Anti-inflammatory Flashcards
Aspirin
reversible acetylation of COX
low dose –> COX 1
high dose –> both COX 1 &2
is an ETC uncoupler–> decreasing ATP
What is the treatment of Aspirin overdose?
activated charcoal
alkalization of urine
What are the side effects of Aspirin ?
decrease gastric mucosa--> ulcerations GI bleeding increased bleeding time afferent arteriole vasoconstriction renal papillary necrosis increase lithium concentration hyperkalemia- hypoaldosteronism
metabolic acidosis with respiratory alkalosis
tinnitus
What is the adverse affect in Children with viral illnesses?
Reyes syndrome -encephalopathy , hepatic dysfunction
Who is contraindicated for NSAIDS
renal insufficiency
pregnant -trimester 3 ( indomethacin, ibuprofen )
Celecoxib
selective COX 2 inhibitor
decreases GI ulcers and bleeding
increases platelet aggregation
is a sulfa drug
Acetaminophen
inhibits COX 2
is antipyretic & analgesic
no anti platelet action, safe in asthma, safe in gout, no uncoupling
What is the side effect with acetaminophen ?
overdose
hepatotoxic - P450 inducer,, alcohol, phenobarbital
NAPQI–>glutathione ( acetaminophen inhibits this process) –> increased NAPQI which causes damage to lier cells
What is the treatment for acetaminophen toxicity ?
N- acetylcyesteine (first 10 hrs)
charcoal
What treats acute gout?
NSAIDS
Glucocorticoids
Colchicine
Allopurinol & Febuxostat
inhibit xanthine oxidase
for long term use
tx: leech Nyann syndrome
Colchicine
tx: pain
microtubule polymerization that disrupts cytoskeleton of neutrophils –> decreased migration , phagocytosis, degranulation
What are the side effects of colchicine?
Diarrhea & vomiting
Characteristics of pseudo-gout
increase calcium pyrophosphate
positive rhomboid shaped bifringent crystals
What other disease cause uric acid crystals?
lymphomas
lymphoblastic leukaemia
What are the side effects of xanthin oxidase inhibitors?
decrease breakdown of 6 mercaptopurine & azathioprine –> toxicity (rash)
Steven johnson syndrome
DRESS syndrome - eosinophilia
Probenecid
increase the rate of excretion of uric acid
decrease the reabsorption of filtered rate
aids in the retention of antibiotics
for long term use only
What are the side effects of probenecid ?
sulpha allergy
urate renal stones
How does aspirin affect uric acid?
at high doses it acts as probenecid and decreases its reabsorption
at low doses it inhibits uric acid excretion
Pegloticase
used in chronic management
turns uric acid into water soluble form (allantoin )
IV administered
Side effect of pegloticase
cause hemolysis in G6PD
anaphylaxis
Rasburicase
tx: hyperurecemia in tumor lysis syndrome
What are the dietary restriction when a patient has gout?
redmeats
beer
seafood
fructose containing beverages
What foods and drink reduce gout?
cherries
whole grains
coffee
