Nonsteroidal Anti- inflammatory Drugs Flashcards
physiological response to tissue injury and infection
inflammation
T/F: Inflammation is synonymous to infection
False
may pertain to pain (dolor), heat (calor), redness (rubor), and swelling (tumor)
inflammation
Immediate response of inflammation
- vascular diameter (vasodilation)
- vascular permeability
increases blood flow to the area of injury, resulting in the heating and reddening of the tissue
vascular diameter (vasodilation)
allows leakage of fluid from the BV into the damaged tissue, resulting in swelling (edema)
vascular permeability
after a few hours, leukocytes arrive at the site of injury to phagocytize the invading pathogens and release soluble mediators, particularly ____________________, ______________________, ______________________
cytokines, prostaglandins, leukotrienes
types of inflammation
- acute
- chronic
inflammation caused by response to tissue injury
acute
inflammation that can lead to progressive tissue destruction (seen in autoimmunity and certain cancers)
chronic
T/F: NSAIDs are particularly used for chronic inflammation
True
six phase leukocyte inflammatory response
P0: ligand-membrane receptor interaction (other stimuli)
P1: mobilization of cell Ca2+
P2: degranulation (release of mediators)
P3: activation of phospholipase
P4: oxidative burst
P5: transcription and translation
initial response to inflammation which causes an increase in Ca2+
mobilization of cell Ca2+
stored mediators
histamine, various proteases, chemoattractants
increased availability of arachidonic acid due to its activation
activation of phospholipase
activation of phospholipase leads to
- eicosanoid synthesis
- synthesis of platelet activating factor (PAF)
ROS prodduction
oxidative burst
production and release of cytokines
transcription and translation
T/F: Non-protein-based soluble factors (eicosanoids, bioamines) dominate the landscape during chronic inflammation
False: acute inflammation
a peptide that induces vasodilation and enhanced vascular permeability, produced by the kinin system
bradykinin
fibrin strands form clots, limiting the spread of infection into the blood
clotting systems
following tissue damage, different plasma proteins are activated including the clotting and kinin systems
acute inflammatory response
results from continuous exposure to the offending element
chronic inflammation
accumulation & activation of macrophages, lymphocytes, and fibroblasts is the hallmark of what type of inflammation
chronic inflammation
[chronic inflammation]
due to ______________________, autoimmune diseases in which self-antigens continuously activate T cells and cancers
pathogen persistence
goals of inflammation tx in px
- relief of symptoms
- maintenance of function, slowing or arrest of tissue-damaging processes
provides relief of symptoms
NSAIDs
maintenance of function, slowing or arrest of tissue-damaging processes
DMARDs
inhibit phospholipids, thereby inhibiting arachidonic acid synthesis
corticosteroids
T/F: inhibition of arachidonic acid would lead to the inhibition of lipoxygenase and cyclooxygenase
True
inhibits COX
NSAID, ASA
inhibit lipoxygenase
lipoxygenase inhibitors
inhibit leukotrienes
receptor antagonists
inhibit inflammation caused by leukotrienes
colchicine
COX synthesizes
prostaglandins, thromboxane, prostacyclin
T/F: leukocyte modulation caused by thromboxane would relieve inflammation
False: lead to inflammation
other name for arachidonic acid (AA)
5,8,11,14-eicosatetraenoic acid
most abundant eicosanoid precursor
AA (5,8,11,14-eicosatetraenoic acid)
essential FA that is converted to linolenic acid after conversion to AA
linoleic acid (omega-6-fatty acid)
T/F: some leukotriene antagonists (e.g., montelukast) are also indicated for asthma
True
examples of prostaglandin antagonists
corticosteroids and NSAIDs
major effects of PG synthesis inhibition
- analgesia
- antipyresis
- anti-inflammatory
- anti-thrombic
- closure of ductus arteriosus
normal constituent needed for body homeostasis (stomach, intestine, kidney, platelet)
COX-1
inducible arachidonic acid that leads to inflammatory site (macrophages, synoviocytes, endothelial cells)
COX-2
a relatively new normal constituent that is specific to the CNS, heart (aorta)
COX-3
blocks mRNA expression leading to the inhibition of COX-2 synthesis from AA
glucocorticoids
dose of aspirin for anti-platelet activity
low-dose (less than or equal to 325 mg)
dose of aspirin for anti-inflammatory activity
high-dose (greater than 325 mg)
generates prostanoids for housekeeping functions (e.g., gastric epithelial cytoprotection)
COX-1
major source of prostanoids in inflammation and cancer
COX-2
T/F: All NSAIDs inhibit PG synthesis
True
enzyme responsible for PG synthesis
COX
COX form that is released in normal body hemostasis
COX-1
COX form released only when there is inflammation
COX-2
irreversibly inhibits platelet COX resulting to an antiplatelet effect that lasts for 8-10 days
aspirin
rarely used as anti-inflammatory med and reviewed only in terms of its antiplatelet activity
aspirin
decreases incidence of transient ischemic attacks, unstable angina, coronary artery thrombosis w/MI, and thrombosis after CABG
clinical use of aspirin
gastric upset (intolerance), gastric and duodenal ulcers
adr of aspirin
T/F: hepatotoxicity, asthma, rashes, GI bleeding, and renal toxicity rarely occur at anti-thrombotic doses of aspirin
True
aspirin is contraindicated for px with
hemophilia
nonacetylated salicylates
MgCl salicylate, Na salicylate, and salicyl salicylate
all are effective anti-inflamm drugs and do not inhibit platelet aggregation
nonacetylated salicylates
preferable when COX inhibition is undesirable (e.g., in px w/asthma, those w/bleeding tendencies, and those w/renal dysfunction)
nonacetylated salicylates
inhibit PG synthesis w/o affecting action of the constitutively active COX-1 isozyme
COX-2 selective inhibitors
at usual doses, have no impact on platelet aggregation which is mediated by TXA2 produced by COX-1
COX-2 selective inhibitors
T/F: COX-2 selective inhibitors offers cardioprotective effects of traditional non-selective NSAIDs.
False: no cardioprotective effect
a benzenesulfonamide that is 10-20 times more selective for COX-2 than COX-1
celecoxib
indicated for tx of OA, RA, JRA, and ankylosing spondylitis (AS)
celecoxib
at 400 mg/d, shows efficacy for adjunct therapy for improving schizophrenic symptoms
celecoxib
racemic acetic acid derivative whose MOA is relatively COX-2 selective
etodolac
indicated for tx of OA, RA, and JRA w/recommended dosage of 300 mg bid-tid or 500 mg bid initially, then 600 mg/d
etodolac
an enolcarboxamide related to piroxicam and a relatively selective COX-2 inhibitor at 7.5 mg/d
meloxicam
inhibits synthesis of TXA2 even at subtherapeutic doses, but its TXA2 blockade does not result in decreased in vivo platelet function
meloxicam
indicated for OA, RA, and JRA px with dosage of 7.5-15 mg/d
meloxicam
nonselective COX inhibitors
- diclofenac
- diflunisal
- flurbiprofen
- ibuprofen
- naproxen
- oxaprozin
- tolmetin
- indomethacin
- ketoprofen
- nabumetone
- piroxicam
- sulindac
phenylactIC adic derivative
dIClofenac
DIFLUorophenyl derivative of SA
DIFLUnisal
PROpionic acid derivative
flurbiPROfen
simple phenylpropionic acid derivative
ibuprofen
NAPthyl-propionic acid derivative
NAProxen
another propionic acid derivative
Oxaprozin
pyrrole alkanoic acid derivative
Tolmetin
indole derivative and potent nonselective COX-i that may also inhibit phospholipase A and C, reduce neutrophil migration, decrease T-cell & B-cell proliferation
Indomethacin
propionic acid derivative that inhibits both COX (nonselective) and lipoxygenase
Ketoprofen
only nonadic NSAID that resembles naproxen
Nabumetone
enolcarboxamide derivative and nonselective COX-i that at high conc. inhibits polymorphonuclear leukocyte migration, decrease O2 radical production, and inhibit lymphocyte function
Piroxicam
SULfoxide nonselective prodrug
SULindac
T/F: Selective COX-2 inhibitors increase incidence of edema, HTN, and possibly MI
True
T/F: All newer NSAIDs are analgesic, anti-inflammatory, and antipyretic to varying degrees
True
T/F: All including COX-2 selective agents and nonacetylated salicylates inhibit platelet aggregation
False: except for COX-2 selective agents and nonacetylated salicylates
NSAIDs can be associated with GI ulcers and bleeding, and are all ________________________
gastric irritants
All NSAIDs are about equally efficacious except for __________________ and ______________
tolmetin (ineffective for gout) and aspirin (less effective for AS)
side effects that limit the use of ketorolac
GI and renal side effects
best for px w/renal insufficiency
nonacetylated salicylates
associated with more liver function test abnormalities than other NSAIDs
diclofenac and sulindac
relatively expensive selective COX-2 inhibitor but is probably safest for px at high risk for GI bleeding (but may increase risk of CV toxicity)
celecoxib