Drugs to Treat Inflammatory Processes Flashcards
what are corticosteroids?
exogenously administered adrenal cortex hormones
pharmacodynamics of glucocorticoids
- have metabolic, anti-inflammatory, and growth-suppressing effects
- increase blood sugar concentrations
- inhibit the immune and inflammatory systems
others actions of glucocorticoids
- increase appetite
- promote fat deposits
- increase uric acid excretion
- decrease serum calcium levels
- osteoporotic activity
main role of mineralocorticoids (predominantly aldosterone)
- retain sodium and water
- excrete K
contraindications for corticosteroids
- contraindicated in the presence of active, untreated infections b/c they mask the s/s of infections
- patients with systemic fungal infections
- may activate latent amebiasis or TB
average and large doses of drugs with high relative mineralocorticoid potency can cause:
- elevated BP
- increased Na and water retention
- increased excretion of K
corticosteroids should be used in caution with patients with:
- renal insufficency (may cause increase edema)
- those at risk for osteoporosis (post-menopausal women)
- patients with DM
clinical uses for corticosteroids
- adrenocortical insufficiency
- inflammation
- immunosuppression
- RA
drugs of choice for adrenocortical insufficiency
- hydrocortisone
- cortisone
- prednisone
corticosteroids
drugs of choice for inflammation
- methylprednisolone
- prednisone
- triamcinolone (aristocort)
- betamethasone (most potent, but most at risk for SE)
- dexamethasone (used in acute care settings)
drugs for immunosuppression
all corticosteroids have immunosuppressive capacity
why is prednisone so commonly used?
- short half life
- low cost
- negligible mineralocorticoid activity
- available in multiple dosage tablets (makes dosages changes simple for the patient to manage)
corticosteroids for RA
oral glucocorticoids are prescribed for moderate to severe RA to initially control inflammation while awaiting response to DMARDS
- should be tapered and discontinued ASAP
patient education for corticosteroids
- avoid people with known contagious illnesses
- defer vaccinations until they consult their provider
- discuss possible body changes
NSAIDs have activity in:
inflammation, pain, and fever
drugs mainly selective for COX-1
- aspirin
- ketoprofen
- flurbiprofen
- indomethacin (Indocin)
- piroxicam
- sulindac
drugs slightly selective for cox-1
ibuprofen
naproxen
diclofenac
drugs slightly selective for cox-2
- Etodolac (Lodine)
- Nabumetone (Relafen)
- Meloxicam (Mobic)
drugs only selective for cox-2
- Celecoxib (Celebrex)
- Rofecoxib (Vioxx)
- Valdecoxib (Bextra)
why would be use drugs that are selective for cox-2
used for patients at higher risks for GI bleeding
acetaminophen poisoning
drugs that induce CYP2E1 enzymes or alcohol ingestion may cause hepatotoxicity when combined with acetaminophen
antidote for acetaminophen poisoning
N-acetlycysteine
aspirin and Nonacetylated Salicylates actions
in addition to the analgesic, anti-inflammatory, and antipyretic properties of NSAIDs, salicylates also possess antiplatelet properties to varying degrees
reye syndrome
a rare, life threatening condition that may be a SE of aspirin and nonacetylated salicylates
usually seen in children with flu or varicella
possible permanent neurological deficits in survivors
