Chapter 44-Antiinflammatory and Antigout Drugs Flashcards Preview

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Flashcards in Chapter 44-Antiinflammatory and Antigout Drugs Deck (22):
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NSAIDS

Large and chemically diverse group of drugs with the following properties

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NSAIDS are:

*Analgesic
*Antiinflammatory
*Antipyretic
*Antirheumatic

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NSAIDS: Mechanism of Action

Activation of the arachidonic acid pathway causes: Pain, headache, fever, inflammation

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Analgesia

Treatment of headaches, mild to moderate pain and inflammation:
-block the chemical activity of either or both COX enzymes (prostaglandin PG pathway)
-result: limits the undesirable inflammatory effect of PGs

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Antipyretic

Reduce fever
-inhibit prostaglandin E2 within the area of the brain that controls temperature

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Chemical Categories of NSAIDS

*Salicylates
*Acetic acid derivatives
*Cyclooxygenase-2 (COX-2) inhibitors
*Enolic acid derivatives
*Propionic acid derivatives

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NSAIDS: Salicylates

*Salicylates also have antiplatelet activity
-inhibit platelet aggregation
-Examples: aspirin, diflunisal (Dolobid)

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NSAIDS: Acetic Acids

*indomethacin (Indocin)
*ketorolac (Toradol)
*diclofenac sodium (Voltaren)
*sulindac (Clinoril)
*tolmetin (Tolectin)
*etodolac (Lodine)

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NSAIDS: celecoxib (Celebrex)

*First and only remaining COX-2 inhibitor
*Indicated for osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea

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NSAIDS: Enolic Acid Derivatives

*piroxicam (Feldene)
*meloxicam (Mobic)
*nabumetone (Relafen)

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NSAIDS: Propionic Acids

*fenoprofen (Nalfon)
*flurbiprofen (Ansaid)
*ibuprofen (Motrin, Advil)
*ketoprofen (Orudis KT)
*naproxen (Naprosyn, Aleve)
*oxaprozin (Daypro)

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NSAIDS: Indications

*Analgesia (mild to moderate)
*Antigout effects
*Antiinflammatory effects
*Antipyretic effects
*Relief of vascular headache
*Platelet inhibition (ASA)
*Relief of mild to moderate pain
*Acute gout
*Various bone, joint, and muscle pain
*Osteoarthritis
*Rheumatoid arthritis
*Juvenile rheumatoid arthritis
*Dysmenorrhea
*Fever

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NSAIDS: Salicylates (aspirin)

*More potent effect on platelet aggregation
-analgesic
-antipyretic
-anti-inflammatory
*Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders

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NSAIDS: Adverse Effects Gastrointestinal

*Dyspepsia, heartburn, epigastric distress, nausea
-GI bleeding
-Mucosal lesions (erosions or ulcerations)

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NSAIDS: Adverse Effects Renal

*Reductions in creatinine clearance
*Acute tubular necrosis with renal failure

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NSAIDS: Salicylate Toxicity

Adults: tinnitus and hearing loss
Children: hyperventilation and CNS effects
Metabolic acidosis and respiratory alkalosis may be present

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NSAIDS: Interactions

Serious interactions can occur when given with:
*Anticoagulants
*Aspirin
*Corticosteroids and other ulcerogenic drugs
*Protein bound drugs

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Gout:

Condition that results from inappropriate uric acid metabolism
-decreased excretion of uric acid
-excessive production of uric acid

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Gout: Uric acid crystals are:

deposited in tissues and joints, resulting in pain

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Antigout Drugs: Indications- allopurinol (Zyloprim)

Used to reduce production of uric acid

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colchicine:

Reduces inflammatory response to the deposits of urate crystals in joint tissue

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probenecid (Benemid), sulfinpyrazone (Anturane)

Increases excretion of uric acid in the urine