Anti-Inflammatories

Question 1

Explain 6(ish) the stages of the Inflammatory response

Answer 1

1. Tissue damage or infection occurs
2. Histamines are released from Mast cells + other pro-inflammatory Cytokines
   * Leading to either:
3. Local Arteriolar vasodilation
4. > Increased blood flow
5. Causing redness + heat
   OR
6. Movement of fluid + proteins into Interstitial space
7. > Swelling + pain

Both leading to:
1. Tissue repair
2. Fighting infection
3. Further Cytokine secretion

Question 2

What are Prostaglandins?
(PGs)

Answer 2

1. Physiologically active Lipid compounds
2. Found in most tissues + organs (GIT, Repro tract)
3. Derived from Arachidonic acid
4. Having hormone-like effects (Inflammation + Blood flow)

Question 3

What are Cyclo-oxygenases?
(COX)

Answer 3

1. Enzymes
2. That are either COX-1 or COX-2
3. COX-1 = responsible for baseline levels of Prostaglandins
4. COX-2 = Inflammation
5. Producing PROSTAGLANDINS by oxygenation of Arachidonic acid
6. Located in the BVs, stomach + kidneys

Question 4

Name 8 NSAIDs

Answer 4

1. Salicylic acid derivatives - Aspirin
2. Propionic acid derivatives - Ibuprofen + Naproxen
3. Diclofenac
4. Indometacin
5. Nabumetone
6. Phenylbutazone
7. Selective COX-2 inhibitors - Ctoricoxib, Celecoxib + Vaidecoxib
8. Analgesic onlys - Paracetamol

Question 5

Name 3 Prostaglandins

Answer 5

1. PGE-2
2. PGD-2
3. Hyperalgesia

Question 6

Name 3 Thromboxane-A2 synthase effects on the body

Answer 6

1. Platelet InsP-3
2. Aggregation
3. Vasoconstriction

Question 7

Name 3 Prostacyclin (PGI-2) effects on the body

Answer 7

1. Platelet cAMP
2. Disaggregation
3. Vasodilation

Question 8

Name the 3 types of NSAIDs

Answer 8

1. Analgesia
2. Anti-inflammatories
3. Anti-pyretics

Question 9

What do Anti-inflammatories do?

Answer 9

Inhibit of COX enzymes

Question 10

Name the 2 Anti-pyretics

Answer 10

1. Metacam
2. Rimadyl

Question 11

How can Meloxicam be administered?

Answer 11

1. Orally
2. SC

Question 12

What is the MOA for Meloxicam?

Answer 12

1. Reduces inflammation by inhibiting production of
2. COX-1 + COX-2 prostaglandins
3. (But essentially more selective for COX-2)

Question 13

Is Meloxicam mainly secreted by the Liver?

Answer 13

Yes, as bile

Question 14

What is the bioavaliability + half-life of Meloxicam?

Answer 14

1. High = bioavaliability
2. Half-life = 24hr

Question 15

What 3 species is Meloxicam licensed for?

Answer 15

1. Dogs
2. Cats
3. Guinea Pigs

But extensively used off-licensed in other animals, too

Question 16

What are the 3 ways in which Carprofen be administered to patients?

Answer 16

1. Orally
2. SC
3. IV injection

Question 17

What is the MOA for Carprofen?

Answer 17

Same as Meloxicam!

Question 18

What are the 3 indications for Carprofen

Answer 18

1. Analgesia
2. Chronic inflammation
3. Post-op pain

Question 19

What is the half-life of Carprofen?

Answer 19

Half-life = 8-11 hr

Question 20

How often is Carprofen administered to patients, per day?

Answer 20

1. Orally
2. 2x a day

Question 21

What NSAID is toxic to Cats?

Answer 21

Paracetamol
(Anti-pyretic analgesic)

Question 22

Name the 6 other NSAIDs used in veterinary patients

Answer 22

1. Aspirin (unlicensed)
2. Fluixin meglumine (Finadyne)
3. Ketoprofen (Ketofen)
4. Paracetamol (Anti-pyretic analgesic)
5. Phenylbutazone (Equipalazone)
6. Robenacoxib (Previcox)

Question 23

What other drugs should you not administer with NSAIDs?

Answer 23

Other NSAIDs or Corticosteroids

Question 24

What should you let clients know about NSAIDs?

Answer 24

1. Potential side-effects
2. Notify the VP if side-effects occur - to stop admin

Remember to regularly monitor patients, esp if geriatric + pre-existing Renal/GI disease

Question 25

What **2** hormones do the **Adrenal glands** *(Cortex)* secrete?

Answer 25

1. **Mineral**ocorticoids = ***Aldosterone*** 2. **Gluco**corticoids = ***Cortisol***

Question 26

What are **Steroids**?

Answer 26

**Gene** ***active*** hormones

Question 27

# 5 .. Whats the MOA of **Steroids**?

Answer 27

1. **Diffuses** ***into*** the **cells** 2. **Binds** with ***Cytoplasmic*** **receptors** 3. In **target** cell 4. **Activated** **receptor** enters the **nucleus** 5. ***Stimulating*** + ***inhibiting*** **protein** synthesis

Question 28

Name **4** **Synthetic** Glucocorticoids

Answer 28

1. **Prenis**olone 2. **Dexametha**sone 3. **Triamcin**olone 4. **Hydrocorti**sone

Question 29

What do **Synthetic** Glucocorticoids do?

Answer 29

**Suppress**: 1. Inflammation 2. **Allergies** 3. **Immune response**

Question 30

What drugs have **striking improvements** in certain diseases but can have **severe** ***adverse effects***?

Answer 30

**Synthetic** Glucocorticoids

Question 31

What are **3 major** effects that **Glucocorticoids** have?

Answer 31

1. **Metabolic** 2. Anti-Inflammatory 3. Immunosuppressive

Question 32

What are the 6 **Metabolic** effects of **Synthetic** Glucocorticoids?

Answer 32

**Stimulates**: 1. ***Gluconeogenesis*** 2. **Protein** **catabolism** > Amino Acids (**AA**s) 3. Liver **glycogen** ***deposition*** + Glucose **release** 4. **Gastric acid** + **Pepsin** ***production*** **Inhibits**: 1. Protein **synthesis** 2. ***Peripheral*** glucose **uptake**

Question 33

What are the **Anti-Inflammatory** + **Immunosuppressive** effects of ***Synthetic*** Glucocorticoids?

Answer 33

**Inhibits**: 1. Pro-**inflammatory** ***mediators*** 2. **Release** of **Interleukins** IL-**1** + IL-**2** *(necesscary to activate + stimulate Lymphocyte proliferation)* 3. **Lymphocyte** ***transportion*** to site of **antigenic stimulation** + **antibody** ***production*** **Reduction**: 1. **Circulating** ***immunocompetent*** cells, **T**-cells + ***macrophages*** 2. **Lymphocyte** monocyte/macrophage **function**

Question 34

How is **Prednisolone** administered?

Answer 34

**Orally** (With ***food***)

Question 35

# 3 ... What is the MOA of **Prednisolone**?

Answer 35

1. **Enters** cell **nucleus** 2. ***Alters*** **gene expression** in cells 3. Leading to the **inhibition** of the ***production*** **Inflammatory mediators** 4. **Absorbed slowly** from the **GIT** 5. **Metabolised** ***slowly*** in the **Liver** 6. By **HYDROLYSIS** + **CONJUGATION** *(So must be given E.O.D!!)*

Question 36

What are the **4** indications **Prednisolone** is used to treat?

Answer 36

1. Severe **allergic reactions** (***Skin*** disease) 2. **Neo**plasia 3. **Asthma** 4. ***Immune mediated*** diseases

Question 37

# 4 .. Why should **Prednisolone** only be administered every other day?

Answer 37

1. Because it has a **NARROW** ***therpeutic index*** 2. **LONG** **half-life** 3. **Slowly** ***absorbed*** by **GIT** 4. Slowly ***metabolised*** by the **Liver**

Question 38

What is a **potent** Corticosteroid, that also has a **diuretic** effect, includign ***PUPD***, ***weight gain*** + ***V+***?

Answer 38

Prednisolone

Question 39

What **5** effects can **long-term** use if **Prednisolone** administration have?

Answer 39

1. Reduced **immunity** 2. **Prolonged** wound healing 3. HAC *(**Hyperadrenocorticism**)* 4. **DM** 5. **BONE** ***catabolism***

Question 40

What is **Colvasone** 0.2% w/v solution for injection?

Answer 40

**Dexa**methasone

Question 41

What is **Colvasone**/Dexamethasone?

Answer 41

1. It's a **potent** anti-inflammatory 1. **Acting** on ***35 X*** 2. As potent as Cortisol

Question 42

How is **Colvasone** 0.2% w/v solution administered to patients?

Answer 42

1. **IM** 2. IV

Question 43

Name the 4 target species that Colvasone/Dexamethasone treat?

Answer 43

1. **Horses** 2. Cats 3. Dogs 4. **Cattle**

Question 44

Name the 6 **adverse** effects of Colvasone/Dexamethasone?

Answer 44

1. **Adrenal** ***suppression*** 2. **Polyphagia**, ***uria*** + ***dipsia*** 3. Increased ***susceptibility*** to **infections** 4. DM 5. **Muscle** ***wastage*** + ***weakness*** 6. **Gastric ulceration**