(3) Blood & Inflammation: Anti-inflammatory (3.1-3.2)

Question 1

What is the precursor molecule to prostanoids and leukotrienes?

Answer 1

Arachidonic acid

Question 2

What enzyme liberates arachidonic acid from the cell membrane?

Answer 2

Phospholipase A₂

Question 3

Which COX enzyme is induced by inflammation?

Answer 3

COX-2

Question 4

List 2 functions of COX-1

Answer 4

(1) TXA₂ ⇒ Platelet aggregation
(2) Gastric cytoprotective prostaglandins

Question 5

Where is COX-2 expressed?

Answer 5

(1) Vascular endothelial cells
(2) Smooth muscle

Question 6

List 5 functions of COX-2

Answer 6

(1) PGI₂⇒ Vasodilation
(2) Inhibits platelet aggregation
(3) Fever
(4) ↑ Pain sensitivity
(5) ↑ Vascular permeability

Question 7

Which COX enzyme dilates the renal afferent arteriole?

Answer 7

Both.

Question 8

Other than Ibuprofen and Aspirin, name 6 non-selective NSAIDs

Answer 8

(1) Diclofenac
(2) Ketorolac
(3) Indomethacin
(4) Meloxicam
(5) Piroxicam
(6) Naproxen

Question 9

Adverse Effects (7) : Non-selective NSAIDs

Answer 9

(1) GI erosions
(2) Bleeding
(3) ↓ Na+ excretion ⇒ ↑ BP
(4) Interstitial nephritis
(5) Renal papillary necrosis
(6) Aplastic anemia
(7) Hypoaldosteronism
* (Bleeding often presents as GI bleed)*

Question 10

Specifically, what type of kidney damage can occur due to NSAID induced vasoconstriction?

Answer 10

Renal papillary necrosis

(Medulla is already hypoxic ∴ ↑ Sensitivity ischemia ⇒ PAPILLARY necrosis)

Question 11

What psychiatric drug’s concentration can be increased by NSAIDs?

Answer 11

Li⁺

Question 12

Which NSAID most commonly causes aplastic anemia?

Answer 12

Indomethacin

Question 13

MOA: Aspirin

Answer 13

IRREVERSIBLY acetylates COX-1 and COX-2

Question 14

What NSAID is used in Kawasaki’s disease?

Answer 14

Aspirin

(Notable as ASA is usually avoided due to Reyes syndrome)

Question 15

Name 2 signs/symptoms of Reye’s syndrome

Answer 15

(1) Encephalopathy
(2) Liver dysfunction

Question 16

Name 3 signs of aspirin toxicity

Answer 16

(1) Metabolic acidosis
(2) Respiratory alkalosis
(3) Tinnitus
* (+ Hyperthermia. Tinnitus presents first)*

Question 17

Treatment: Aspirin toxicity

Answer 17

(1) Charcoal
(2) NaHCO₃

Question 18

Contraindications (2) : NSAIDs

Answer 18

(1) Kidney ischemia
(2) Pregnancy
* (i.e., ACE inhibitors ⇒ ↓ renal perfusion. Also, remember they antagonize the effects of loop diuretics)*

Question 19

Name 2 COX-2 selective antagonists

Answer 19

(1) Celecoxib
(2) Acetaminophen

Question 20

Name one reason Celecoxib is better and one reason it’s worse than other NSAIDs

Answer 20

(1) Positive: Minimal GI damage
(2) Negative: ↑ Risk of cardiovascular damage

Question 21

Which COX inhibitor is a sulfa drug?

Answer 21

Celecoxib

Question 22

MOA: Acetaminophen toxicity

Answer 22

Consumption of GS-SH

⇒ ↑ NAPQI

⇒ Free radical liver damage

(⇒ Centrilobular liver necrosis)

Question 23

Treatment: Acetaminophen toxicity

Answer 23

(1) Charcoal
(2) N-acetyl-cysteine

Question 24

Why is N-acetyl-cysteine used for Acetaminophen toxicity?

Answer 24

Restores GSH

(GSH - glutathione)

Question 25

Gout is caused by the build-up of:

Answer 25

Uric acid

Question 26

What is uric acid derived from?

Answer 26

Purines

Question 27

What enzyme converts hypoxanthine to uric acid?

Answer 27

Xanthine oxidase

Question 28

Name 3 classes of drugs used in the acute treatment of gout

Answer 28

(1) NSAIDs (Indomethacin) (2) Glucocorticoids (3) Colchicine

Question 29

**MOA**: Colchicine

Answer 29

Inhibits polymerization of microtubules *(∝ Vinca alkaloids and Griseofulvin)*

Question 30

What cell does Colchicine inhibit when used in treatment of gout?

Answer 30

Neutrophils

Question 31

Describe the crystals of pseudogout

Answer 31

(1) Rhomboid (2) Positively birefringent

Question 32

Name 2 drugs used to treat chronic gout _due to uric acid overproduction_

Answer 32

(1) Allopurinol (2) Febuxostat

Question 33

**Indications** (3) : Allopurinol

Answer 33

(1) Gout (2) Tumor lysis syndrome (3) Lesch-Nyhan syndrome

Question 34

What type of cancer most commonly causes tumor lysis syndrome?

Answer 34

(1) Lymphoma (2) Acute lymphoblastic leukemia (ALL)

Question 35

What drug class is notable for its interaction with Allopurinol?

Answer 35

Purine analogs

Question 36

**Adverse Effects** (2) : Allopurinol

Answer 36

(1) Steven-Johnson syndrome (2) DRESS syndrome

Question 37

**Treatment** (3) : Gout (in under-excreters)

Answer 37

(1) Probenecid (2) HIGH DOSE Aspirin (3) Pegloticase

Question 38

**Adverse Effect**: Probenecid (in treatment of gout)

Answer 38

⇒ Renal stones

Question 39

What drug used to treat gout is notable for increasing the serum levels of several antibiotics?

Answer 39

Probenicid

Question 40

Name a Sulfa drug used to treat gout

Answer 40

Probenicid

Question 41

**MOA**: Pegloticase

Answer 41

Converts uric acid ⇒ Allantoin

Question 42

**Adverse Effects** (2) : Pegloticase

Answer 42

(1) Hemolytic anemia (G6PD) (2) Anaphylaxis

Question 43

Name a drug used to treat gout which is only administered IV

Answer 43

Pegloticase