Week 10- Corticosteroids + Nonsteroidal Anti-Inflammatory Drugs *didn't finish Flashcards
Corticosteroids are naturally occurring hormones produced by the ___________
Adrenal cortex
Types of corticosteroids
Glucocorticoids (cortisol)
Mineralocorticoids (aldosterone)
Type of corticosteroid that mainly affects carbohydrate and protein metabolism
Glucocorticoids
Type of corticosteroid that regulates electrolyte and water metabolism
Mineralocorticoids
Effects of glucocorticoids on glucose, protein, and lipid metabolism
Increase blood glucose and liver glycogen
Anti-inflammatory effects of glucocorticoids
-Act on macrophages, lymphocytes, and endothelial cells to inhibit the expression of inflammatory proteins (cytokines)
-Reduce the number of circulating lymphocytes, eosinophils, and other cells that can promote inflammation
-Inhibiting the production of adhesion molecules diminishes the ability of leukocytes to find and enter inflamed tissues
-Reduce vascular permeability by suppressing the local release of vasoactive substances such as histamine and kinins to control swelling and erythema
Applications of glucorticoids
-Decrease inflammation in a broad range of local or systemic conditions (cancer, transplantation, autoimmune disorders, and respiratory diseases (e.g., asthma))
-For immunosuppression
-Replacement steroid for adrenal insufficiency
Possible adverse effects of prolonged systemic corticosteroids
-Metabolic
-Endocrine
-Cardiovascular
-Immune (has most serious side effects)
-Musculoskeletal
-Gastrointestinal
-Nervous
-Ophthalmologic
-Integumentary
Adverse effects of glucocorticoids
-Mood
-Effects on Skin and Connective Tissue
-Cardiovascular Effects
-Steroid-Induced Myopathy
-Effect of Growth and Bone
-Other Effects
Pharmacological properties of nonsteroidal anti-inflammatory drugs
-To decrease inflammation
-To relieve mild-to-moderate pain (analgesia)
-To decrease elevated body temperature associated with fever (antipyresis)
-To decrease blood clotting by inhibiting platelet aggregation (anticoagulation)
SLIDE 3-8
Clinical applications of aspirin-like drugs
Pain and inflammation
Fever
Vascular disorders
Prevention of cancer
True or false: Aspirin provides analgesic effects similar to opioid drugs (e.g., morphine) but without the harmful or undesirable opioid side effects (i.e., sedation, nausea, respiratory depression)
True
Mild-to-moderate pain of various origins due to aspirin
-Headache
-Toothache
-Diffuse muscular aches and soreness, joint disorders (RA & OA)
-Primary dysmenorrhea
-Minor or intermediate surgeries (e.g., arthroscopic)
Aspirin is the primary NSAID in treating _______ in adults
Fever
True or false: Treating fever in children is not contraindicated
False
(it is due to Reye syndrome)
Used frequently as a nonprescription antipyretic NSAID in both adults and children
Ibuprofen
Aspirin helps prevent the onset or recurrence of heart attacks by inhibiting ___________ in the coronary arteries
Thrombus formation
Daily aspirin use may help prevent transient ischemic attacks and stroke by preventing ___________
Cerebral infarction
Mechanism of aspirin for vascular disorders
Inhibit platelet-induced thrombus formation through its ability to inhibit thromboxane biosynthesis
True or false: Aspirin decreases only the risk of prostate cancers
False
(colorectal, stomach, esophageal, bladder, breast, prostate cancers)
Main problems and adverse effects of aspirin-like drugs
GI and cardiovascular problems
True or false: GI problems range from minor stomach discomfort to variable amounts of upper GI hemorrhage and ulceration
True
Cause of GI problems
Loss of protective prostaglandins from the mucosal lining
Risk factors of GI problems
-Advanced age
-History of ulcers
-Use of multiple or high dose NSAIDs
-Use of other agents (e.g., anti-inflammatory steroids, anticoagulants)
-Helicobacter pylori in the stomach
Strategies to manage GI problems
-Enteric-coated aspirin tablets (pros and cons)
-Taking with meals (pros and cons)
-Use of other drugs in conjunction
___________ lead to increase blood pressure and the chance of thrombotic events (even though aspirin reduces the risk of platelet-induced clots)
CV problems
CV problems include…
-Myocardial infarction
-Heart attack
-Stroke in susceptible individuals
-Hypertension, coronary artery disease, and other CVDs
True or false: Cardiovascular risks should not be considered whenever NSAIDs are administered (even if on healthy people)
False
(it should)
Other side effects of aspirin
-Produce adverse changes in hepatic function on patients with liver disease
-Nephrotic syndrome, acute interstitial nephritis, and even acute renal failure on patients with impaired renal function, diabetes mellitus, heart failure, or people with decreased body water (volume depletion)
-Decreased blood flow and perfusion pressure to organs on patients with hypovolemia, hepatic cirrhosis, CHF, and HTN
-Aspirin intoxication or poisoning (when overdose)
-Reye syndrome
-Intolerance or hypersensitivity (allergic)
-Inhibit bone and soft tissue healing
True or false: There is clear evidence that any of the commonly used NSAIDs are markedly better than aspirin as anti-inflammatory analgesics
False
(no clear evidence)
True or false: Non-aspirin NSAIDs are less GI discomfort (but still have some stomach irritation), less toxic to liver and kidney, but more expensive
True
Have a much lower incidence of gastric irritation than aspirin-like drugs but may still increase risk of upper respiratory tract infections
COX-2 selective drugs
True or false: COX-2 drugs are not necessarily more effective in reducing pain and inflammation than aspirin and traditional NSAIDs, but useful to patients who cannot tolerate them
True
COX-2 selective drugs may be be preferred in patients who are at risk for the prolonged _______ and _______ that can occur with aspirin and other NSAIDs
Bleeding
Bruising
COX-2 inhibitors spare the production of ___________, thus allowing normal platelet activity and less chance of excessive bleeding
Thromboxanes
True or false: COX-2 drugs do not increase the risk of serious cardiovascular events such as heart attack and stroke
False
(they may)
COX-2 inhibition may cause a selective loss of ___________that cause vasodilation and prevent ___________, thus allowing the ________________ to predominate
Prostaglandins
Thrombosis
Prothrombotic prostaglandins
True or false: COX-2 drugs inhibit the production of thromboxane from the COX-1 enzyme, and thromboxane is a prostaglandin that facilitates platelet aggregation and clot formation
False
(do not inhibit)
True or false: Patients must be screened carefully to determine individuals who are at risk for coronary or carotid ischemia
True
Similar to aspirin and other NSAIDs in its ability to decrease pain and fever
Acetaminophen
Major advantage of acetaminophen
Less upper GI tract irritation
True or false: Acetaminophen is an NSAID
False
(because it lacks anti-inflammatory and anti-coagulant properties)
True or false: Acetaminophen treats non-inflammatory mild-to-moderate pain
True
High doses of acetaminophen (e.g., 15 g) can be especially toxic to the liver and may be fatal because of ____________
Hepatic necrosis
True or false: People with pre-existing liver disease or individuals who are chronic alcohol abusers may be particularly susceptible to liver damage caused by acetaminophen
True
Acetaminophen is metabolized in the ___________ and excreted in ____________
Liver
Urine
NSAID PT implications
-Provide analgesia without sedation and psychomimetic (e.g., hallucinogenic, etc.) effects that are associated with opioid (narcotic) analgesics
-Patient may use for prolonged periods without the serious side effects associated with steroidal drugs
-Patient education
