L20 Inflammatories & Anti-Inflammatories

Question 1

Outline acute inflammation

Answer 1

The local accumulation of fluid containing plasma proteins and white blood cells
- often non-specific
- very dynamic
- local physiological response to injury
- responds to infection and cell death

Question 2

What does the response of inflammation aim to do?

Answer 2

• restrict damage or infection to a localised area
• remove the causative agent and damaged tissue
• promote immune cell access to the site to initiate repair of damaged tissue

Question 3

List the innate, non-specific first line defence mechanisms

Answer 3

1) skin
2) mucous membranes
3) secretions of the skin and mucous membranes

Question 4

List the innate, non-specific second line defence mechanisms

Answer 4

1) phagocytic white blood cells
2) antimicrobial proteins
3) the inflammatory response

Question 5

List the adaptive, specific third line defence mechanisms

Answer 5

1) lymphocytes
2) antibodies

Question 6

What are the cardinal signs of acute inflammation?

Answer 6

• heat
• erythema
• oedema
• pain (loss of function)

Question 7

Which innate response induce acute inflammation?

Answer 7

1) bacteria trigger macrophages to release cytokines and chemokines

2) vasodilation and increased vascular permeability cause redness, heat and swelling

3) inflammatory cells migrate into tissue which releases inflammatory mediators that cause pain

Question 8

What are the innate responses that induce acute inflammation?

Answer 8

1) bacteria trigger macrophages to release cytokines and chemokines

2) vasodilation and increased vascular permeability cause redness, heat and swelling

3) inflammatory cells migrate into tissue which releases inflammatory mediators that cause pain

Question 9

Which key cells are recruited during acute inflammation?

Answer 9

1) macrophages
2) dendritic cells
3) neutrophils
4) eosinophils
5) basophils
6) mast cells

Question 10

What is the function of macrophages?

Answer 10

Phagocytosis and activation of bactericides mechanisms

Antigen presentation

Question 11

What is the function of dendritic cells?

Answer 11

Antigen uptake in peripheral sites

Antigen presentation

Question 12

What is the function of neutrophils?

Answer 12

Phagocytosis and activation of bactericidal mechanisms

Question 13

What is the function of eosinophils?

Answer 13

Killing of antibody-coated parasites

Question 14

What is the function of basophils?

Answer 14

The promotion of allergic responses and augmentation of anti-parasitic immunity

Question 15

What is the function of mast cells?

Answer 15

Release of granules containing histamine and active agents

Question 16

What are the four stages of inflammation?

Answer 16

1) tissue damage
2) vasodilation
3) cell recruitment - phagocyte migration and marginal ion
4) tissue repair

Question 17

What occurs during the tissue repair stage?

Answer 17

1) clotting, annexin and fibrin release
2) fibrin lays down collagen - scars

Question 18

What is the structure of a scar?

Answer 18

Linear collagen structure

Question 19

What happens when a superficial cut leaves no scar?

Answer 19

The basement membrane remains in tact and a cross-collagen layer remains for new tissue to build on

Question 20

What are Eicosanoids?

Answer 20

A group of physiologically active lipid compounds

Signalling molecules made by the enzymatic or non-enzymatic oxidation of arachidonic acid

Question 21

What’s the role of prostacylclin?

Answer 21

• vasodilation
• stops platelet activation
• increases blood flow

Question 22

What is the role of prostaglandins?

Answer 22

• fever
• pain
• vascular permeability

Question 23

What is the role of thromboxane?

Answer 23

• vasoconstriction
• activates platelets

Question 24

What are the roles of leukotrienes?

Answer 24

• inflammation
• chemotatic effect on neutrophils (recruit more)

Question 25

What are the pros and cons of ibuprofen?

Answer 25

+++ short term analgesic and anti-inflammatory action

• • • gastric irritation and increased risk of ulceration

Question 26

What are the pros and cons of celecoxib?

Answer 26

+++ specific COX-2 inhibits and fewer side effects

• • • increase risk of stroke and heart attack following use

Question 27

What are the pros and cons of aspirin?

Answer 27

+++ acetylates COX, irreversible inhibitor, anti-platelet activity

• • • increased risk of gastrointestinal bleeding and irritation

Question 28

What are the pros and cons of paracetamol?

Answer 28

+++ analgesic and antipyretic activity

• • • no anti-inflammatory action and liver damage on overdose

Question 29

What are the pros and cons of paracetamol?

Answer 29

+++ analgesics and antipyretic activity

• • • no anti-inflammatory action and liver damage on overdose

Question 30

What are the side effects of steroidal anti-inflammatories?

Answer 30

Immunosuppression
Natural corticosteroid synthesis suppression
Hyperglycaemia
Growth impairment

Question 31

List some manafactured glucocorticoids

Answer 31

• beclometasone (asthma inhaler)
• hydrocortisone cream
• prednisolone (allergies, skin infections)

Question 32

What does ACTH stimulate and under what conditions?

Answer 32

Stimulates the production of natural glucocorticoid steroid hormones
- increased in response to stress
- increased production of cortisol

Question 33

What does cortisol prevent?

Answer 33

The release of inflammatory mediators

Question 34

What does cortisol inhibit?

Answer 34

Inhibits TNF-alpha and Thelper1 cells
Decreased phagocyte and macrophage activation

Question 35

What is the protective mechanism which prevents an over reaction of the inflammatory response?

Answer 35

Cortisol switches towards the Thelper 2 response rather than general immunosuppression

Question 36

How is Cushing’s syndrome caused?

Answer 36

Caused by the build up of cortisol
- Latrogenic cushings due to long-term high dose corticosteroid use
- endogenous cushings due to ACTH over-production in the body

Question 37

What are the symptoms of Cushing’s syndrome?

Answer 37

Easy bruising
Muscle wasting and atherosclerosis
Euphoria, depression and psychosis
Thinning skin, poor wound healing
Hyperglycaemia