Case 1 Unveil Independent Learning Flashcards
What do NSAIDs do
Inhibit PGHS-2 dervied prostaglandins (e.g. PGE2) which reduces the extend and duration of local inflammation caused by vasodilation and increased vascular permeability
What two effects do NSAIDs have
Analgesic and anti-pyretic
What does analgesic mean
Decrease in pain and swelling
What does anti-pyretic mean
Decrease in temperature
How do NSAIDs exert their anti-pyretic property
NSAIDs inhibit hypothalamic PGHS-2 which normally generates PGE2 in response to circulating pyrogens. So by blocking PGE2 you stop pyrexia
How do NSAIDs decrease pain and swelling
Largely due to PGH2. PGH2 supercharged the pain response
What is the full name form aspirin
Acetyl salicylic acid
What is the only irreversible inhibitor of PGHS-1 and PGHS-2
Aspirin
Describe the mechanism of action of aspirin
Acetylation of serine reside in the COX domain active site
What is the origin of aspirin
Willow tree bark containing salcin
Describe ibuprofen
It is produced as a racemate, the S-enantiomer is the active NSAID
Describe the mechanism of action of ibuprofen
It competes with AA for the COX domain site of PGHS-1 and PGHS-2. It is a reversible, competitive inhibitor
Describe the origin of ibuprofen
Derived from propanoic acid
Why may paracetamol be chosen over NSAIDs
It can have better analgesic and anti-pyretic effects
What is one thing paracetamol doesn’t do that NSAIDs do
Little anti-inflammatory activity
What is the mechanism of action of paracetamol
May affect peroxidase domain activity in PGHS-2 or PGHS-3 in the CNS or its metabolites may be having affects in the CNS>
Describe the WHO pain ladder
Mild pain- paracetamol. Moderate pain- paracetamol/ weak opiods (codine). Strong pain- strong opiods (morphine/ heroine)
What converts phospholipids to AA
Phospholipase A2
Describe stage 1 of a bruise
Red bruise- fresh blood from capillaries, well oxygenated
Describe stage 2 of a bruise
Blue bruise (around 24 hours later), oxygen is used up
Describe stage 3 of a bruise
Purple bruise (2-4 days later) RBCs break down and release Hb
Describe stage 4 of a bruise
Green bruise (5-7 days later) Hb broken down into verdin
Describe stage 5 of a bruise
Yellow bruise (1-2 weeks later) verdin is converted to bilirubin
Describe stage 6 of a bruise
(2-4 weeks later) pale discoloration of bruise
Describe the timescale of a wound healing
- Haemostasis. 2. Inflammatory phase. 3. Proliferation and migration. 4. Maturation
Describe proliferation and migration
Granulation (in granulation tissue fibroblasts produce collagen and ECM, neutrophils and capillaries needed for angiogenesis). Contraction- wound can feel itchy (myofibroblasts) and epithelialisation
Why will the timescale on healing be shorter due to having stitches
1st intention rather than 2nd intention
Describe maturation
When the collagen is remodelled from type 3 to type 1, and small blood vessels decrease
Describe serous exudate
Exudate during inflammatory wound healing stages (excessive is a sign of high bioburden)
Describe sanguinous exudate
Fresh blood- indicator wound bed has undergone trauma such as dressing change, small amount is usual during inflammation
Describe purulent discharge
Milky/ green/ yellow colour and thick, indication of infection
What does discharge aid
Cells t migrate into the affected area e.g. WBCs
Describe a fibroclot
A scab which contains neutrophils and macrophages which secrete growth factor
What are neutrophils replaced by in the wound
After 48-96 hours neutrophils are replaced by macrophages as the predominant cells in the wound
What type of cut requires a suture
Secondary intention, wound 6.5mm deep or 20mm long
