Management of pain and inflammation Part 2 Flashcards
Nonopioid analgesions incluse
NSAIDs (nonsteroidal anti-inflammator drugs) and Acetaminophen
NSAIDs: primary effects
-analgesic
-anti inflammatory
-antipyretic (reduce fever)
-anticoagulant
-anticancer?
(NSAAAAAIDs)
OTC (over the counter) NSAIDs
aspirin, ibuprofen, naproxen, ketoprofen
prescription NSAIDs
- Etodolac
- Fenoprofen
- Ketorolac
- Meclofenamate
- Piroxicam
- etc.
OTC vs Rx: therapeutic differences?
not really if give same relative dose
OTC vs Rx: safety differences?
not really– related to dosage
OTC vs Rx: cost differences
OTC much cheaper
NSAIDs inhibit synthesis of
prostaglandins
lipid compounds produced in cells (usually when cell is injured)
prostaglandins
NSAIDs decrease prostaglandins by inhibiting
cyclooxygenase
NASIDs inhibit
cyclooxygenase enzyme (COX) (decreaes prostaglandin synthesis)
COX enxyme: 2 primary subtypes
1) COX-1
2) COX-2
COX-1 vs COX-2: normal constituent certain cells
COX-1
COX-1 vs COX-2:synthesizes PGs to protect cells, maintain function
COX-1
COX-1 vs COX-2: induced when cell is injured
COX-2
COX-1 vs COX-2:synthesizes PGs that mediate pain, inflammation
COX-2
COX-1 vs COX-2: ex= stomach, kidneys, platelets
COX-1
COX-1 vs COX-2: ex= RA, other pathologies
COX-2
COX-2 selective drugs inhibit …
synthesis of PGs in pain, inflammation
COX-2 selective drugs spare production of beneficial PGs in…
stomach, kidney, platelets
COX-2 selective drugs may decrease pain and inflammation with…
less toxicity
COX-2 selective drugs include
celecoxib (Celebrex)
Evidence that COX-2 inhibitors promote ( )
infarction (heart attack, stroke)
some ( ) more selective for COX-2
NSAIDs
which NSAIDs are 5-50 times more selective for COX-2?
- Diclofenac (voltaren)
- Etodolac (lodine)
- Meloxicam (mobic)
why does COX-2 inhibition promote infarction:
normally there is balance b/w PGs that cause vasodilation/constriction…the drugs allow PGs that increase platelet activity and promote constriction to dominate
acetaminophen effects
analgesic and antipyretic
what effects does acetaminophen not have?
gastric irritation, anti-imflammatory, anticoagulant (peripheral effects)
high doses of actaminophen lead to
liver toxicity
actaminophen and opioid combos: tramadol + acetam
altraCET
actaminophen and opioid combos: hyrocodone + acetam
lorTAB, lorCET, vidoden, detc.
actaminophen and opioid combos: oxycodone + acetam
endoCET, roxiCET, primalev
are NSAIDs the same as acetaminophen?
NO
anti inflammatory: nonsteroidal
NSAIDs
anti inflammatory: steroids
glucocorticoids
NSAIDs inflammation: inhibit ( )
PG biosynthesis
NSAIDs inflammation: anti-inflammatory higher or lower dosage than analgesisc?
higher
NSAIDs inflammation: T/F: should be used continuously until inflammation is resolved
T (ex. dumping water on fire)
glucocorticoids inflammation: powerful anti-inflammatory AND ( )
immunosuppressive effects
common glucocorticoids
betamethasone, cortisone, dexamethasone, hydrocortisONE, praramethasONE, predinisolONE
anti inflammatory effects: act on ( )
inflammatory cells (macrophages, leukocytes)
anti inflammatory effects: drug binds to ( ) in cytoplasm
glucocorticoid receptor
anti inflammatory effects: when drug-receptor travels to nucleus, it decreases…
expression of inflammatory proteins (cytokines, enzymes, etc)
anti inflammatory effects: when drug-receptor travels to nucleus, increases…
expression of antiinflammaotry proteins
administration methods: regular maintenance dose, dose packs
oral, systemic
administration methods: intra-articular, 3-4 per year
injections
administration methods: other
inhalation, topical, nasal, opthalmic, otic
why would you use injection?
put drug right where you need it
primary concern for anti-inflammatory steriods
catabolic effect on bone, muscle, ligament, tendon, skin (break down collagen in these tissues)
other anti-inflammatory steroid side effects:
salt/water retention, increased infection, gastric ulcers, glucose intolerence, glaucoma…adrenal suppression (METABOLIC DYSFUNCTIONS)
can we intervene with the primary problem?
yes, with resistance exercises and stuff
how long is gap where body does not have adrenal hormones?
4-5 days
glucocorticoids: adrenocortical shock
vascular collapse, severe hypotension, organ damage
when can adrenocortical shock occur?
when GCs are suddenly discontinued