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Anti-inflammatory & GI & Chemo drugs > NSAIDs & GI & Chemo Drugs > Flashcards

NSAIDs & GI & Chemo Drugs Flashcards

1
Q

What 3 main actions do NSAIDs do?

A
  • Anti-inflammatory
  • Analgesic
  • Anti-pyretic
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2
Q

What does NSAIDs stand for?

A

Non-steroidal anti-inflammatory drugs.

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3
Q

What is COX?

A

NSAIDs inhibits COX which stands for cyclo-oxygenase enzymes.

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4
Q

What and When are the two different COX enzyme used?

A

COX-1
- Found in most of the body tissues.
- Involved in homeostasis
COX-2
- Induced in inflammatory cells when activated.
- Responsible for inducing inflammatory medications.

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5
Q

Describe the NSAIDs mechanisms of action.

A

The majority of NSAIDs inhibit BOTH COX-1&2.
The anti-inflammatory effect is produced by the COX-2 enzyme.
The side effects are caused by the COX-1.
So many practices use COX-2 selection.

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6
Q

How does NSAID provide analgesia?

A
  • Effective against pain of inflammation or tissue damage.
  • Decrease prostaglandin production that sensitises the pain receptors.
  • Most effective against pain of muscular, skeletal and vascular origin. Less effective against visceral pain.
  • Used in combination with opioids for post-op pain.
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7
Q

What is Prostaglandins?

A

This is produced by inflammation that alter the firing rate of neurons in hypothalamus which controls the thermoregulation.

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8
Q

How does Anti-pyretic work?

A
  • This increases the body’s thermal set point = fever.
  • Maintained by vasodilation and sweating.
  • NSAIDs inhibit PG production, reducing pyrexia.
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9
Q

What are the properties of Meloxicam?

A
  • Commonly used in veterinary NSAIDs.
  • Licensed in dogs and cats
  • Oral suspension, oral tablets, solution for injection - SC.
  • Preferably inhibits COX-2.
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10
Q

What are the uses of Meloxicam?

A
  • Acite and chronic muscoskeletal pain.

- Post-op -orthopaedic and soft tissue procedures.

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11
Q

What are the contraindications of Meloxicam?

A
  • Dehydration
  • Hypotension
  • GI disease
  • Pregnancy
  • <6 weeks old
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12
Q

What are the adverse reactions of Meloxicam?

A
  • V+ D+ GI Ulcerations and bleeding.

- NOT to be administered with other NSAIDs or corticosteriods.

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13
Q

What are the properties of Carprofen?

A
  • Injection - IV,SC, oral tabs.
  • Inj licensed for Dogs and Cats. Tabs only dogs.
  • ## Preferential COX-2 inhibition.
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14
Q

What are the uses of Carprofen?

A

Uses are similar to Meloxicam

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15
Q

What are the adverse reactions of Carprofen?

A

V+ D+ GI Ulcerations and bleeding.

- NOT to be administered with other NSAIDs or corticosteriods.

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16
Q

How should Carprofen be administered?

A

With Food.

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17
Q

What are the properties of Firocoxib?

A
  • COX-2 inhibition.
  • To have lesser effects on GI tract then Meloxicam/Carprofen.
  • Licensed for dogs only.
  • Oral tabs.
  • Can be given with/out food.
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18
Q

What are the adverse reactions of Firocoxib?

A
  • V+ D+ GI Ulcerations and bleeding.

- NOT to be administered with other NSAIDs or corticosteriods.

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19
Q

What 3 other NSAIDs drugs are used in practice?

A

Robenacoxib - Onsior
Cimicoxib - Cimalgex
Mavacoxib - Trocoxil

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20
Q

What are the properties of Paracetamol?

A

Licensed in dogs as Pardale-V (+codeine)

Not considered an NSAIDs as it treats pain mainly by blocking COX-2 in the central nervous system.

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21
Q

Why can Parcetamol NOT be given to cats?

A
  • Cats lack the glucuronyl transferase enzyme to metabolise paracetamol - toxic intermediates NAPQ-1.
    Damage RBCs
    Liver damage - icterus
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22
Q

How does Paracetamol damage RBCs in cats?

A
  • Causing methaemaglobinaemia - chocolate brown MM - cyanosis.
  • Anaemia
  • Haemoglobinuria
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23
Q

What are the treatment for paracetamol toxicity in cats?

A
  • IV fluids
  • Blood transfusion
  • N-acetycysteine
    -Increased glutathione reserves in liver and enhances metabolism
    May cause anaphylaxis
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24
Q

What does the Medulla, hormones secrete?

A
  • Adrenaline

- Noradrenaline

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25
Q

What do the hormones secrete do to the body?

A
  • These prepare body for “fight” or “flight” situations in combination with the sympathetic nervous system.
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26
Q

What two anatomical landmarks the Adrenal Glands obtain?

A

Medulla and Cortex

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27
Q

In the cortex, what hormones are produced?

A

Steroids

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28
Q

What are the three groups of Steroids?

A
  1. Glucocorticoids
  2. Mineralocorticoids
  3. Adrenal Sex hormones.
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29
Q

Why do the Glucocorticoids secrete?

A
  • In response to stress.
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30
Q

What is the Glucocorticoids responsible for?

A
  • increase in bloog glucose.
  • Aid in control of electrolytes (e.g. Ca).
  • Anti-inflammatory response/suppress immune response (inhibits prostaglandin A2).
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31
Q

What are Mineralocorticoids responsible for?

A
  • Aldosterone - Retain Na, Excrete K.

Increase blood volume and blood pressure.

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32
Q

How often do sex steroids produce for?

A

Produced in small amounts.

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33
Q

How is Cortsol release controlled?

A
  • Controlled by negative feedback.
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34
Q

How is Cortisol released?

A
  • Low blood cortisol stimulates ACTH release from anterior pituitary gland.
  • Stimulates corticosteroid release from adrenal gland.
  • Exogenous steroid increases blood cortisol levels and so inhibits ACTH production.
35
Q

What hormones do glucocorticoids secrete?

A
  • Hydrocortisone (Cortisol) and Cortison (inactive form).
36
Q

What synthetic drugs come under the glucocorticoids drugs?

A
  • Prednisolone
  • Methylprednisolone
  • Betamethasone
  • Dexamethasone
  • Triamcinolone
37
Q

What are the effects of Glucocorticoids?

A

Metabolic - - Converting protein to glycogen.

  • Stimulates protein catabolism to AAs
  • Glucose uptake inhibited.
38
Q

What anti-inflammatory effects does Glucocorticoids have?

A
  • Decrease all stages of inflammatory process and later stages in chronic inflammation.
  • Immunosuppressive.
39
Q

What have you seen glucocorticoids used for?

A
  • Suppress inflammation.
  • arthritis, colitis etc.
  • Allergy
    -asthma, atopic dermatitis etc
  • Immune response
  • IMHA, lymphoma etc.
    Different effect according to increasing dose levels.
40
Q

How is Hydrocortisone used?

A
  • Addisons treatment (Oral), shock (IV) Topical ointments.
41
Q

Why is Prednisolone used?

A

inflammatory and allergic diagnosis (oral).

42
Q

What is Betamethasone Diproprionate used for?

A

Asthma (inhalation).

43
Q

What is Triamcinolone used for?

A

Severe asthma, intra-articular injection for arthritis.

44
Q

When an increase of the adrenal gland, what is secreted?

A

Increased secretion known as cushings disease

45
Q

When a decrease of adrenal gland, what is secreted?

A

Decrease secretions known as Addisons disease

46
Q

What is Betamethasone and Dexamethasone used for?

A
  • Very potent (25-30x)

- High dose indications.

47
Q

What are some of the adverse effects associated with glucocorticoid treatment?

A

Higher doses produce similar effects to that of cushing’s disease -(steroid excess)

48
Q

How is Hydrochloric acid produced?

A

In the fundus by parietal cells.

49
Q

What are the clinical signs associated with this disease and how it is treated?

A
  • Muscle wasting
  • Thin skin and poor habit coat
  • PU/PD
  • Polyhagia
  • Panting
  • Restlessness
50
Q

How is Mucus produced?

A

Produced throughout the stomach y Goblet cells. Prevents AUTO DIGESTION

51
Q

How is Gastrin produced?

A

Hormones produced in fundus by G cells >stimulates HCL production

52
Q

What 4 functions of GIT that drugs focus on?

A
  • Gastric secretion
  • V+ (emesis)
  • Motility of the intestines
  • Bile formation/excretion
53
Q

What is the process of regulating acid secretion?

A
  • Stomach parietal cells produce HCL
  • Secreted via a proton pump (K+/H+)
  • Regulated by (stimulated acid secretion)
  • Prostaglandins inhibits acid secretions.
54
Q

What are the indication that drugs inhibit gastric acid secretion?

A
  • Gastric or duodenal ulcer
  • Reflux oesophagitis
  • Zollinger - Ellison Syndrome (gastrin-producing tumour).
55
Q

What are the methods of action when drugs inhibit GAS? (gastric acid secretion)

A
  • Histamine H2 receptor antagonist
  • Proton pump inhibitors
  • Antacids to neutralise secreted acid.
56
Q

What example of drugs of Histamine receptor antagonist?

A

Famotidine
Cimetidine
Ranitidine

57
Q

What example drugs of Proton pump inhibitors?

A

Omeprazole

Aspirin

58
Q

What examples drug of antacids?

A

Gaviscon

Maalox

59
Q

What are the side effects of Histamine receptors blockers?

A 
Constripation
D+
Restlessness
Hypotension
Arrythmias
60
Q

What are the side effects of Proton Pump inhibitors?

A

Constipation, D+, Nausea/V+, Skin rashes, Rugal hypertrophy (thickens the stomach wall). - BAD

61
Q

How does Proton pump work?

A
  • inhibits the H/K+ proton pump.
62
Q

How does H2 receptor work?

A
  • inhibits histamine action ->
63
Q

What is mucosal protectors?

A
  • Provides physical barrier over the ulcer.
64
Q

What 3 drugs are a mucosal protectors?

A
  • Sucralfate (Antepsin)
  • BIsmth Chelate
  • Misoprostol (Cytotec)
65
Q

What are the properties of Sucralfate (Antepsin)?

A
  • In presence of acid forms complex gels with mucus.
  • Prevents degradation of mucus
  • Stimulates mucosa protection mechanism.
  • Oral
  • Constipation, Dry mouth, V+, Rashes.
66
Q

What are the properties of Bismuth Chelate?

A
  • Coats ulcer base.
  • Reduces prostaglandin synthesis (salucylate) - aspirin.
  • Enhances bicarbonate production
  • Very toxic to cats
67
Q

What are the properties of Misoprostol (Cytotec)?

A
  • Prostaglandin analogue
  • Inhibits gastrin, stimulates mucus and bicarbonate.
  • Oral
  • Used to treat ulcers resulting from chronic NSAIDs use.
68
Q

What are the properties of Cerenia?

A
  • Licensed for dogs and cats
  • inhibits the vomiting reflex.
  • NK 1 receptor antagonist in medullary vomiting centre.
  • Tx and prevention of V+, chemotherapy, motion sickness (high dose).
  • SC/IV injection, oral tabs.
  • Pain on SC injection common (refrigerate?).
  • Not to be used >48hours without diagnosis
  • Not to be used in cases of obstruction.
69
Q

What are the properties of Cerenia?

A
  • Licensed for dogs and cats
  • inhibits the vomiting reflex.
  • NK 1 receptor antagonist in medullary vomiting centre.
  • Tx and prevention of V+, chemotherapy, motion sickness (high dose).
  • SC/IV injection, oral tabs.
  • Pain on SC injection common (refrigerate?).
  • Not to be used >48hours without diagnosis.
  • Not to be used in cases of obstruction.
  • Good for analgesic for pancreatitis.
70
Q

What are the properties of Metoclopramide? (Maxolon/Emeprid).

A

Acts at dopamine receptor (D2) in the chemoreceptor trigger zone in the medulla.

  • Upper GI prokinetic
  • Affects dopamine receptor elsewhere in CNS therefore a lot of side effects.
  • Depression, nervousness, twitching, restlessness, (esp. cats may be disorientated).
  • Not to be used in bowel obstruction.
  • Oral tabs, syrup and injectable- IV/IM
71
Q

What are the 3 types of Purgatives?

A
  • Bulk and osmotic laxatives
  • Faecal softeners
  • Stimulant purgatives.
72
Q

What are the bulk laxatives?

A
  • Bran, Ispaghula, Sterculia. Retain water and promote peristalsis.
73
Q

What are the osmotic laxatives?

A

lactulose. Maintain water in intestinal lumen by osmosis. Accelerates throughout.

74
Q

What are the faecal softeners?

A

Docusate sodium - acts like a detergent to product soft faeces.

75
Q

What are the stimulant purgatives?

A
  • Increase water and electrolyte secretion and peristalsis.
  • Micralax
  • Bisacodyl - Suppository.
  • Sodium picosulfate (Dulcolax) - given orally in prep for surgery/colonoscopy.
76
Q

What are the stimulant purgatives?

A
  • Increase water and electrolyte secretion and peristalsis.
  • Micralax
  • Bisacodyl - Suppository.
  • Sodium picosulfate (Dulcolax) - given orally in prep for surgery/colonoscopy.
  • Senna
77
Q

What anti-diarrhoeals drugs are there?

A

Opiates such as morphine and codeine are highly effective in decreasing intestinal mobility. However, due to actions on other systems, they are rarely used.

78
Q

Name the types of anti-diarrhoeals.

A

Loperamide (Imodium) - Antisecretory effect and reduce motility.

  • Bismuth Subsalicylate
  • Adsorbents - Kaolin, Pectin, Chalk, Charcoal, Magnesium Aluminium silicate. Adsorb micro-orgaisms? Alter intestinal flora? Coat and protect mucosa?
79
Q

What drugs are used for inflammatory Bowel disease?

A

Glucocorticoids - anti-inflammatory.
Sulfasalazine (Salazopyrin) - acts as local ant-inflammatory in colon. Activated by colonic bacteria. Exact mechanisms of action unknown. Side effects - KCS (dry eyes), V+, Allergic, dermatitis.
Metronidazole used - Antibiotic.

80
Q

What is Chemotherapy?

A

Drugs that inhibit mechanisms of cell proliferation.

- Kill rapidly dividing cells: higher proportion of malignant cells are dividing compared to normal tissues.

81
Q

Identify the cell types that are mostly affected by chemotherapy?

A

Bone Marrow

  • GI tract
  • Skin, Hair Follicles
82
Q

Identify the route by which chemotherapy drugs are administered?

A

IV/Oral

83
Q

What are the side effects in patient receiving chemotherapy?

A

Fatigue, V+, Nausea, Reduced appetite, D+, Neutropaenia.

84
Q

What are the side effects in patient receiving chemotherapy?

A

Fatigue, V+, Nausea, Reduced appetite, D+, Neutropaenia, alopecia

Anti-inflammatory & GI & Chemo drugs (1 decks)

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