Anti Inflammatory Drugs

Question 1

What is the action of acetomenophen?

Answer 1

(Tylenol)

Reversibly inhibits Cox in the CNS- analgesic and anti-pyretic (inactive peripherally- not anti-inflammatory)

Question 2

What is the clinical use of acetomenophen?

Answer 2

anti-pyretic, anagesic
NOT anti-inflammatory
Used instead of aspirin for children with viral infection bc of Reyes syndrome

Question 3

What are the toxicities of acetomenophen?

Answer 3

hepatic necrosis (NAPQ1 metabolite depleates glutathione and forms toxic metabolites in the liver; treat with N-acetyl cysteine)

Question 4

What is the method of action of aspirin?

Answer 4

Irreversibly inhibits COX1/2 via acetylation

Decrease synthesis of TxA2 to increase bleeding time

Question 5

What is the clinical uses of aspirin?

Answer 5

Low dose (300 mg/day): anti-platelet
Medium dose (300-2400 mg/day): analgesic, anti-pyretic
High dose (2400-4000 mg/day): anti-inflamatory

Question 6

Toxicity of aspirin?

Answer 6

Gastric ulceration
Tinnitis
Chronic use –> acute renal failure, interstilial nephritis, GI bleeding
Reyes in kids
Respiratory alkalosis early followed by a metabolic acidosis for a mixed picture
Can treat with alkalization

Question 7

What is the mechanism of action of celecoxib?

Answer 7

reversible inhibition of COX2
Inflammatory cells and vasc endothelium to mediate inflammation and pain
(sparring of COX1 spares gastric mucosa and TxA2 function in platelets)

Question 8

When is celecoxib used?

Answer 8

osteoarthritis, rheumatoid arthritis

Question 9

What is the toxicity of celecoxib?

Answer 9

increased risk of thrombosis

sulfa allergy

Question 10

What is the mechanism of action for NSAIDS?

Answer 10

ibuprofen, naproxen, indomethicin

Reversible COX1/2 inhibition

Question 11

What are the clinical uses of NSAIDS?

Answer 11

anti-pyretic, anagesic, anti-inflammatory

Question 12

What are toxicities of NSAIDS?

Answer 12

Interstitial nephritis, gastric ulcers (prostaglandins protect gastric mucosa/COX1), and renal ischemia (prostaglandins dilate afferent arteriole)

Question 13

What are the mechanisms of bisphosphonates?

Answer 13

pyrophasphate analogs, bind to hydroxyappetite in bones and inhibit osteoclast action

Question 14

When are bisphosphonates used?

Answer 14

Osteoporosis, hypercalcemia, Pagets disease of the bone

Question 15

What are toxicities of bisphosphonates?

Answer 15

Corrosive esophagitis (take with water and stay upright for 30 mins)
osteonecrosis of the jaw

Question 16

What is the mechanism of action of teriparatide

Answer 16

recombinant PTH
increase osteoblast activity
given subcutaenously

Question 17

When is teriparatide used?

Answer 17

osteoporosis

Can increase bone growth as opposed to anti-absorptive therapies like bisphophanates

Question 18

What is the toxicity of teriparatide?

Answer 18

transient hyerpcalcemia

May increase risk of osteosarcoma

Question 19

What is a toxicity of TNF-a inhibitors?

Answer 19

reactivation of infection, esp TB

TNF-a is important for granuloma formation and stabilization

Question 20

What is the mechanisms of etanercept?

Answer 20

Fusion protein (receptor for Ig Fc + TNF-a) produced by recombinant DNA that acts as a decoy receptor for TNF-a

Question 21

When do you use etanercept?

Answer 21

Rhematoid arthritis, psoriasis, ankalosing spondylitis

Question 22

What is the mechanisms of action of infliximab or adalimumab?

Answer 22

Monoclonal antibody to TNF-a

Question 23

When would you use infliximab /adalimumab?

Answer 23

IBS, RA, psoriasis, ankalosing spondylitis