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Dental Therapeutics Final Exam > Prostanoids and NSAIDs > Flashcards

Prostanoids and NSAIDs Flashcards

1
Q

Major Prostaglandins

A

Prostanoid Acid and PGI2 (Prostacyclin)

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2
Q

Prostaglandin Synthases

A

Cox 1 - Constitutive

Cox 2 - Induced

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3
Q

NSAIDs

A 
Analgesic
Anti-pyretic
Anti-inflammatory
All inhibit COX (Some may inhibit LOX)
Short-term relief
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4
Q

Salicylic Acid Derivatives

A

ASA

Diflunisal

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5
Q

Par-aminophenol Derivatives

A

Acetaminophen (Not Anti-Inflammatory)

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6
Q

Indole and Irdene Acetic Acids

A

Etodolac

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7
Q

Heteroaryl Acetic Acids

A

Diclofenac

Ketorolac

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8
Q

Arylpropionic Acid

A

Ibuprofen
Naproxen
Flurbiprofen
Ketoprofen

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9
Q

Anthraniic Acids (Fenamates)

A

Mefanamic Acid

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10
Q

Enolic Acids

A

Mecloxicam

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11
Q

Alkanones

A

Nabumetone

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12
Q

Diarylheterocycles (COX2 Selective Inhibitors)

A

Celecoxib

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13
Q

Prostaglandin

A

Hyperalgesia
Allodynia
Spontaneous pain

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14
Q

Aspirin

A

Irreversible acetylation of serene in active site of both cyclo-oxygenases; Acetylation of COX2 alters enzymatic action to produce 15-epi-lipoxins and resolvins
May induce asthma
Anaphylactoid reaction: Arachidonic acid to Prostaglandin (COX inhibit) switch to Leukotrienes (LOX)

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15
Q

NSAID Platelet Function

A

Blocks
Aspirin - Irreversible block of thromboxane synthesis in platelets and effect lasts until new platelets form (7days); NSAID - Reversibly inhibits COX so short term thromboxane effect
COX2 inhibitors - Reduce PGI2 protective effect, Blood clots, Cardiac arrest, Death (Inhibit COX2 in endothelial cells - Reduce beneficial vasodilatory activity of PGI2 and prevent platelet aggregation (No effect on COX1)

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16
Q

NSAID Renal Function

A

PG and Renin regulate renal blood flow - NSAID alter salt retention and hypertension by reducing blood flow

17
Q

Prostaglandin Fever

A

Pyrogen to Cytokines - Increase COX2 - mPGES1 - Increase PGE2 - Activate EP3 receptor in hypothalamus - Increase efferent outflow (Muscles, Sweat glands, Brown adipose tissue)

18
Q

COX-2 Inhibitors

A

GI cytoprotection - COX1
Inflammatory response - COX2
COX 2 -> Reduce GI disturbance
COX 2 Selective Analgesics - Cardiovascular effects due to no action on platelets (COX-1) but significant effect on PGI2 production in endothelium, Increased heart attack and stroke; Adverse effect on resolvin production; Negative effect on bone healing

19
Q

Current COX-2 Inhibitors

A

Celecoxib (Celebrex)
Rofecoxib (Vioxx) GONE
Etoricoxib (Arcoxia) EUROPE
Lumiracoxib (Prexige) MEXICO, UK

20
Q

NSAID Bone Healing

A

Prostanoid production normal in would healing, fracture repair
NSAID - slow fracture reapir (COX2) poorer repair and worsening of radiological joint deterioration
Reduced bone healing - Reduced diff of mesenchymal cells to osteoblasts - Reduced activity of transcription factors essential for osteoblastogenesis - COX 2 +BMP osteoclast formation blocked
Retard ortho movement; Extraction bone repair; Implant osteo-integration; Reduce periodontal inflammation and bone loss

21
Q

Reyes Syndrome

A 
Influenza and Salicilate (Aspirin, Pepto-Bismol, Difunisal); Stage I - Vomit, Brain dysfunction, Energy loss; Stage II - Irritability; Stage III - Confusion, Combative;
Vomiting
Elevated blood NH3
Hypoglycemia and Hepatomegaly
DONT USE ASPIRIN ON KIDS
22
Q

Prostaglandin Gender

A

Obstetrics: Promote cervical ripening, Induce labor, Induce abortion; Misoprostol (Cytotec) - GI, Uterine; Post delivery - Post partum hemorrhage; PG maintain ductus arteriosus - Premature close of DA; Avoid in pregnancy; Breast feeding - Naproxen or Ibuprofen analgesic do not enter breast milk

23
Q

Non-Antiinflammatory Analgesic

A

Phenacetin

Acetaminophen

24
Q

Acetaminophen

A

Only low O2 environment - Brain; Affects Peroxidase site
Anaglesic, Anti-pyretic, Little anti-inflammatory, Doesn’t interfere with tooth movement or implant osteo-integration, Few GI adverse effects, Few renal adverse effects, No platelet function alter, In children, In pregnancy

25
Q

Acetaminophen Hepatotoxicity

A

Metabolism of acetaminophen to N-acetyl-para-benzoquinoneimine; Worse by alcohol
Acetaminophen to NAPQI to Mercaptopuric acid (w/GSH)
Limit GSH - NAPQI to toxic

26
Q

Zileuton

A

Specific 5-lipoxygenase inhibitor, Mild persistent asthma, Effective as inhaled glucocorticoids, Inhibit numerous P450

27
Q

Zafirlukast

Montelukast (Singulair)

A

LTD4 receptor antagonist
Effective as Zileuton - Fewer drug interactions
Headache, Hepatic enzyme elevation

28
Q

DMAARDS

A

Disease Modifying Anti Arthritic Drugs
Anti-TNF Drugs or Anti-IL
Cimzia, Enbrel, Humira, Remicade, Simponi, Kineret, Actemra, Orencia, Rituxan
But injection site reactions, Immune dysfunction, Infections and Very High cost

Dental Therapeutics Final Exam (7 decks)

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