Inflammation

Question 1

I am characterized by local vasodilation and increased capillary permeability. What phase of inflammation am I?

Answer 1

Acute transient phase

Question 2

I am characterized by infiltration of leukocytes and phagocytic cells. What phase of inflammation am I?

Answer 2

Delayed, subacute phase

Question 3

I am characterized by tissue degeneration and necrosis. What phase of inflammation am I?

Answer 3

Chronic proliferative phase

Question 4

What type of allergic reaction is histamine a mediator in?

Answer 4

Type I

Question 5

What are the actions of histamine during inflammatory responses?

Answer 5

1) local increase of blood flow by capillary dilation
2) edema by increasing post capillary venule permeability
3) itching by sensitizing primary sensory neurons

Question 6

What is the name of the two kinins and what effects do they have on injury and inflammation?

Answer 6

Bradykinin and kallidin. They acutely cause pain due to the excitation of primary sensory neurons and chronically cause capillary dilation, increase in pcv permeability, and stimulate PLA2 to activate arachidonic acid release

Question 7

What releases IL-1 and what is IL-1’s role in inflammation?

Answer 7

Release by macrophages. Induces inflammatory response! Also regulates B and T cells and induces fever.

Question 8

What does IL-8 do in inflammation?

Answer 8

powerful chemotactic

Question 9

What does TNF do during inflammation?

Answer 9

regulates production of other cytokines, induces fibrosis and tissue catabolism

Question 10

What are the potential products of arachidonic acid release?

Answer 10

leukotrienes or cyclooxygenases (prostaglandins, prostacyclins, thromboxanes)

Question 11

What is COX-1 involved in and when is it produced?

Answer 11

Produced constitutively, and involved in
- gastric cytoprotection (PGE2)

• platelet aggregation (TXA2)
• renal blood flow autoregulation
• initiation of parturition (PGF2)

Question 12

What is COX-2 involved in and when is it produced?

Answer 12

Produced during inflammation, produces prostaglandins at site of inflammation or tissue damage

Question 13

How does aspirin do its thang? (MOA)

Answer 13

irreversibly acetylates COX-1 and COX-2

Question 14

Put these desired effects of aspirin in order from lowest dose to highest dose:

A) analgesic and antipyretic

B) antiplatelet

C) anti-inflammatory

Answer 14

B, A, C

Question 15

Name some side effects of aspirin

Answer 15

GI irritation, nephrotoxicity, bleeding and anemia, hepatotoxicity

Question 16

What are the main differences when comparing aspirin with diflunisal?

Answer 16

Difunisal reversibly inhibits COX-1 and COX-2. Diflunisal is better tolerated due to fewer GI side effects and less effect on platelets. Diflunisal is great for anti inflammatory effects. However comma diflunisal is not a good antipyretic.

Question 17

Why does acetaminophen have poor anti-inflammatory properties?

Answer 17

• poor ability to inhibit COX in the presence of high concentrations of peroxides, such that are found at sites of inflammation

Question 18

A patient comes into the ED after having taken a bottle of acetaminophen. What is happening in their liver and what do you give them to counteract those effects?

Answer 18

Glutathione stores are depleted and the quinone intermediate attacks hepatic cells. Administer acetylcysteine to detoxify the reactive metabolite.

Question 19

What are the drugs indomethacin and sulindac used for? Which is more potent?

Answer 19

Used for RA, ankylosing spondylitis, OA, and acute goat. Indomethacin is more potent.

Question 20

What do the drugs ibuprofen flurbiprofen, naproxen, and oxaprozin have in common?

Answer 20

• Reversibly inhibit COX-1 and COX-2 but favors COX-1
• Treat rheumatic disorders, OA, ankylosing spondylitis, postpartum pain, dysmenorrhelal pain
• SE: GI irritation and hepatotoxicity

Question 21

Of the proprionic acid derivatives (ibuprofen, flurbiprofen, naproxen, and oxaprozin) which has the longest half life?

Answer 21

Oxaprozin (50 hrs)

Others:
Naproxen (13 hrs)
Ibuprofen, flurbiprofen (1-2 hrs)

Question 22

What is piroxicam especially useful for and why?

Answer 22

Long term treatment of RA or OA because of long half life (45 hrs)

Question 23

Your patient has a history of oxycodone abuse and just had an emergency appendectomy. What do you administer to relieve the pain while avoiding the temptation of opioids?

Answer 23

Ketorolac (injectable!)

Question 24

What’s the big deal about coxibs (celocoxib, etoricoxib) and how do they work?

Answer 24

Coxibs show greater selectivity for COX-2 inhibition, so could potentially have all of the anti-inflammatory, antipyretic, and analgesic effects without the GI toxicity. They are larger than traditional COX inhibitors and only fit into the larger COX-2 channel.

Question 25

What are the main and scariest side effects of coxibs?

Answer 25

Increased risk of MI, stroke, and thrombosis. Contraindicated in heart problems and pregnancy. In fact, coxibs have no impact on platelet aggregation so do not offer the cardioprotective effects of traditional NSAIDs.