Anti-inflammatory and Immunosuppressant Drugs Flashcards
What are the different types of anti-inflammatory drugs? (4)
- Steroidal anti-inflammatory drugs
- NSAIDs
- Non-selective NSAIDs
- COX-2 Inhibitors
Where is the mechanism of actions of NSAIDs?
NSAIDs inhibit the production of prostaglandins from arachidonic acid by COX enzymes
What type of affects does aspirin have on the body? (3)
- Analgesic
- Anti-inflammatory
- Anti-thrombotic
Where is aspirin metabolised and excreted?
Metabolised in the liver and excreted through the kidneys
Which patients should avoid aspirin?
- With liver disease
- On dialysis
How does aspirin affect platelets?
Permanently affects platelet cohesiveness for the entire life span of the platelets (10-14 days)
How does aspirin affect primary homeostasis?
Prolongs bleeding time
Give some examples of non-selective NSAIDs (5)
- Ibuprofen
- Naproxen
- Diclofenac
- Mefenamic acid
- Indomethacin
What type of affects do non-selective NSAIDs have on the body? (3)
- Analgesic
- Anti-inflammatory
- Antipyretic actions
What do non-selective NSAIDs inhibit?
- Inhibit both COX-1 and COX-2
- Inhibition of COX-1 accounts for NSAIDs side effects and toxicity
- Inhibition of COX-2 accounts for anti-inflammatory actions
What are some side effects of NSAIDs? (4)
- Gastric irritability
- Platelet dysfunction
- Acute renal failure
- Leukotriene overproduction (leading to bronchoconstriction)
Give 2 examples of COX-2 inhibitors
- Celecoxib
- Etoricoxib
Give 3 Antimitotic agents
- Azathioprine
- Cyclophosphamide
- Chlorambucil
Give 2 Calcineurin inhibitors
- Ciclosporin
- Tacrolimus
What do Antimitotic agents do?
Inhibit cell division
What do Calcineurin inhibitors do?
Inhibit macrophages and T cell interaction
Give 3 Biological response modifiers
- Adalimumab
- Infliximab
- Etanercept
What is the mode of action of corticosteroids? (2)
- Anti-inflammatory action
- Immunosuppressive action
What is the mechanism of action of corticosteroids? (2)
- Reduces inflammatory reaction by limiting the capillary dilatation and permeability of the vascular structures
- Restrict the accumulation of polymorphonuclear leukocytes and macrophages and reduce the release of vasoactive kinins
When would you use corticosteroids? (5)
- Primary or secondary adrenocortical insufficiency
- Autoimmune atrophy (ie arthritis)
- Connective tissue disease
- Leukemias
- Inflammatory bowel disordes
What measurements need to be found out before corticosteroid use? (5)
- Blood pressure
- Body weight
- Height
- HbA1c, triglycerides and potassium
- Eye assessment
What are some endocrine side effects of corticosteroids? (3)
- Adrenal insufficiency
- Weight gain
- Diabetes Mellitus
What are some GI side effects of corticosteroids? (4)
- Peptic ulceration
- Haemorrhage
- Abdominal distension
- Oesophageal ulceration
What are some psychiatric side effects of corticosteroids? (4)
- Confusion
- Irritability
- Delusions
- Suicidal thoughts
What are some musculoskeletal side effects of corticosteroids? (2)
- Osteoporosis
- Proximal Myopathy
What is a cardiovascular side effects of corticosteroids? (3)
Hypertension
What are some ophthalmic side effects of corticosteroids? (3)
- Glaucoma
- Cataract
- Blurred vision
What are some skin side effects of corticosteroids? (3)
- Thinning of skin
- Easy brushing
- Delayed wound healing
How can you minimise side effects of corticosteroids? (3)
- Prescribe low effective dose for the minimum time possible
- Withdraw from treatment gradually
- Take corticosteroids in the morning and on alternate days
What should you prescribe to someone with high risk of GI bleeding when they’re taking corticosteroids?
Prescribe a proton pump inhibitor for gastrointestinal protection
What type of affects does Azathioprine have on the body? (2)
- Immunosuppressive
- Antimetabolite
What is the mechanism of action for Azathioprine?
Inhibits purine and DNA synthesis necessary for the proliferation of cells, especially leukocytes and lymphocytes
What is Azathioprine used to manage? (6)
- Rheumatoid arthritis
- Preventing renal transplant rejection
- Crohn’s disease
- Recurrent oral ulceration
- Behçet’s disease
- Colitis
What pre-treatment screen needs to be carried out before Azathioprine is prescribed?
Thiopurine methyl transferase test
What are some side effects of Azathioprine? (5)
- Myelosuppression
- Hepatotoxicity
- Leucopenia
- Thrombocytopenia
- Infections
What are some side effects of Ciclosporin? (6)
- Hypertension
- Nephrotoxicity
- Neurotoxicity
- Gingival hypertrophy
- Lymphoproliferative disorders
- Malignancies
What is Mycophenolate mofetil?
Antibiotic substance derived from Penicillium stoloniferum
What does Mycophenolate mofetil do? (2)
- Blocks biosynthesis of purine nucleotides by inhibiting inosine monophosphate dehydrogenase
- Prevents the proliferation of T-cells, lymphocytes and the formation of antibodies from B-cells
What are some side effects of Mycophenolate mofetil? (6)
- Fever
- Hyperglycaemia
- Hypertension
- Easy bruising / Bleeding
- GI bleed
- Depression
What do biological response modifiers do?
Act directly to neutralise specific target immune components
What are some things biological response modifiers are used to treat? (5)
- Rheumatoid arthritis
- Ankylosingspondylitis
- Psoriasis
- Crohn’s disease
- Malignancies
Give some examples of biological response modifiers (3)
- Adalimumab
- Infliximab
- Etanercept
What is the mechanism of action for biological response modifiers?
TNF-alpha inhibitors
