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Pharmacology > Inflammation (Chapter 6) > Flashcards

Inflammation (Chapter 6) Flashcards

1
Q

what is inflammation ?

A

localized heat, swelling, redness and pain in response to a trigger

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2
Q

what can be a trigger for inflammation ?

A

extreme heat/cold, radiation, UV light, chemicals, anything that damages the skin, allergy infection, cancer

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3
Q

inflammation is propagated by chemical factors. where do they come from (3 places)

A

plasma
injured cell
immune system

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4
Q

is inflammation good or bad ?

A

it’s good, meant to remove infections and to promote clotting and tissue repair, however side effects are uncomfortable

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5
Q

inflammation is good, but there are bad side effects. what are 5 examples of chronic and debilitating inflammatory diseases that arise from inflammation ?

A 
rheumatoid arthritis
gout
arthritis 
tonsillitis
asthma
multiple sclerosis
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6
Q

if something is inflamed, is it infected ?

A

no, but something may become inflamed with infection

eg psychosomatic inflammation

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7
Q

explain the main goal of the arachidonic acid pathway

A

metabolites produced inside an injured cell

COX enzymes activated, producing prostaglandins, thromboxane, leukotriene

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8
Q

how does the arachidonic acid pathway result in inflammation and clotting ?

A

when a cell is injured:
phospholipase A2 removed arachidonic acid from diacylglycerol/phospholipid membrane

then cox-1, cox-2, peroxidase turns it into prostaglandin, prostacyclin, thromboxane

lipooxygenase turns arachidonic acid into leukotrienes

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9
Q

what enzymes is the prostaglandin pathway promoted by

A

PGH2 synthase

cox-1, cox-2, peroxidase

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10
Q

what pathway would a drug acting against lipooxygenase target ?

A

it would target the leukotriene pathway and therefore would not help against inflammation

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11
Q

what enzymes do leukotrienes require ?

A

no enzymes.

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12
Q

what is the main purpose of leukotrienes ?

A

attract immune cells

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13
Q

what is the role of thromboxane ?

A

forming platelet aggregation (blood clots) and reducing blood flow to the site of a clot.

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14
Q

what happens in healthy vs injured endothelial cells ?

A

healthy: produce prostacyclins and nitric oxide that prevent clotting
injured: cells stop producing prostacyclin, meaning clotting can begin. therefore collagen sticks on platelets to create clotting.

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15
Q

what is a prostacyclin ?

A

a vasodilator that opposes the clotting pathway

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16
Q

how are leukotrienes involved in asthma ?

A

they trigger contractions in the smooth muscles lining the bronchioles

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17
Q

what is the role of bradykinin ?

A

causes vasodilation and pain response

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18
Q

what do chemotactic factors do ?

A

attract other cells to the injury

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19
Q

what do platelet-activating factors do ?

A

stimulate platelets to help form a clot

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20
Q

what does NSAID stand for ?

A

Non-steroidal anti-inflammatory drug

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21
Q

what pathway do NSAIDs target ?

A

arachidonic acid

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22
Q

name 3 examples of NSAIDs

A

aspirin, ibuprofen, naproxen (aleve)

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23
Q

what are the 4 purposes of NSAIDs

A

anti-pyretic (reduce fever)
analgesic (reduce pain)
anti-inflammatory (reduce inflammation)
anti-coagulant (thin blood)

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24
Q

how do NSAIDs act on the arachidonic pathway ?

A

inhibit COX enzymes, preventing prostaglandin production

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25
Q

what are the advantages of NSAIDs?

A

prostaglandins can be suppressed by NSAIDs, which prevents the pain caused by vascular permeability and edema

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26
Q

what are the bad sides of NSAIDs?

A

prostaglandins are also important to protect stomach lining from acid, so inhibiting prostaglandins means more acid damage, ulcer, GI tract issues. NSAIDs therefore cause stomach problems sometimes

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27
Q

what are the risks of NSAIDs?

A

modulating COX enzymes affects balance of blood clotting vs thinning, increasing risk of stroke or hemorrhage bleeding

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28
Q

what is COX1? what does it produce ? when it is expressed ?

A

expressed all the time in most cells of the body

produces thromboxane, which promotes blood clotting

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29
Q

what happens if you inhibit COX-1?

A

it thins the blood (anti-clotting)

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30
Q

what is COX-2? what does it produce ? when it is expressed ?

A

expressed only when there is inflammation in the cells that are injured

produces prostacyclin, which causes pain, and inhibits blood clotting

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31
Q

what happens if you inhibit COX-2?

A

it promotes clotting (clotting effect)

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32
Q

how does aspirin act on the arachidonic acid pathway ?

A

it is a very strong COX-1 inhibitor.

this inhibits blood clotting, therefore is a blood thinner

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33
Q

what does aspirin do to the GI system ?

A

causes disturbance

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34
Q

which NSAID inhibits COX-2?

A

ibuprofen (advil, aleve) a little

specific inhibitors: celebrex, vioxx, and vextra

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35
Q

which COX does ibuprofen inhibit ?

A

COX-2 and COX-1

inhibits COX-2 a lot more
inhibits COX-1

therefore only a slight anti-coagulant effect, with strong anti-inflammatory effect

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36
Q

why is it not good to use ibuprofen right after an injury?

A

it inhibits the clotting.

also increases swelling, edema, and pain.

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37
Q

what are three cox-2 specific inhibitors ? which ones are still on the market ?

A

celebrex, vioxx, vextra

only celebrex is still being used

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38
Q

what is the action of celebrex, a cox-2 specific inhibitor ?

A

this causes cox-1 to be more active, enhances clotting. this acts as a coagulant, can be dangerous

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39
Q

what are the risks of taking a cox-2 specific inhibitor ?

A

promotes clotting, therefore increases manifold the risk of myocardial infarction or stroke

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40
Q

what are the benefits of taking a cox-2 specific inhibitor ?

A

relieves GI symptoms

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41
Q

what is the best medication to take 24-48 hours after an injury for pain relief ?

A

tylenol which is not an NSAID.

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42
Q

how does tylenol work ?

A

doesn’t have the anti-coagulant effect, but works only in the brain to prevent pain so the injury heals faster

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43
Q

which tissues are affected by tylenol?

A

the brain

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44
Q

why doesn’t tylenol have all the blood and GI side effects NSAIDs do ?

A

because it only affects the brain

45
Q

what are the clinical guidelines for NSAIDs?

A

there aren’t many, so a lot of people die and are hospitalized from the side effects

46
Q

what are the recommendations for using aspirin for children ?

A

avoid it, risk of Reyes syndrome in children 17 or younger.

47
Q

what is Reye’s syndrome?

A

causes swelling in liver and brain following a viral infection

48
Q

what is the right dose to take for aspirin ?

A

it depends on what it is being used for:

analgesic, anti-inflammatory, blood thinner

49
Q

what are the food intake recommendations for aspirin ?

A

always take with a meal, or at least with milk. this is because prostaglandins protect the GI tract, so prostaglandin inhibitors will be less harsh with food

food and milk helps neutralizes acid in stomach

50
Q

why is it not a good idea to use NSAIDs on musculoskeletal injuries ?

A

NSAIDs are anti-inflammatory, but inflammation is a necessary component in the healing process.

51
Q

why is it not a good idea to use NSAIDs on tendon injuries ?

A

a lot of tendon injuries are actually degenerative and not inflammatory conditions, therefore NSAIDs won’t help.

52
Q

what is the major concern with concussion in the early phases

A

cerebral hemorrhage

53
Q

what is a concussion ?

A

a traumatic brain injury that changes the way your brain functions
brain shifts and hits against the skull

54
Q

in the brain, what can a concussion lead to ?

A

bruising and swelling of the brain, tearing of blood vessels, injury to nerves

55
Q

what are the symptoms of a subdermal or epidermal hematoma ?

A

increased headache with worsening symptoms

56
Q

what medication to give to a concussed person ?

A

none, it will mask the symptoms

don’t give anti-coagulants

57
Q

when can you rule out an epidural hematoma ?

A

after a few days

58
Q

if you really need to recommend a medication for a concussion, what would it be

A

tylenol

59
Q

what are the base of corticosteroids ?

A

cortisol

60
Q

what are the effects of cortisol ?

A
  • glucogenic effects
  • reduces inflammation
  • increases healing
61
Q

what are the three steps in an injury?

A

1) injury
2) inflammation
3) resolution and healing

62
Q

at what stages of the injury does cortisol play a role ?

A

it blocks inflammation early on and then accelerates later stages of healing

63
Q

what is hydrocortisone ?

A

a steroidal anti-inflammatory drug

64
Q

what are the abilities of hydrocortisone?

A

cause anti-inflammation and mineral retention

65
Q

what is dexamethasone ?

A

a steroidal anti-inflammatory drug

66
Q

what are the abilities of dexamethasone ?

A

more potent anti-inflammatory as compared to mineral retention

67
Q

what do the effects of corticosteroids reflect ?

A

natural glucocorticoid response

68
Q

what are the effects of corticosteroids (5)

A

gluconeogenesis in liver
protein breakdown for amino acids
triglyceride hydrolysis to supply glycerol
increased excretion of calcium from kidney
diminished immune and inflammation response

69
Q

how do corticosteroids decrease swelling and pain ?

A

by decreasing prostaglandins and leukotrienes

70
Q

how exactly do corticosteroids inhibit inflammation

A

inhibit infiltration of phagocytes and lymphocytes at the site of inflammation

71
Q

what diseases are corticosteroids used in ?

A

autoimmune, bronchial asthma, inflammatory bowel disease, tendonitis, bursitis, allergies, dermatitis, cancers, organ rejection, adrenocortical insufficiency

72
Q

what is the dose-response relationship between concentration of cytokine IL-17A (symbolizing immune T-Cell response) and a corticosteroid like dexamethasone ?

A

in an environment with activated immune cells, the more dexamethasone, the less of a response in t-cells will happen.

73
Q

what should be the dosing of corticosteroids ?

A

lowest amount for the shortest time, with exception of cancers or chronic diseases.

74
Q

how should corticosteroids be administered ?

A

depends on the location of desired effect. can be oral, intramuscular injection, inhalation, topical

75
Q

what are the adverse effects of corticosteroids ?

A

nausea, anorexia, headache, lethargy, fever

76
Q

what can happen to adrenal glands with corticosteroid use ?

A

adrenal suppression through negative feedback

77
Q

prolonged use of corticosteroids can lead to what syndrome?

A

Cushing’s, which is due to hypercortisolism

78
Q

what is glucosamine ?

A

dietary supplement

79
Q

what is glucosamine used for ?

A

treating osteoarthritis

80
Q

how does glucosamine affect the arachidonic pathway ?

A

it doesn’t

it’s not an analgesic and not an anti-inflammatory agent

81
Q

what is the chemical structure of glucosamine ?

A

aminomonosaccharide

82
Q

what is the use of glucosamine based on ?

A

it stimulates the production of cartilage to replace damaged cartilage

is used to make glysoaminoglycans which are used to make cartilage

83
Q

what have clinical studies shown for the use of glucosamine in treating osteoarthritis short term ?

A

it reduces its symptoms, compared with placebo

84
Q

studies have shown that glucosamine can be effective in treating osteoarthritis combined with a medication. which one ?

A

ibuprofen

85
Q

what is the difference between treating osteoarthritis with glucosamine or ibuprofen

A

ibuprofen- takes 1 week to be effective
glucosamine- takes 2 weeks

just as effective or more effective with glucosamine and ibuprofen

86
Q

how is glucosamine consumed ? what does this imply ?

A

oral route

therefore first pass effect reduces bioavailability to about 1/4 oral dose

87
Q

are there any benefits to using glucosamine with chrondroitin to treat osteoarthritis ?

A

in a controlled study, it was found that there was no difference between that group and the placebo group

however, in the subset with severe disease, there was a significant benefit

88
Q

adverse effects of glucosamine ?

A

minimal

mostly GI distress

89
Q

what are topical anti-inflammatory products?

A

treat topical inflammatory conditions

90
Q

what is salicylate?

A

a counterirritant NSAID

91
Q

where is salicylate usually applied ?

A

on strains, sprains, muscle soreness

92
Q

how do salicylates work ?

A

by penetration directly to the tissue rather than absorption into the systemic circulation
greater rate of absorption on abdomen than on foot

93
Q

are salicylates transdermal medication ?

A

no since the amount absorbed is too low to be for systemic therapeutic purposes
used for local response only

94
Q

are salicylates less risky to use than oral NSAIDs?

A

no

to be used with caution if risk factors like renal disease, liver disease, GI bleeding, alcohol use

95
Q

what is the form of salicylate usually used ?

A

methyl salicylate or trolamine salicylate

96
Q

what happens if you apply methyl salicylate and then use an occlusive bandage or heating pad ?

A

increased irritation, tissue damage

97
Q

what kind of skin are counterirritants applied on ?

A

intact skin, never wounds

98
Q

what are the benefits of capsicum ?

A

relieving pain associated with osteoarthritis and rheumatoid arthritis

99
Q

how does capsicum work ?

A

inhibits substance P, a NT involved in pain at peripheral sites

also has anti-inflammatory properties

100
Q

what medications are used to relieve itching ? what kind of med are they ?

A

camphor and menthol

local analgesics

101
Q

what is the word for a med that relieves itching ?

A

antipruritic

102
Q

what is good in a combination with camphor and/or menthol for the antipruritic response ?

A

local anesthetics

103
Q

what is the only corticosteroid available without prescription ?

A

hydrocortisone

104
Q

what about eucalyptus oil, wormwood, Echinacea ? are they effective as anti-inflammatory / anti-irritants ?

A

we dont know for sure

105
Q

how many NSAIDs should be used at a time

A

1

106
Q

what should NSAIDs be taken with ?

A

food/ milk

107
Q

what NSAID should you not prescribe to a teen with a viral infection ?

A

aspirin

108
Q

athlete takes NSAID, gets dark black stools. what could it be ?

A

GI bleeding

Pharmacology (15 decks)

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