Inflammation As A Drug Target

Question 1

Define inflammation

Answer 1

A local response to cellular injury that is marked by capillary dilation, leukocytes infiltration, redness, heat and pain: serves as a mechanism initiating the elimination of noxious agents and damaged tissue

Question 2

Acute inflammation aims to:

Answer 2

Aims to contain/isolate the injury, destroy foreign matter and heal and repair damage

Question 3

Chronic inflammation

Answer 3

Continued inflammatory response, due to persistent antigen presence or due to autoimmune disease

Question 4

Examples of acute inflammation

Answer 4

Acute bronchitis, paronychia (infected ingrown toenail) , sports injury

Question 5

Paronychia is

Answer 5

Infected ingrown toenail

Question 6

Acute bronchitis is…

Answer 6

Sore throat from cold or flu

Question 7

4 key clinical features of acute inflammation

Answer 7

Redness, heat, swelling and pain

Question 8

What is a clinical feature of acute inflammation associated with increased vessel permeability

Answer 8

Swelling

Question 9

What is a clinical feature of acute inflammation caused by stimulation of local nerve endings, from mech. And chem. Mediators?

Answer 9

Pain

Question 10

What is a clinical feature of acute inflammation associated with localised increase in temperature, also due to increased blood flow?

Answer 10

Heat

Question 11

What class of drug is ibuprofen?

Answer 11

NSAIDs

Question 12

What class of drug is naproxen?

Answer 12

NSAIDs

Question 13

What class of drug is aspirin and diclofenac?

Answer 13

NSAIDs

Question 14

General advice on how to treat acute inflammation

Answer 14

Conservative: rest, ice, compress and elevate (Rice)
Pharmacological: anti-inflammatories

Question 15

Potential side effects of NSAIDs

Answer 15

GI side effects: diarrhoea, constipation
Worsening asthma symptoms
GI bleeding (peptic ulcers)
Acute kidney injury

Question 16

Examples of inflammatory bowel disease (ibd)

Answer 16

Ulcerative colitis, Crohn’s disease

Question 17

Ulcerative colitis and Crohn’s disease are caused by? What inflammation?

Answer 17

Chronic inflammation of the bowel/ colon

Question 18

Cause of ulcerative colitis

Answer 18

Unclear but seems to occur in generally susceptible people in response to environmental triggers

Question 19

Extra - intestinal manifestations of IBD include?

Answer 19

Peripheral arthritis
Erythema nodosum
Pyoderma gangrene
Anterior uveitis
Ankylosing spondylitis

Question 20

Diagnosing inflammatory diseases

Answer 20

Clinical diagnosis ( history and examination)
Antibody testing( disease specific)
Inflammatory markers( blood tests, stool tests)
Imaging (e.g. CT scan or MRI)
Tissue biopsy (disease / tissue specific)

Question 21

When in remission for inflammatory disorders are steroids given?

Answer 21

No

Question 22

Role of corticosteroids

Answer 22

Act to inhibit inflammation by inhibiting activation of cells and inflammatory mediators involved in the inflammatory process

Question 23

Patient has tonsillitis. What might you prescribe?

Answer 23

Anti-inflammatories : for the pain and inflammation NSAIDs
Antibiotics: to treat cause of the inflammation

Question 24

What might ulcerative colitis cause thought to be?

Answer 24

Probably an autoimmune disease initiated by inflammatory response to colonic bacteria

Question 25

Examples of inflammatory markers

Answer 25

Blood tests, stool tests e.g. CRP, ESR, white cell count, faecal calprotecin in IBD

Question 26

Antibody testing example RA

Answer 26

Rheumatoid factor in RA. None available for IBD

Question 27

Time course in inflammatory disorders:

Answer 27

Diagnosis Treatment (Steroids) Remission (no steroids) It relapse/flare ( steroids) —> back to treatment

Question 28

What class of drugs are predisolone, hydrocortisone?

Answer 28

Corticosteroids/steroids

Question 29

List some side effects of corticosteroids

Answer 29

C- Cushing’s syndrome O-osteoporosis R- reduced growth T— thin skin I- immunosuppression O- oedema Obesity Diabetes

Question 30

Some short-term side effects

Answer 30

Weakness Hyperglycaemia Mood changes

Question 31

List some local complications of IBD

Answer 31

Anaemia Malnutrition and absorption Bowel obstruction

Question 32

List some systemic complications of IBD

Answer 32

Joint pain and swelling Osteoporosis Skin rashes

Question 33

Infliximab is?

Answer 33

Monoclonal anti-tumuor necrosis factor (TNF) - alpha antibody ( blocker/ inhibitor)

Question 34

How is infliximab given?

Answer 34

Intravenous infusion every 6-8 weeks in hospital

Question 35

TNF ALPHA IS?

Answer 35

A key pro-inflammatory cytokine involved in chronic inflammatory disease

Question 36

Infliximab disrupts?

Answer 36

The activation of pro-inflammatory cascade signalling

Question 37

Infliximal licensed to treat?

Answer 37

a lot of chronic inflammation disease: UC, Crohn’s disease, RA etc

Question 38

Infliximab side effects

Answer 38

Increased risk of infection (immunosuppressed) Diarrhoea and gi discomfort Fatigue

Question 39

Impacts of IBD

Answer 39

Psychologically - anxiety of flare up Economically Socially