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Internal Medicine > Week 10- Corticosteroids + Nonsteroidal Anti-Inflammatory Drugs *didn't finish > Flashcards

Week 10- Corticosteroids + Nonsteroidal Anti-Inflammatory Drugs *didn't finish Flashcards

1
Q

Corticosteroids are naturally occurring hormones produced by the ___________

A

Adrenal cortex

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2
Q

Types of corticosteroids

A

Glucocorticoids (cortisol)
Mineralocorticoids (aldosterone)

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3
Q

Type of corticosteroid that mainly affects carbohydrate and protein metabolism

A

Glucocorticoids

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4
Q

Type of corticosteroid that regulates electrolyte and water metabolism

A

Mineralocorticoids

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5
Q

Effects of glucocorticoids on glucose, protein, and lipid metabolism

A

Increase blood glucose and liver glycogen

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6
Q

Anti-inflammatory effects of glucocorticoids

A

-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

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7
Q

Applications of glucorticoids

A

-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

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8
Q

Possible adverse effects of prolonged systemic corticosteroids

A

-Metabolic
-Endocrine
-Cardiovascular
-Immune (has most serious side effects)
-Musculoskeletal
-Gastrointestinal
-Nervous
-Ophthalmologic
-Integumentary

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9
Q

Adverse effects of glucocorticoids

A

-Mood
-Effects on Skin and Connective Tissue
-Cardiovascular Effects
-Steroid-Induced Myopathy
-Effect of Growth and Bone
-Other Effects

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10
Q

Pharmacological properties of nonsteroidal anti-inflammatory drugs

A

-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)

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11
Q

SLIDE 3-8

A
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12
Q

Clinical applications of aspirin-like drugs

A

Pain and inflammation
Fever
Vascular disorders
Prevention of cancer

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13
Q

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)

A

True

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14
Q

Mild-to-moderate pain of various origins due to aspirin

A

-Headache
-Toothache
-Diffuse muscular aches and soreness, joint disorders (RA & OA)
-Primary dysmenorrhea
-Minor or intermediate surgeries (e.g., arthroscopic)

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15
Q

Aspirin is the primary NSAID in treating _______ in adults

A

Fever

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16
Q

True or false: Treating fever in children is not contraindicated

A

False

(it is due to Reye syndrome)

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17
Q

Used frequently as a nonprescription antipyretic NSAID in both adults and children

A

Ibuprofen

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18
Q

Aspirin helps prevent the onset or recurrence of heart attacks by inhibiting ___________ in the coronary arteries

A

Thrombus formation

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19
Q

Daily aspirin use may help prevent transient ischemic attacks and stroke by preventing ___________

A

Cerebral infarction

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20
Q

Mechanism of aspirin for vascular disorders

A

Inhibit platelet-induced thrombus formation through its ability to inhibit thromboxane biosynthesis

21
Q

True or false: Aspirin decreases only the risk of prostate cancers

A

False

(colorectal, stomach, esophageal, bladder, breast, prostate cancers)

22
Q

Main problems and adverse effects of aspirin-like drugs

A

GI and cardiovascular problems

23
Q

True or false: GI problems range from minor stomach discomfort to variable amounts of upper GI hemorrhage and ulceration

A

True

24
Q

Cause of GI problems

A

Loss of protective prostaglandins from the mucosal lining

25
Q

Risk factors of GI problems

A

-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

26
Q

Strategies to manage GI problems

A

-Enteric-coated aspirin tablets (pros and cons)
-Taking with meals (pros and cons)
-Use of other drugs in conjunction

27
Q

___________ lead to increase blood pressure and the chance of thrombotic events (even though aspirin reduces the risk of platelet-induced clots)

A

CV problems

28
Q

CV problems include…

A

-Myocardial infarction
-Heart attack
-Stroke in susceptible individuals
-Hypertension, coronary artery disease, and other CVDs

29
Q

True or false: Cardiovascular risks should not be considered whenever NSAIDs are administered (even if on healthy people)

A

False

(it should)

30
Q

Other side effects of aspirin

A

-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

31
Q

True or false: There is clear evidence that any of the commonly used NSAIDs are markedly better than aspirin as anti-inflammatory analgesics

A

False

(no clear evidence)

32
Q

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

A

True

33
Q

Have a much lower incidence of gastric irritation than aspirin-like drugs but may still increase risk of upper respiratory tract infections

A

COX-2 selective drugs

34
Q

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

A

True

35
Q

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

A

Bleeding
Bruising

36
Q

COX-2 inhibitors spare the production of ___________, thus allowing normal platelet activity and less chance of excessive bleeding

A

Thromboxanes

37
Q

True or false: COX-2 drugs do not increase the risk of serious cardiovascular events such as heart attack and stroke

A

False

(they may)

38
Q

COX-2 inhibition may cause a selective loss of ___________that cause vasodilation and prevent ___________, thus allowing the ________________ to predominate

A

Prostaglandins
Thrombosis
Prothrombotic prostaglandins

39
Q

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

A

False

(do not inhibit)

40
Q

True or false: Patients must be screened carefully to determine individuals who are at risk for coronary or carotid ischemia

A

True

41
Q

Similar to aspirin and other NSAIDs in its ability to decrease pain and fever

A

Acetaminophen

42
Q

Major advantage of acetaminophen

A

Less upper GI tract irritation

43
Q

True or false: Acetaminophen is an NSAID

A

False

(because it lacks anti-inflammatory and anti-coagulant properties)

44
Q

True or false: Acetaminophen treats non-inflammatory mild-to-moderate pain

A

True

45
Q

High doses of acetaminophen (e.g., 15 g) can be especially toxic to the liver and may be fatal because of ____________

A

Hepatic necrosis

46
Q

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

A

True

47
Q

Acetaminophen is metabolized in the ___________ and excreted in ____________

A

Liver
Urine

48
Q

NSAID PT implications

A

-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

Internal Medicine (25 decks)

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