Anti-inflammatory drugs

Question 1

NSAIDs are like which drug?

Answer 1

Aspirin like

Question 2

What do NSAIDs inhibit?

Answer 2

COX enzyme
Prostaglandin synthesis
Thromboxane synthesis

Question 3

NSAIDs inhibit COX, prostaglandins and thromboxanes. What affects do NSAIDs have on blood vessels?

Answer 3

Vasodilation

Increased vascular permeability

Question 4

What do COX enzymes do?

Answer 4

Synthesise prostaglandins, which cause inflammation

NSAIDs - inhibit COX

Question 5

What are NSAIDs used to treat?

Answer 5

Pain, inflammation and fever

Question 6

What do anti-inflammatories do?

Answer 6

Prevent prostaglandin and prostacyclin synthesis

Cause vasodilation - oedema

Question 7

What do analgesics do to cause pain relief?

Answer 7

Inhibit prostaglandin

Decreases sensitivity of nociceptive nerve endings to inflammatory mediators

Question 8

Give an example of an inflammatory mediator

Answer 8

Bradykinin

Question 9

When are prostaglandins produced? What do they cause?

Answer 9

In response to injury or infection - causes inflammation and fever

Question 10

Antipyretics reduce fever by reducing prostaglandin. What releases prostaglandins in the CNS? How does prostaglandin cause fever?

Answer 10

IL-1 releases prostaglandins in CNS

Prostaglandins raise hypothalamic set point of temperature

Question 11

What type of enzyme is COX1? What is it involved with?

Answer 11

Constitutive enzyme

Homeostasis

Question 12

What type of enzyme is COX2? Where is it produced? What is it responsible for?

Answer 12

Induced enzyme
In inflammatory cells
Responsible for prostanoid-mediators of inflammation

Question 13

NSAIDs work by inhibiting COX and prostanoid (prostaglandin, thromboxane) synthesis. Do NSAIDs inhibit COX1 or COX 2? What is the significance of this?

Answer 13

Either or both
Inhibiting COX 2 causes anti-inflammatory. antipyretic and analgesic effects
COX 1 causes side effects
Drugs that are specific COX 2 inhibitors aren’t very common yet

Question 14

How are NSAIDs administered? Why are they given like this, and not as injections?

Answer 14

Oral -weak acids easily absorbed from GI tract

Injectable solutions tend to be alkaline - painful

Question 15

NSAIDs are distributed by binding to which protein?

Answer 15

Albumin

Question 16

How are NSAIDs eliminated?

Answer 16

Urine and faeces

Question 17

When are adverse effects of NSAIDs experienced?

Answer 17

When using large doses for a long period of time

Question 18

Can be paracetamol be used in cats and dogs?

Answer 18

Dogs only- with care

Question 19

Is ibuprofen used in small animals?

Answer 19

No - not licensed as too many adverse effects

Question 20

Which NSAID drugs cause poisoning in small animals?

Answer 20

Aspirin
Paracetamol
Ibuprofen

Question 21

What are the adverse affects of using NSAIDs such as ibuprofen, paracetamol and aspirin in small animals?

Answer 21

Toxicity - renal and hepatic
GI ulceration
CNS depression
Circulatory disturbances

Question 22

How does NSAID use cause gastric ulceration?

Answer 22

Inhibit prostaglandins
Prostanglandins protect mucosa and inhibit gastric acid secretion
NSAIDs = decreased gastric mucosal production and increase gastric acid production

Question 23

When are NSAIDs contraindicated?

Answer 23

Renal, liver, cardiac impairment
Pregnancy
If taking glucocorticoids- don’t use NSAIDs and glucocorticoids together!

Question 24

Why should NSAID use be very careful in cats?

Answer 24

Cats lack the enzymes required that safely metabolise the drug

Question 25

How does aspirin work? (What enzyme does it affect)

Answer 25

COX 1 inhibitor | less side effects

Question 26

What does aspirin cause?

Answer 26

Anti-inflammation and anti-thrombotic effects

Question 27

Aspirin itself is inactive but is metabolised to an active form. What is its active form?

Answer 27

Salicylic acid

Question 28

What are the adverse effects of aspirin? (Fewer than other NSAIDs as COX 1 inhibitor)

Answer 28

GI upset Vomitting Ulceration Anorexia

Question 29

Why should aspirin not be given before surgery?

Answer 29

Antithrombotic effects - could cause haemorrhage

Question 30

What is the only licensed NSAID drug in cats? How does it work?

Answer 30

Meloxicam | COX 2 inhibitor

Question 31

What is meloxicam used for? Where is it metabolised?

Answer 31

Acute/chronic pain and inflammation | Liver

Question 32

How does firocoxib work? What is it used to treat?

Answer 32

Selective COX-2 inhibitor | Acute or chronic pain and inflammation

Question 33

Where is firocoxib metabolised and excreted?

Answer 33

Metabolised in liver | Excreted in faeces

Question 34

What is the drug commonly known as bute? What does it inhibit?

Answer 34

Phenylbutazone | COX 1 AND COX 2

Question 35

Why is phenylbutazone popular in dogs and horses?

Answer 35

Cheap Very effective pain killer and local anti-inflammatory Long duration (long half life)

Question 36

Which animals is phenylbutazone not licensed in? Why?

Answer 36

Food production animals | Long half life

Question 37

What are paracetamols actions?

Answer 37

Antipyretic Analgesics (Poor anti-inflammatory!)

Question 38

Does paracetamol have many adverse effects?

Answer 38

No - hence popularity in humans

Question 39

How does paracetamol work?

Answer 39

Inhibit prostaglandin synthesis in BRAIN only

Question 40

Where is paracetamol metabolised? Why should paracetamol not be used in cats?

Answer 40

Liver | If not metabolised in liver, converted to toxic compound that kills hepatocytes