Pain & Inflammation Flashcards
Inflammation: histamines
Increased vascular permeability
Endothelial activation
Vasodilation
Inflammation: 5HT
Vasodilation, increased vascular permeability.
Inflammation: prostaglandins
Pain
Vasodilation
Fever
Inflammation: leukotrienes
Increased permeability
Chemotaxis
Leukocyte adhesion and activation
Inflammation: kinins
Increased vascular permeability
Vasodilation
Pain
Nonsteroidal anti-inflammatory drugs
Mild to moderate pain and inflammation.
Block cox-1/2
Acetaminophen, ibuprofen, naproxen, dicofenac.
Anti-inflammatory (except acetaminophen)
Analgesic
Antipyretic
Anticoagulant
Aspirin
First NSAID
As well as pain and inflammation; also anticoagulant.
NSAIDs: Adverse effects
Damage to gastric mucosa
Nephrotoxicity
Coagulation
Opiates: effects
Analgesic
Anti-diarrheal
Anti-tussive
Anti-anxiety
Narcotics: mechanism of action
- altering Na+/K+ flow in and out of cell
- affect cellular second messenger system
Narcotics: adverse effects
Hypotension Hypoventilation Constipation Delirium Sedation Urinary retention Habit forming.
Skeletal muscle relaxants
Reduce muscle spasm and spasticity
Depresses sensory and motor impulses at different sites in the CNS
Muscle spasm
Abnormally high muscle tone.
response to trauma, or unexpected trauma
Splinting
Spasticity
Hypertonicity, clonus, exaggerated reflux
CNS damage
Muscle relaxant: uses
Central: inhibit painful mm HT from injury/inflammation
Peripheral: management of spasticity and adjective to general anaesthetic.
Muscle relaxants: adverse effects
Drowsiness
Dry mouth
Heart rate abnormalities
Dizziness
Two main events in inflammation
- Change in caliber and permeability of blood vessels
- Emigration of leukocytes from bloodstream to inflamed area
Neutrophils first, then macrophages
Why is acetaminophen weird?
Doesn’t work at site of inflammation; limits pain and fever by acting in CNS only.
Thought to be inactivated by peroxide – inflammatory byproduct.
Four categories of corticosteroids action
- Anti Inflammatory
- Immunosuppressive
- Catabolic effect on connective tissue
- Other. (Increased Na+ resorption, mood changes, decreased Ca+ absorption, impaired osteoblast activity).
Corticosteroids : physiologic dose
Small. Replacing natural production.
Corticosteroids: pharmacologic dose
Large. To achieve anti inflammatory and immunosuppressive effects.
Corticosteroids: adverse effects
Hypertension Diabetes Avascular necrosis Weakened connective tissue Mood disturbances Osteoporosis
