DRUGS FOR INFLAMMATION Flashcards by Olivia Pypka

what are the signs of inflammation?

pain, warmth, redness, edema

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causes of inflammation

infection, cell death, hypersensitivity reactions, extreme heat, chemical injury, physical trauma

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what is acute inflammation?

associated with minor physical injury, chemical damage, infection, antigens
typically lasts 8-10 days, followed by repair an healing
usually self limiting; consider non pharmacological methods, topical antiinflammatories should be used whenever possible

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what is chronic inflammation?

may occur if the body is not able to contain or neutralize the trigger of the into; inflammation; associated with many chronic conditions (SLE, rheumatoid arthritis)
leads to tissue damage, with symptoms becoming worse overtime

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what is maladaptive?

body unable to adapt to pain on its own

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bradykinin

present in an active form in plasma and also stored an released by mast cells; vasodilator that causes pain; effects are similar to those of histamine

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complement

series of at least 20 proteins that combines in a cascade fashion to neutralize or destroy an antigen

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histamine

stored and released by mast cells; causes dilation of blood vessels, smooth muscle constriction, tissue swelling and itching

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leukotrienes

stored an released by mast cells; effects are similar of those of histamine

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prostaglandins

present in most tissues and stored and released by mast cells; increase capillary permeability, attract white blood cells to site of inflammation, an cause pain

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arachidonyl ester is covered into arachidonic acid by which enzyme?

phospholipase A2

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when tissue is damaged, what acid is produced?

arachidonic acid (AA)

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cyclooxygenase

converts AA into prostaglandins

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prostaglandins

enhance vasodilation, gastric cytoprotection, decrease gastric acid secretion

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thromboxane A2

stimulates platelet aggregation

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lipoxygenase

converts AA into leukotrienes

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leukotrienes

phagocyte activation, neutrophil chemotaxis, bronchoconstriction

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what are the two anti-inflammatory drug classes?

NSAIDS, glucocorticoids drugs

what’s the difference between NSAIDS and glucocorticoids drugs?

NSAIDS: used for management of mild to moderate pain, inflammation an fever
Glucocorticoids drugs: used for short term management of severe or disabling inflammation

additional drug classes have been developed for which diseases?

IBD (ulcerative colitis, crohn’s disease), rheumatoid arthritis

what additional drug classes were developed for specific disease states?

immunosuppressive drug, anti-TNF agents

are NSAIDS non specific or specific?

non specific - all prostaglandin synthesis is inhibited

is aspirin irreversible inhibitor or reversible?

irreversible inhibitor of cyclooxygenase enzyme
- significant impact on platelets; potent anticoagulant effect

what do non selective NSAIDS inhibit?

COX-1 an COX-2 enzymatic activity

what are the function of non selective NSAIDS?

- reduces inflammation an fever - inhibits the formation of gastric mucosa, increases gastric acid secretion - inhibits platelet aggregation (significant inhibition - thromboxane A2)

what is the second leading cause of peptic ulcer disease?

NSAIDS, significant risk GI bleeding

what are the risks of selective NSAIDS?

high risk of MI, stroke and asymptomatic hypertension

what are the 3 examples of aspirin?

A. coated B. original strength C. with stomach guard

what is coated aspirin?

enteric coated products are intended to absorb in the alkaline environment of the small intestine (NOT ABSORBED IN THE STOMACH)

what is original strength aspirin?

regular product that dissolves and begins to absorb in the stomach

what is stomach guard aspirin?

buffered products contain ions that decrease gastric acidity and slow absorption

prolonged excessively high fevers can induce what?

febrile seizures (especially in children), tissue damage, reduced mental acuity, delirium or coma

what are the two antipyretic therapies?

NSAIDS and acetaminophen

NSAIDS (Reye's syndrome) - antipyretic therapy

- most common between 4-14 years - associated with previous viral illness (chicken pox, influenza) and use of aspirin, causing brain inflammation, fatty deposits in the liver, death within days - overdose of aspirin

acetaminophen - antipyretic therapy

direct action on hypothalamus and dilation of peripheral blood vessels (enables sweating and fever)

why should you never use aspirin in paediatric patients with a fever?

you don't know what's causing the fever

when is histamine released?

during an allergic reaction

what are antihistamines?

block the action of histamine at the H1 receptor for the treatment of allergic rhinitis; provide symptomatic relief of runny nose, sneezing, itchy eyes an throat, most effective when administered prophylactically

what effects do antihistamines produce?

sedative effects - more prominent in 1st general H1 antagonists (eg. diphenhydramine (Benadryl) vs loratadine (Claritin)) - can also be used for treatment of motion sickness an vertigo

anaphylaxis

- hyperimmune and hyper inflammatory response to an antigen - body responds within minutes to the antigen, releasing massive amounts of histamine and other chemical mediators of inflammation

symptoms of anaphylaxis

itching, hives, tightness in throat and chest, swelling of the larynx, causing cough, rapid decrease in BP, reflex tachycardia, difficulty breathing (bronchoconstriction)

anaphylaxis of pharmacological management (epinephrine (IM) adrenergic agonist drug)

alpha1 receptor - increases BP beta2 receptor - bronchodilation beta1 receptor - cardiac output

anaphylaxis of pharmacological management (in cases of continued upper airway obstruction - what should be given?)

nebulized epinephrine

anaphylaxis of pharmacological management (in cases of persistent wheeze - what should be given?)

- beta2 adrenergic agonists (eg. salbutamol - inhaled) - promotes bronchodilation - systemic glucocorticoids (eg. prednisolone - PO) or hydrocortisone (IV); inhibits immune and inflammatory responses to the antigen