Anti-Inflammatory Meds

Question 1

Phospholipase A2

Answer 1

1st step in pathway
inhibiting prevents all downstream effects

Question 2

Leukotrienes

Answer 2

synthesized by lipoxegenase
binds receptors in nose and bronchi
causes rhinitis and bronchoconstriction

Question 3

Thromboxanes

Answer 3

induce platelet aggregation

Question 4

Cyclooxygenase

Answer 4

Cox 1: inhibit gastric secretions
Cox 2: mediate inflammation
Prostaglandins

Question 5

Hydrooxychloroquine (Plaquenil)

Answer 5

-inhibits phospholipase A2 causing heme buildup
-indicated for lupus, RA, and malaria
-whorl keratopathy
-bulls eye maculopathy
-Baseline DFE within 1 year of starting drug. Annual screening after 5 years and drug (10-2 and SD-OCT). If greater risk, exams every 6 months to 1 year after baseline.

Question 6

Bull’s Eye Maculopathy Risk (Hydrooxychloroquine)

Answer 6

-dosage 400 mg/kg per day or 5 mg/kg of real body weight
-<135lbs
-treatment duration >5 years
-abnormal renal function
-high body fat percentage
-age >60
-liver disease
-concomitant retinal disease

Question 7

Steroids

Answer 7

-inhibit phospholipase A2
-sone and lone
-diabetes, weight gain, delayed wound healing, fat redistribution, hypertension, immune suppression, osteoporosis
-PSC cataracts, glaucoma, secondary infections
-inquire about pregnancy, peptic ulcers, and diabetes before prescribing

Question 8

Hydrocortisone

Answer 8

treat adrenal insufficiency

Question 9

Triamcinolone (Kenalog)

Answer 9

-injection for: DME, graves, posterior uveitis, chalazia, Irvine-Gass, CME, edema due to CRVO
-Adverse effects: Elevated IOP, endophthalmitis (rare), depigmentation of eyelid skin in darker skinned patients

Question 10

Fluticasone (Flonase)

Answer 10

Intranasal corticosteroid
-cataracts, increased IOP, conjunctivitis, dry eye
-floppy iris syndrome

Question 11

NSAIDS

Answer 11

Cox 1 and Cox 2 inhibitors
-All have GI effects

Question 12

Aspirin

Answer 12

irreversible Cox 1 and 2 inhibitor
-antiplatlet effect may cause bleeding in ye
-Reyes syndrome (brain dz) in children

Question 13

Indomethacin/Ibuprofin/naproxen/naproxen sodium

Answer 13

reversible Cox 1 and 2 NSAIDs
-contraindicated in heart dz
-used for episcleritis and scleritis
-increase risk of bleeding complications in eye
-GI bleeding
-Fatal MI or Stroke

Question 14

Misoprostol (Cytotec)

Answer 14

-synthetic prostaglandin E1
-Prevention and treatment of NSAID induced stomach ulcers
-Can cause miscarriages and premature labor

Question 15

Celecoxib

Answer 15

-Selective Cox 2 inhibitor
-Spares Cox 1: helps protect GI