Anti-Inflammatorys

Question 1

Arachidonic acid pathway

Answer 1

Membrane phospholipids
Phospholipase A

                            Arachidonic acid

Lipoxygenase COX I and COX II

Leukotrienes PGG2 to PGH2

                                   Prostacyclines  Prostaglandins    Thromboxanes

Question 2

COX II

Answer 2

Responsible for synthesizing prostaglandins that mediate inflammation

Question 3

COX I

Answer 3

Responsible for synthesizing prostaglandins that inhibit gastric secretions

Question 4

HYDROXYCHLOROQUINE

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 4

1. Lupus, RA, and malaria prophylaxis and treatment
2. Inhibits phospholipase A2, causing a buildup of heme
3. Whorl keratopathy
   Bullseye maculopathy
4. Daily does should not exceed 400mg/day or 5mg/kg of body weight/day
   Patients < 135 lbs at increased risk for macular toxicity
   SOC testing: mac OCT, 10-2 VF (24-2 if Asian), FAF

Question 5

HYDROCORTISONE

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 5

1. Adrenal insufficiency
   Potent anti-inflammatory
2. Inhibits phospholipase A2
3. Systemic:
   Diabetes/insulin resistance
   Weight gain
   Fat redistribution
   Immune suppression
   Osteoporosis
   HTN
   Poor wound healing
   Peptic ulcers (Blocks COX I)
   Ocular:
   PSC cataract
   Glaucoma
   Increased risk of secondary infections (HSV)

Question 6

TRIAMCINOLONE

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 6

1. IV injection for:
   DME
   Grave’s
   Posterior uveitis
   Chalazia
   Irvine Gass CME
   CME associated with posterior uveitis
   ME secondary to CRVO
2. Inhibits phospholipase A2
3. Elevated IOP
   Depigmentation of eyelid in dark-skinned patients

Other general steroid SEs

Question 7

FLUTICASONE

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 7

1. Intranasal: Allergic rhinitis
2. Inhibits phospholipase A2
3. Dry eye disease, conjunctivitis

Other general steroid SEs

Question 8

ASPIRIN

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 8

1. Antipyresis
   Analgesia
   Reduce risk of recurrent MI in patients with heart disease
2. IRREVERSIBLE COX I and II inhibitor
3. GI effects
   Bleeding complications in the eye
   Reye’s syndrome in children

CI: CHILDREN

Question 9

INDOMETHACIN, IBUPROFEN, NAPROXEN SODIUM, PIROXICAM, FLURBIPROFEN, ETODOLAC

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 9

1. (Epi)scleritis
   Analgesia
   Indomethacin: Gout
2. Reversible COX I and II inhibitors
3. Bleeding complications in the eye
   Fatal MI and/or stroke
   Indomethacin: whorl keratopathy and retinal pigmentary changes

CI: Patients with heart disease

4. Take with food to avoid GI symptoms
   Safe in children - do not cause Reye’s syndrome

Question 10

MISOPROSTOL

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 10

1. Prevention and treatment of NSAID-induced stomach ulcers
2. Synthetic prostaglandin E1, similar to the prostaglandin that protects the stomach lining
3. Miscarriages, premature labor

Question 11

CELECOXIB

1. Indications
2. MOA
3. SEs and contraindications
4. Other

Answer 11

1. Same as aspirin, but helps protect the gastric mucosa and limits GI bleeding
2. Selective COX II inhibitor, spares the COX I pathway
3. Conjunctivitis
   Blurry vision
   SJS