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1390-59 Intro to Pharmacology > Chapter 20 > Flashcards

Chapter 20 Flashcards

1
Q

analgesia

A

inhibition of the perception of pain

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2
Q

anaphylaxis

A

condition in which the body develops a severe allergic response; this is a medical emergency

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3
Q

anemia

A

condition in which the number of red blood cells or the amount of hemoglobin inside the red blood cells is less than normal

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4
Q

anti-inflammatory

A

minimizing or stopping the response to tissue injury by reducing the pain, localized swelling and chemical substances released at the site of injury

  • known as NSAIDs (nonsteroidal anti-inflammatory drugs)
  • Decrease inflammation by inhibiting prostaglandin synthesis
  • Not structurally related to cortisone
    • NSAIDs selectively inhibit the cyclooxygenase enzymes further along the pathway, while cortisone inhibit the formation of arachidonic acid
  • Groups
    • Original NSAIDs  salicylates & aspirin
    • Non-NSAIDs  acetaminophen
    • Synthetic NSAIDs  ibuprofen and celecoxib
  • All NSAIDs are nonopioid analgesics.
    • Relieve mild to moderate pain associated with inflammation
    • Do not affect consciousness or mental function
    • Not related to morphine and do not produce tolerance or physical dependency
    • Not effective against severe, sharp pain
    • Produce analgesia through a central and a peripheral mechanism of action
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5
Q

antipyresis

A

reducing an elevated body temperature

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6
Q

arthralgia

A

joint pain

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7
Q

arthritis

A

inflammation of the joints

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8
Q

cyclooxygenase(COX)

A
  • cyclooxygenase, a family of enzymes that produce prostaglandins from arachidonic acid
  • Known as prostaglandin synthetase, but COX is the newer terminology
  • Subtypes - COX-1 and COX-2
    • COX-1 – believed to always be available in the cells
    • COX-2 – manufactured in activated macrophages in response to injury or damage to local tissues
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9
Q

dysmenorrhea

A

difficult or painful

-mensuration

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10
Q

erythema

A

abnormal redness of the skin, caused by capillary congestion

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11
Q

inflammation

A

condition in which tissues have been damaged, characterized by swelling, pain, heat and sometimes redness

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12
Q

intoxicaiton

A

state in which a substance has accumulated to potentially harmful levels in the body

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13
Q

ischemia

A

reduction in blood supply and oxygen to localize area of the body or tissue

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14
Q

lavage

A

washing with fluids or flushing of a cavity such as the stomach

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15
Q

leukopenia

A

condition in which the total number of white blood cells circulating in the blood is less than normal

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16
Q

megaloblastic anemia

A

condition for which there is a large, immature form of the red blood cell, which does not function as efficiently as the mature form

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17
Q

myalgia

A

pain associated with muscle injury

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18
Q

petechia

A

small area of the skin or mucous membranes that is discolored because of localized hemorrhages

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19
Q

phagocyte

A

circulating cell ( such as a leukocyte) that ingests waste products or bacteria in order to remove them from the body

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20
Q

prophylaxis

A

treatment of drug given to prevent a condition or disease

21
Q

prostalglandins (PG)

A
  • Mediators of inflammatory response
  • substance naturally found in certain tissues of the body; can stimulate urterine and intestinal muscle contractions and may cause pain by stimulating nerve endings; can elevate body tempurature (In conjunction with histamine and bradykinin)
  • Formed in the cell membranes of organs
  • Involved in erythema, edema, and pain
22
Q

rhemumatic fever

A

condition in which pain and inflammation of the joints or muscles are accompanied by evaluated body temperature usually a complication of untreated strep throat

23
Q

salicylism

A

condition in which toxic doses of salicylates are ingested, resulting in nausea, tinnitus, and delirium

24
Q

selectiv COX-2 inhibitors

A

drugs that only interact with one of the enzymes in the cyclooxygenase family

25
Q

What is the process of inflammation?

A

Substances are released.
-Produce vasodilation and increase permeability in the capillary walls

Pain receptors are stimulated.

Phagocytes migrate to destroy harmful substances.

Results in the cardinal signs of inflammation:
-redness, swelling, warmth, pain, and loss of function

26
Q

inflammation is good until…

A

It becomes exaggerated or prolonged
Will result in further tissue damage
It becomes the disease itself

27
Q

Clinical indications of Anti-inflammatory Analgesics

A
  • Headache, dental extraction, soft tissue injury, sunburn, musculoskeletal, joint overexertion, and strain
  • Chronic treatment of dysmenorrhea

-Tendinitis, bursitis, osteoarthritis, and rheumatoid arthritis
Aspirin is used in the treatment of osteoarthritis, spondylitis, and gout

28
Q

Actions of Nonopioid anti-inflammatory analgesics

Salicyclates and NSAIDs

A

-Salicylates include aspirin, salicylic acid, and methyl salicylate.

  • Produce antipyresis
    • Affect the hypothalamic centers in the brain to reduce elevated body temperature
    • Mechanism of the central action - Block prostaglandin stimulation of the central nervous system (CNS)
  • Produce Analgesia
    • Inhibit the synthesis of prostaglandins and prevent bradykinin from stimulating pain receptors
    • Inhibit pain centrally and peripherally

Anti-inflammatory Action

  • Inhibit a primary pathway in prostaglandin synthesis
  • Drugs vary in in their ability to reduce all types of inflammation.

Produce gastrointestinal effects

  • Blockage of COX-1 results in gastric ulcers and distress.
  • Gastrointestinal (GI) irritation and CNS stimulation cause vomiting.

Aspirin is a useful anticoagulant.
-Inhibit the aggregation of platelets necessary for blood clot formation

29
Q

Cardiovascular benefit is associated with aspirin.

A

Reduces risk of death and re-infarction post myocardial infarction

Prevents heart disease

NSAIDs like ibuprofen and celecoxib act as antagonists.

Prevents the formation of thromboemboli

30
Q

Drug preparations of aspirin and NSAIDs

A

Aspirin and salicylates are available in oral formulations.

Other NSAIDs are primarily for oral administration.

Ibuprofen, indomethacin, and ketorolac tromethamine can be administered parenterally

31
Q

Drug disposition

A

Salicylates and NSAIDs are rapidly absorbed from the stomach and small intestine

Possess a 4- to 6-hour duration of action

Metabolized in the liver, excreted into urine

32
Q

Clinical Indications of NSAIDs

A

Fever reduction, mild to moderate pain, and inflammation contributing to headache and to muscle and joint pain

33
Q

Clinical Indications of Aspirin

A

Treatment and prevention of cardiovascular disease and management of adenomatous polyps, and colorectal cancer

34
Q

Clinical Indications of Salicylates

A

Management of ulcerative colitis

35
Q

Acetaminophen

A

Analgesic and antipyretic

  • Does NOT have anti-inflammatory properties
  • Directly acts on heat regulation centers in the hypothalamus to reduce body temperature
  • Relieves headaches by inhibiting prostaglandin synthetase within the CNS
  • Does not produce GI irritation or ulceration

Clinical indications

  • Indicated for patients allergic to aspirin
  • Fever, headache, minor musculoskeletal pain, and discomfort associated with the common cold and flu
  • Recommended for patients who experience GI upset from aspirin or NSAIDs

Available as OTC products in a variety of formulations

Toxicity may develop from chronic use
-People that consume more than 3 alcoholic beverages daily have potential hepatic sensitivity that becomes compromised with increased exposure to acetaminophen

Adverse effects of hepatotoxity
-Nausea and vomiting, hepatic damage, acidosis, respiratory complications, and death

Treatment for overdose

  • Gastric aspiration and lavage
  • Maintenance of fluid balance
  • Activated charcoal
  • Liver transplantation
  • N-acetylcysteine
36
Q

Adverse effects and Boxed warnings of NSAIDs

A

Common effects

  • Vertigo, vomiting, mental confusion, and headaches due to CNS stimulation
  • NSAIDs and aspirin - Nausea, GI distress, and ulceration

Gastrointestinal effects of NSAIDs

  • Mucosal irritation
  • Ulceration, GI bleeding, and perforation of the stomach or intestines

Boxed warning
-Every OTC NSAID product includes a bolded warning, advising about the potential risks

Cardiovascular effects

  • Boxed warning
    • NSAIDs can cause fatal cardiovascular thrombotic events, myocardial infarction, and stroke.

NSAIDs and COX-2 inhibitor drugs
-Sodium and water retention

Hypersensitivity and allergic effects of NSAIDs

  • Mild rashes, fever, hepatic damage, respiratory distress
    - Serious side effects of NSAIDs - Exfoliative dermatitis, and Steven’s Johnson syndrome
    - Acetaminophen - Reddening of the skin, blisters, and detachment of the upper surfaces of the skin
37
Q

Hematological effects of NSAIDs

A

Megaloblastic anemia – larger than normal RBC that are structurally abnormal and immature

iron deficiency anemia – due to blood loss through hemorrhage

Bone marrow suppression – leads to blood disorders

Idiopathic hemolytic anemia – RBC are destroyed faster than they are produced

38
Q

Acute toxicity and overdose

A

Acetaminophen

  • Causes hepatic damage, acidosis, and respiratory complications
  • Antidote - N-acetylcysteine

Salicylates and NSAIDs

  • Respiratory depression and acidosis
  • Dehydration, cardiovascular depression, vasodilation, and hypotension
  • Treatment for aspirin poisoning - Administration of sodium bicarbonate and infusion of fluid and electrolytes
39
Q

Chronic toxicity

A

Nausea, vomiting, and salicylism
-Salicylism – series of symptoms that include:
-nausea, ringing in the ears, HA, delirium, and
hyperventilation
-Hyperglycemia
-Signs of overdose in elderly patients
-Ringing in the ears (tinnitus), gastric upset, and GI bleeding

40
Q

Salicylates Contraindications

A

Produce Reye’s syndrome
When aspirin is given to children (ages 1-4 & 10-14) as treatment to a viral illness, symptoms include N/V, HA, excitability, delirium, and combativeness, which may progress to coma and death

41
Q

Aspirin and ibuprofen Contraindications

A

Not be used during pregnancy

Can cause premature closure of vessels in the baby’s heart and aspirin may induce bleeding

42
Q

nonaspirin NSAIDs Contraindications

A

Contraindicated for the treatment of perioperative pain

43
Q

Gout

A

Caused by the deposition of uric acid in joint fluid and soft tissue
-May occur due to overproduction or uric acid and/or an inefficient excretion of uric acid

Characteristics

  • Acute gout - Edema, redness, and severe pain
  • Chronic gout - Deposition of uric acid in soft tissue, causing tophi
  • Hypouricemic agents
    • Allopurinol – inhibits the enzyme that is necessary to make uric acid
    • Febuxostat - used for chronic management of hyperuricemia in gout patients

Uricosuric agents
-Probenecid - used for the chronic management of gout; inhibits renal reabsorption by of uric acid so it passes through the urine

Modified Enzyme
-Pegloticase – converts uric acid to a water-soluble metabolite that can be excreted in the urine

44
Q

Adverse effects
Colchicine

(Gout Medication)

A

Nausea, vomiting, diarrhea, abdominal cramps, and blood in the urine (hematuria)

45
Q

Adverse effects
Allopurinol

(Gout Medication)

A

ever, rash, and leukopenia

46
Q

Adverse effects
Febuxostat

(Gout Medication)

A

Dizziness, rash, nausea, and temporary elevation in liver enzymes

47
Q

Adverse effects
Probenecid

(Gout Medication)

A

GI disturbances, including nausea and vomiting, arthralgias, skin rash, and fever

48
Q

Adverse effects
Pegloticase

(Gout Medication)

A

Anaphylaxis, infusion reactions, nausea, vomiting, and constipation

49
Q

Clinical Indications and preffered treatment for Gout

A

Lifelong process including diet adjustment and medication

Colchicine, specific NSAIDs, and sodium thiosalicylate
-Used in the treatment of acute gout attacks, relief of pain, and interruption of the inflammatory process

Probenecid

  • Used to treat hyperuricemia associated with gout and gouty arthritis
  • Used as an adjunct to antibiotic therapy

Allopurinol

  • Manages primary and secondary gout, acute gout attacks, tophi, nephropathy, joint destruction, or uric acid stones
  • Reduces serum and urinary uric acid resulting from the treatment of malignancies, leukemia, and lymphoma

1390-59 Intro to Pharmacology (17 decks)

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