ch 24: antiinflammatories Flashcards
(27 cards)
what chemical mediator causes inflammation? What enzymes does this come from?
- Prostaglandins
- cox 1 and 2 enzymes
What is cox 1 and cox 2 enzymes responsible for?
- cox 1 protects the stomach lining
- cox 2 triggers inflammation and pain
what happens when you are on aspirin for a long period of time?
ulcers because it becomes less selective
what are the four types of anti-inflammatory drugs?
- INSAIDs
- courtico steroids
- disease modified drugs (DMD)
- antigout drugs
what do INSAIDs do? what are the 2 types?
- they inhibit cox enzymes which inhibit prostaglandin synthesis
- 1st generation and 2nd generation
what are 1st generation INSAIDs? what are the 6 types?
- they are nonselective to both cox 1 and 2
- salicylates
- para-chlorobezoic acid
- phenylacetic acid derevatives
- propionic acid derevatives
- fenamates
- oxicams
what is the drug example for salicylates? what is a therapeutic dose? what is a toxic dose? what happens with warfarin? what happens with oral anti-diabetics? with cortico steroids? what can cause gout? what food items have yuric acid in them? what causes Raye’s syndrome? what is salicylism? what are the symptoms? what are the symptoms > 50mgdL?
- aspirin
- 15-30 mg-dL
- > 30mg-dL
- increased bleeding with warfarin
- hypoglycemia with oral anti-diabetics
- increase ulcers with cortico steroids
- increase yuric acid can lead to gout
- pruns, licorice, raisins
- dont give to children with the flu or virus vs; can result in Reye’s syndrome
- salicylism is toxicity ( >30)
- tinnitus, dizziness, confusion, peptic ulcer
- > 50mg-dL = convulsions, cardiovascular collapse
what does the drug example for paracloralbezoic acid? what is it used for/ what are some side effects? who do you not give this to? what should you take this with?
- indomethazcine
- arthritis
- sodium and water retention and increase bp
- patients with high bp
- take with food because it upsets stomach
what are the 2 drug examples for phenylacetic acid derivatives?
- diclofenac sodium
- ketorolac
what is diclofenac used for? combined with?
- rhuematoid arthritis and osteoarthritus
- combined with misoprostal and is aka arthrotech to protect stomach lining
what is ketorolac used for? How is it given? what is it as strong as?
- short term management of pain post surgery
- via injection
- morphine but without addiction
what is a drug example for propionic acid derivatives? what happens with warfarin with aspirin? what are some side effects? what should you take this wth?
- ibuprofen
- increase bleeding and effect with warfarin
- decrease effect with aspirin
- gastric disstress, tinnitus, dizziness, confusion, edema, nephrotoxicity
- take with food
what is the drug example for fenamates? what is it used for? what is the side effects?
- meclofenamate
- acute and chronic arthritis
- gastric irritation, edema, dizziness, and tinnitus
what is the drug example for oxicams? what is it used for? how long does it take? what should you not take it with?
- piroxicam
- long term arthritis
- 1 to 2 weeks
- aspirin
what are second generation NSAIDs? what is the only category and only drug? what are side effects? who is at high risks of ulcerations?
- they are selective to cox 2
- cox 2 inhibitors decrease pain and inflammation
- inhibits cox 2 enzymes
- celecoxib (true)
- nabumetone (not true in high doses. it can lose selectivity)
- peripheral edema tinnitus and dizziness
- older adults due to taking other drugs and pregnant women in 3rd trimester
what are corticosteroid examples? what do they end in? what are they not used for? what are the side effects?
- prednison, prednisolone, and dexamethasone
- (-sone or -lone)
- not used for arthritis because of side effects
- weight gain and suppressing the immune system
what are the 3 types of disease modified drugs? (DMD)
- imuno suppressants
- imuno modulators
- anti-malarial
when are imuno suppressants used? what are the 3 drug examples? what can a bad side effect be?
- when other drugs fail for arthritis
- could have impact on liver, so check enzymes
- azathiopine, cyclophosphamide, methotrexate
what are the 2 types of imuno modulators?
- IL-1 receptor antagonists
- tumor necrosis factor blockers
what is the drug example for IL-1 receptor antagonists?
anakinra
what are the 3 tumor necrosis factor blocker drugs? how are they given? whats it used for? what does it do? how much are they?
- etanercept, infliximab, adalimumab
- via injection
- severe rumatoid arthritis
- delay the disease progression
- 3500-4500 $
what are anti-milarial drugs used for? how long do they take? what is the mechanism of action? what are they used with?
- rumatoid arthritis
- long acting; up to 3 months
- MAO is unclear
- use with NSAIDs when arthritis isnt under control
what is gout? what is a main symptom? what foods contain purine?
- inflammatory disease with the joints
- large big toe because of gravitational pull due to poor purine metabolism leading to yuric acid accumulation
- sardines, salmon, gravy, liver, alcohol
what is colchicine used for? what does it do? what does it cause? how do you prevent this? what patients should not take this?
- gout
- blocks migration of leukocytes to innflammed cite
- gi distress, so take with food
- patients with renal, cardiac, or gi problems should not take this
