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PM3A > Inflammation > Flashcards

Inflammation Flashcards

1
Q

What are the 5 cardinal signs of inflammation?

A 
Heat=callor 
Redness = rubor 
Swelling = tumor 
Pain = dollor
loss of function
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2
Q

What type of immune response is inflammation?

A

Innate immune response - non-adaptive

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3
Q

What is the inflammation initiated by?

A

Pattern recognition receptors - recognise pathogens by their pathogen associated molecular patterns (sugar. molecules on bacteria). e.g. Toll like. receptors - specific stimulus can evoke different inflammatory response

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4
Q

What events is inflammation characterised by?

A

Cellular & vascular

initial cellular and late cellular

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5
Q

What incorporates the initial cellular events?

A

Sentinel cells activate mast cells, dendritic, macrophages to release cytokines. - trigger response
Mast cells release histamine activated by IgE antibody and c3a/c5a
Endothelial cells releasing pro inflammatory mediators to cause vasodilation. e.g. prostaglandins, NO
Adhesion molecules for leukoytes

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6
Q

What incorporates the vascular events?

A

Redness/swelling/heat (due to blood/fluids).
Proteolytic cascades - factor 12a from plasma stimulates pro inflammatory products that activate complement cascade C1-9. Coagulation, fibrinolytic and kinin
Generate mediators that stimulate components of the response e.g. C3a/c5 stimulating mast cells to release histamine.

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7
Q

What incorporates the later cellular events?

A

Monocytes differentiate into macrophages to eat cell debris. (after neutrophils)

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8
Q

Is inflammation a symptom or cause of disease?

A

Symptom

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9
Q

What happens when the inflammation in the cellular & vascular events fails to resolve?

A

chronic inflammation

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10
Q

Explain the anti-pyretic effects of NSAIDS

A

There is prostaglandin E2 formation in the hypothalamus triggered by fever causing pathogens. NSAIDs reduce/prevent PG production to reduce body temp (but do not affect normal body temp)

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11
Q

Explain the analgesic effects of NSAIDS

A

Inhibition of COX1/2 Reduce the formation of prostaglandins that sensitise nociceptors as inhibited COX2 enzymes.
(prostaglandins usually sensitise the pain produced by inflammatory mediators e.g. bradykinin)

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12
Q

Explain the anti-inflammatory effects of NSAIDS

A

Inhibit COX1/2 enzymes. Reduce inflammation produced by prostaglandins esp those produced by COX2.

  • Reduce vasodilation caused by PGE2/PGI1
  • reduce swelling and vascular permeability/wheal/oedema
  • BUT only reduce the components of the inflammatory response dependent upon prostaglandin formation
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13
Q

What is a limit to the anti-inflammatory effects of NSADIS?

A

only reduce the components of the inflammatory response dependent upon prostaglandin formation

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14
Q

What side effects can non-selective COX inhibitors give and why?

A

GI effects because gastric COX1 usually produces prostaglandins that reduce acid secretion and promote mucosa formation. If inhibiting = mild get dyspepsia, diarrhoea, If severe can be bleeding, ulcers

Bronchospasm in some pts e.g. asthma as prostaglandins have a role in bronchodilation

Skin reactions
Nephropathy as reduction in renal blood flow due to reduced prostaglandins

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15
Q

Which COX inhibitors cause cardiovascular s/e?

A

COX2 selective possibly due to reduced PGI2 production or chance in the balance of PGI2 and thromboxane A2 production

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16
Q

What is the risk of NSAIDS in 3rd trimester of pregnancy?

A

Pulmonary hypertension in the foetus

17
Q

What are NSAIDS used in caution with/ci?

A

Contraindicated in pts with GI disorders
C/I in people with renal failure
COX2 contraindicated in cardiac failure

18
Q

What are some indications of naproxen

A

Pain & inflammation in rheumatic disease
Musculoskeletal pain
Dysmenorrhoea
Acute gout

19
Q

What are some indications of ibuprofen?

A 
Pain &inflammation in rheumatic disease 
Mild to moderate pain
dysmenorrhoea 
post-op analgesia
migraine
dental
fever in children 
post immunisation pyrexia
20
Q

What are some indications of diclofenac?

A

POM - pain and inflammation in rheumatic disease
acute gout
post op pain

21
Q

What subtype of prostaglandin predominates in inflammation?

A

PGE2

22
Q

What are the roles of prosaglandins?

A

Vasodilatiton
fever
pain (sensitisers)
Inflammatory response

23
Q

What are the effects of histamine?

A

Flush (arterial vasodilation)
Redness, wheal, oedema, swelling, flare (sensory nerve induced vasodilation CGRP)
- inflammation

24
Q

What are the inflammatory effects of histamine mediated by?

A

Stimulation of h1 receptor -

  • constricts bronchial and GI smooth muscle
  • dilates blood vessels by stimulating endothelial cells
  • itch usually associated with wound healing
25
Q

What is the role of antihistamines?

A

Block H1 receptor - constrict blood vessels, less blood flow and oedema, reduced redness

26
Q

What is the mechanism of action of corticosteroids?

A

Bind to a cytosolic GPCR (glucocorticoid receptor). That steroid-receptor complex goes into the nucleus where it affects steroid response elements of gene transcription.
Act at the level of protein formation/expression
Increase gene transcription of anti-inflammatory mediators e.g. IL1, IL-10
Decrease gene expression/transcription of pro-inflammatory mediators e.g. cytokines, TNF-a,PGs, NO, complement proteins
- overall they reduce cardinal signs, reduce the synthesis of inflammatory mediators and affect the function of inflammatory cells

27
Q

What effects do glucocorticoids have on inflammatory mediators?

A

Reduced PG synthesis (reduced COX2 expression) & Affects annexin so reduced PLA2
Reduce cytokines
reduce complement protetins
reduce NO

Other rapid affects not dependent on gene transcription e.g. skin

Increased pro-inflammatory e.g. IL-1, IL-10

28
Q

What effects do glucocorticoids have on inflammatory cells?

A

Reduced cytokine generation means reduced movement of neutrophils from blood to. inflammatory site.
Decreased actions of leukocytes

29
Q

Why does prolonged use of corticosteroids impaired wound healing?

A

There is decreased fibroblast function which may. mean reduced scar tissue, but will also mean reduced healing and repair process. Prolonged use reduces healing

30
Q

Name 6 common unwanted effects of corticosteroids

A
  1. reduced wound healing
  2. susceptibility to infection
  3. changes in electrtolytes, increased blood glucose, risk of steroid-induced diabetes
  4. Osteoporosis
  5. Mental health problems
  6. Cushings syndrome

PM3A (17 decks)

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