Pharmocology

Question 1

Name 3 classes of Anti-Inflammatory Drugs?

Answer 1

1. NSAIDS (non-steroidal antiinflammatory drugs)
2. DMARDS (Disease-modifiying antirheumatic drugs )
3. Glucocorticoids

Question 2

What pathway is effected by a variety of anti-inflammatory durgs?

Answer 2

The arachidonic acid pathway

Question 3

What are the 2 major types of NSAIDS?

Answer 3

1. Non-Selective
2. Selective

Question 4

What do non-selective NSAIDS inhibit?

What do selective NSADIS inhibit?

Answer 4

• Non-Selective - COX-1 and COX-2 enzymes
• Selective - COX-2 enzymes more so than COX-1

Question 5

Name 4 non-selective NSAID drugs and 2 selective NSAID drugs.

Answer 5

Non-Selective (COX-1 & COX-2):

• Ibuprofen (advil, motrin)
• Aspirin
• Indomethacin
• Naproxen (Aleve)

Selective (COX-2):

• Celecoxib (Celebrex)
• Meloxicam

Question 6

What metabolic products do NSAIDS inhibit? What effect do those products have on the body?

Answer 6

Prostaglandins

• Vasodilation
• Bronchodilation

Thromboxane (Only Aspirin effects this product)

• Vasoconstriction
• Bronchoconstriction
• Increase Platlet Aggregation

Question 7

What do glucocorticoids inhibit?

What metabolic products will this decrease?

Answer 7

• COX-2 enzymes
• Phospholipase A2 (turns membranes into arachidonic acid)

Glucocorticoids will decrease

• Prostaglandins
• Leukotrienes

Question 8

Name 3 major pharmacologic effects of NSAIDS.

Answer 8

1. Analgesic (pain relief)
2. Antipyretic (fever reducer)
3. Anti-inflammatory (reduces inflammation)

Question 9

Name some side effects of NSAIDS.

Answer 9

• CNS – headaches, tinnitus (ringing of ear)
• Cardiovascular – fluid retention, hypertension (selective mostly)
• GI – nausea, vomiting, ulcers/bleeding (non-selective mostly)
• Hematologic – Rare thrombocytopenia
• Hepatic – abnormal liver function
• Pulmonary – asthma
• Rashes – all types
• **Renal – kidney damage. **

Question 10

Does Aspirin reversibly or irreversibly inhibit cyclooxygenase (both COX-1 and COX-2)?

Answer 10

Irreversibley - This drives down the synthesis of Thromboxane and Prostaglandins. This can cause low platlets for days.

All other NSAIDS and Acetaminophen are reversible.

Question 11

Asprin is considered a weak acid (acetylsalicylic acid). What would be an antidote for an overdose of aspirin?

Answer 11

Bicarbonate (alkaline)

Question 12

Beside pain, fever, and inflammation relief, what is another effect of aspirin on the body? Why does it have this effect?

Answer 12

Blood thinner - aspirin inhibits Thromboxane which normally increases platlet aggregation in the body.

Question 13

My nine month old has a fever, should I give her tylenol or aspirin? Why?

Answer 13

Tylenol - Aspirin can cause liver toxicity and death in children.

Question 14

What is Reyes Syndrome?

Answer 14

A disease that occurs when you give a child aspirin. The child can get liver toxicity and die.

The one exception is children who have Kawasakis disease (inflammation of medium blood vessels).

Question 15

What is the treatment for Patent Ductus Arteriosis (PDA)? Why is it an effective treatment?

Answer 15

NSAIDS - PDA occurs when the ductus arteiosis remains open in newborn’s hearts. Prostaglandins keep it open (vasodilation). Inhibiting Prostaglandin will close the hole.

Indomethacin is the NSAID typically prescribed.

Question 16

When would you give someone a COX-2 inhibitor? What is a potential risk factor?

Answer 16

When the patient needs an antiinflammatory, but they have GI problems (ie - ulcers).

COX-2 inhibitors increase the risk of cardiovascular disease.

Question 17

Why are non-selective (COX-1 & COX-2) NSAIDS hard on the stomach and GI tract?

Answer 17

The COX-1 enzyme helps maintain gastric mucosa.

COX-2 inihbitors spare this enzyme from inhibition.

Question 18

Regarding its effects on the body, what makes acetaminaphin different from aspirin or other NSAIDS?

Answer 18

Acetaminophen is an anelgestic and antipyretic, but is a weak anti-inflammatory.

Question 19

What happens if you over dose on aspirin?

What is the treatment?

Answer 19

Hepatic Necrosis (Liver damage) - acetaminophen depletes glutathione (antioxidant), which leads to liver damage. The solution is to recharge glutathione with N-acetylcysteine. However, you must give it within 4-6 hours of OD.

Question 20

What are glucocorticoids given for? What are the toxic effects?

Answer 20

• Addisons disease, inflammation, immune suppresion, asthma.
• Gluccorticoids are very potent anti-inflammatory drugs.
• Toxicity can lead to a form of Cushings Syndrome