answer 10

Ibuprofen

*high anti-inflammatory dose

Question 11

Similar to ibuprofen, what drug is available in slow-release formulation?

Answer 11

Naproxen (aleve)

Question 12

Celecoxib (celebrex) is an example of what type of drug that is analgesic, antipyretic and anti-inflammatory as well as having no effect on platelet aggregation and is used to treat osteoarthritis, rheumatoid arthritis as well as other pains?

Answer 12

COX-2 Selective inhibitor

*10-20X more selective for COX-2 than COX-1

Question 13

Which drug is used for mild-moderate pain or fever as an alternative to aspirin or ibuprofen but has no anti-inflammatory effects and effects the hypothalamus to induce sweating?

Answer 13

Acetominophen

*overdose results in hepatotoxicity

Question 14

Which class of drugs are steroid hormones that suppress immune activity by blocking phospholipase A2?

Answer 14

Glucocorticoids

Question 15

What is an example of a glucocorticoid that must be activated by hepatic metabolism?

Answer 15

Prednisone

*active form is prednisolone

Question 16

What group of drugs suppress the progression of the disease through their actions against underlying immunological abnormalities?

Answer 16

Non-biologic DMARDs (small molecules)

Question 17

What are the two main Non-biologic DMARDs (small molecules)?

Answer 17

1-Methotrexate

2-Azathioprine

Question 18

Which drug is the first line DMARD for RA, inhibits pro-inflammatory cells, can be life-threatening when taken with NSAIDs and is contraindicated in pregnancy?

Answer 18

Methotrexate

Question 19

Which drug suppresses DNA synthesis of rapidly proliferating cells like B-cell and T-cells, is used for transplant rejection prophylaxis and may cause bone marrow suppression and increased risk of infection?

Answer 19

Azathioprine (Imuran)

Question 20

What are two main biologic DMARDs (large molecules)?

Answer 20

1-T-cell modulators (abatacept)

2-TNFa-blocking agents (adalimumab)

Question 21

Which drug inhibits T-cell activation, and is used in RA patients who fail to respond to anti-TNFa therapy?

Answer 21

Abatacept (Orencia)

*$3,500-$3,800 a month

Question 22

Which drug prevents ligand from binding to TNFa receptor and is used in RA patients?

Answer 22

Adalimumab (humira)

Question 23

What are 5 different TNFa inhibiting biologic DMARDs?

Answer 23

Monoclonal antibody:
1-inflixamab (remicade)
2-adalimumab (humira)
3-certolixumab pegol (cimzia)
4-golimumab (simponi)
circulating receptor fursion protein:
5-etanercept  (Enbrel)