Inflammation 3

Inflammation 3

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• Inflammation is a complex process with various stages and mediators.

Glucocorticoids & When Are They Used?

• Glucocorticoids are hormones secreted by the adrenal cortex.
• They are used to treat inflammation.
• Different types of glucocorticoids, like those in the adrenal glands, are used to decrease inflammation or treat hypersensitivity reactions.
• Administration routes include intravenous (IV), intramuscular (IM), and oral (PO).

Allergy - Reflecting Back on Allergies

• Allergy symptoms include rash, lacrimination (tearing), runny nose, sneezing, red eyes, and itching.

Allergy tx overview

• Allergens trigger allergic reactions.
• Local allergies, like contact dermatitis, can be treated with antihistamines (e.g., Benadryl).
• Systemic exposure to known allergens requires non-drowsy antihistamines (e.g., Reactin) and, if high-dose exposure is anticipated, leukotriene modifiers (e.g., Singulair) for preventative treatment.
• Eye symptoms are managed with topical antihistamines.
• Severe allergic reactions may necessitate treatment with epinephrine.

Anaphylaxis

• Anaphylaxis is severe, systemic inflammation and vasodilation caused by a high histamine reaction.
• It includes bronchoconstriction and hypotension.
• Treatment focuses on ABCs (airway, breathing, circulation) with epinephrine (IM or IV), dexamethasone (IV), antihistamines (IV), and IV fluids to maintain blood pressure.

Epinephrine

• Epinephrine is a neurotransmitter and hormone, acting as a non-selective adrenergic agonist (α and β).
• It has an antihistamine effect.
• It's administered intravenously (IV) or intramuscularly (IM).
• Onset is rapid (takes effect quickly); repeat doses are sometimes required.
• Duration of approximately 20 minutes.

Glucocorticoids side effects, caution

• Glucocorticoids have minimal side effects for acute use but increased risks with long-term systemic treatment (e.g., oral).
• Systemic glucocorticoids can cause Cushing's syndrome.
• Local routes (e.g., topical or intranasal) are preferred for shorter-term treatment.
• Abrupt discontinuation of glucocorticoids is not advised; a gradual dose reduction is necessary. This supports tissue recovery without harmful rebound inflammation.

Examples of diagnoses marked by chronic inflammation

• Chronic inflammation can result from conditions like allergic rhinitis, dermatitis, psoriasis, arthritis, IBD, asthma, and COPD.

Chronic Inflammation

• Chronic inflammation involves tissue destruction, scar tissue formation, decreased vascularity, and reduced strength.
• This process is ongoing for more than 10 days.
• Inflammation factors like lymphocytes, macrophages, fibroblasts, inflammatory mediators, and tissue growth factors play crucial roles.

Allergic Rhinitis

• Allergic rhinitis affects up to 40% of the population.
• Inhaled allergens, especially seasonal triggers (like pollen), can cause hypersensitivity and nasal inflammation.
• Symptoms of rhinitis include nasal discharge, swelling, conjunctivitis (eye irritation), sneezing, itching, and nasal congestion.
• Antihistamines and intranasal corticosteroids (e.g., Flonase, Nasonex) may be used to reduce symptoms.

Brainstorm

• Dymista contains Fluticasone and Azelastine.
• Class: Nasal corticosteroid, antihistamine
• Mechanism: Decreases inflammation, blocks histamines
• Uses: Treat nasal congestion and inflammation, associated with allergies.

Eczema (Atopic Dermatitis)

• Eczema is a condition characterized by inflammation of the skin.
• Triggered by allergens.
• Often involves an allergy-triggered, chronic inflammatory response, especially with a genetic pre-disposition
• Treatment involves topical corticosteroids, moisturizers, and, if needed, antibacterial or antiviral medications.

Atopic Dermatitis

• Atopic dermatitis—a form of eczema—is a common skin condition characterized by a genetic tendency towards allergic reactions and a chronic inflammatory skin condition, often presenting with itching and scar formation.
• Triggers include allergies and infections.
• Treatment includes moisturizers and anti-inflammatory medications (like topical corticosteroids) possibly combined with antihistamines for the allergic component.
• Risk of infection related to a compromised skin barrier

Atopic Triad

• Atopic dermatitis, allergic rhinitis, and atopic asthma are interconnected.

Psoriasis

• Psoriasis is a chronic skin condition caused by inflammation and a fast-turnover rate of skin cells, resulting in dry, scaly patches, sometimes painful, common in chronically inflamed parts of the body (joints, elbows, and knees).
• Triggers can include genetics and environmental factors (trauma, stress, medications).

Rheumatoid Arthritis (RA)

• RA is a chronic, systemic, autoimmune disease.
• It involves joint inflammation, often triggered by an antigen.
• Damage includes destruction of the synovial cavity and surrounding connective tissues (cartilage, bone).
• Risk factors include family history, gender, and trigger antigens.

Rheumatoid Arthritis (RA) Effects on the Body

• RA causes effects throughout the body, involving widespread inflammation, potentially harming eyes, lungs, heart, digestive system, and skin.

Rheumatoid Arthritis (RA) S&S and Tx

• Symptoms include joint pain, swelling, generalized fatigue, and anorexia.
• High C-reactive protein (CRP) may be detected.
• Treatment options include NSAIDs and glucocorticoids (potentially via injection).

Tx (Treatment)

• Multiple drugs for various inflammatory conditions exist.
• Biological response modifiers (BRMs), disease-modifying antirheumatic drugs (DMARDs), and glucocorticoids are examples.
• Routes of administration can include oral, intravenous (IV), and subcutaneous (SC).

Osteoarthritis (OA)

• OA is a "wear-and-tear" process that progressively damages cartilage and underlying bone in joints.
• Cartilage breakdown from the repetitive use and mechanical stress of the joint.
• Risk factors include age, obesity, and gender.

Osteoarthritis (OA) Tx

• Treatment options include NSAIDs, glucocorticoids (potentially via injection), and local glucocorticoid administration to control the symptom.

Glucocorticoid, Intra-articular Injection: Betamethasone (Celestone)

• Betamethasone, via injection, is used to reduce inflammation in a joint.

Osteoarthritis vs. Rheumatoid Arthritis in the Joint

• Different effects on joint tissues—one involves cartilage loss, and the other, bone and soft tissue inflammation.