Anti-Inflammatory Drugs and Prostaglandins

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Questions and Answers

Prostaglandins play a role in maintaining temperature homeostasis.

True (A)

PGD2 is responsible for the anti-inflammatory effects of some prostaglandins such as PGE1.

False (B)

PGI2 promotes platelet aggregation.

False (B)

PGE2 causes vasodilation and bronchoconstriction.

<p>True (A)</p> Signup and view all the answers

TXA2 causes vasodilation.

<p>False (B)</p> Signup and view all the answers

Acidic NSAIDs tend to accumulate in inflamed synovial tissues.

<p>True (A)</p> Signup and view all the answers

NSAIDs with lower pKa values tend to have longer half-lives.

<p>False (B)</p> Signup and view all the answers

COX-1 is primarily induced by pro-inflammatory stimuli like LPS, TNFα, IL-2, and IFNγ.

<p>False (B)</p> Signup and view all the answers

COX-2 is ubiquitously expressed in the body.

<p>False (B)</p> Signup and view all the answers

Aspirin has a short half-life, which is known to be less than 6 hours.

<p>True (A)</p> Signup and view all the answers

Naproxen has a short half-life, which is within 6 hours.

<p>False (B)</p> Signup and view all the answers

COX-1 produces PGE2 in vascular endothelium.

<p>True (A)</p> Signup and view all the answers

NSAIDs can increase the risk of bleeding when taken with anticoagulants like warfarin.

<p>True (A)</p> Signup and view all the answers

NSAIDs enhance the effects of anti-hypertensive medications.

<p>False (B)</p> Signup and view all the answers

NSAIDs reduce gastric acid production and provide protection.

<p>False (B)</p> Signup and view all the answers

The risk of GI bleeding is decreased when taking NSAIDs, due to their protective effect on the stomach.

<p>False (B)</p> Signup and view all the answers

Aspirin is used for platelet inhibition to prevent stroke and myocardial infarction.

<p>True (A)</p> Signup and view all the answers

Metoclopramide and caffeine decrease the absorption of aspirin.

<p>False (B)</p> Signup and view all the answers

Sulfasalazine is recommended for the treatment of severe ulcerative colitis.

<p>False (B)</p> Signup and view all the answers

Oligospermia, which is a possible side effect of sulfasalazine, is a decrease in sperm count.

<p>True (A)</p> Signup and view all the answers

Ibuprofen is contraindicated in patients with a history of gastrointestinal disease.

<p>True (A)</p> Signup and view all the answers

Naproxen is in the proprionic acid class of NSAIDs.

<p>True (A)</p> Signup and view all the answers

Oxaprozin demonstrates the least selectivity for COX-2 compared to other NSAIDs.

<p>False (B)</p> Signup and view all the answers

Aspirin is indicated for treatment of mild to moderate ulcerative colitis.

<p>False (B)</p> Signup and view all the answers

Sulindac is safe to use in patients with renal disease.

<p>True (A)</p> Signup and view all the answers

Concomitant use of ketorolac and probenecid is recommended.

<p>False (B)</p> Signup and view all the answers

Aspirin can be used safely with other NSAIDs without concern of interaction.

<p>False (B)</p> Signup and view all the answers

Ketorolac is an acetic acid derivative.

<p>True (A)</p> Signup and view all the answers

Patients with rheumatoid arthritis are at a lower risk of adverse corneal events after ocular surgeries.

<p>False (B)</p> Signup and view all the answers

Elevated liver function tests can occur with the absorption of some NSAIDs.

<p>True (A)</p> Signup and view all the answers

Short-term management of acute pain can involve NSAIDs for less than 5 days.

<p>True (A)</p> Signup and view all the answers

Patients with complications like diabetes are not at risk for corneal adverse events.

<p>False (B)</p> Signup and view all the answers

Acetaminophen is primarily used for analgesia and anti-pyretic purposes.

<p>True (A)</p> Signup and view all the answers

The antidote for acetaminophen overdose is ibuprofen.

<p>False (B)</p> Signup and view all the answers

Coxibs, including Celecoxib and Valdecoxib, are noted for causing severe hepatic reactions.

<p>False (B)</p> Signup and view all the answers

Rofecoxib is indicated for treating acute pain in children.

<p>False (B)</p> Signup and view all the answers

Valdecoxib may increase the efficacy of ACE inhibitors.

<p>False (B)</p> Signup and view all the answers

Patients with renal disease should generally avoid taking Coxibs.

<p>True (A)</p> Signup and view all the answers

Dyspepsia is a common side effect of Coxibs.

<p>True (A)</p> Signup and view all the answers

Hypersensitivity reactions may occur with the use of Coxibs in patients who have allergies to NSAIDs.

<p>True (A)</p> Signup and view all the answers

Etanercept may be administered with or without methotrexate.

<p>True (A)</p> Signup and view all the answers

Anakinra is primarily used to treat psoriatic arthritis.

<p>False (B)</p> Signup and view all the answers

Adalimumab has been shown to increase the risk of infections and lymphomas.

<p>True (A)</p> Signup and view all the answers

Infliximab should be administered without methotrexate.

<p>False (B)</p> Signup and view all the answers

Cytokine antagonists can lead to rare conditions such as pancytopenia.

<p>True (A)</p> Signup and view all the answers

Fatigue and nausea are common side effects of all cytokine antagonists.

<p>False (B)</p> Signup and view all the answers

Patients using Infliximab are at risk of congestive heart failure.

<p>True (A)</p> Signup and view all the answers

The administration of cytokine antagonists guarantees reduced symptoms in rheumatoid arthritis.

<p>False (B)</p> Signup and view all the answers

Flashcards

Prostaglandins

A class of lipid compounds that play important roles in various physiological processes, including inflammation, pain, and fever.

Temperature homeostasis

The process of maintaining a stable body temperature.

Cyclooxygenase (COX)

The enzyme that catalyzes the first step in the biosynthesis of prostaglandins, thromboxanes, and prostacyclins.

COX-1

A type of COX enzyme that is constitutively expressed in various tissues and contributes to normal physiological functions.

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COX-2

A type of COX enzyme that is induced by pro-inflammatory stimuli and contributes to inflammation and other pathological processes.

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PGI2 (Prostacyclin)

A prostaglandin that inhibits platelet aggregation, dilates blood vessels, and increases vascular permeability.

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PGE2

A prostaglandin that contributes to pain, fever, inflammation, and other pro-inflammatory effects.

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TXA2 (Thromboxane A2)

A prostaglandin that promotes platelet aggregation, constricts blood vessels, and contributes to bronchoconstriction.

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NSAID Accumulation in Inflammation

NSAIDs are more likely to accumulate in inflamed areas, like swollen joints, due to their acidic nature.

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NSAID Excretion

NSAIDs are efficiently removed from the body through the gut and kidneys.

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Half-Life of NSAIDs

The time it takes for the concentration of a drug in the body to decrease by half.

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NSAID Drug Interactions: Displacement

NSAIDs can displace other drugs from their binding sites on proteins in the blood, leading to increased concentrations of those drugs.

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NSAID Drug Interactions: Anti-Hypertensives

NSAIDs may reduce the effectiveness of blood pressure medications, potentially causing high blood pressure or kidney damage.

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NSAID Drug Interactions: Inhibition of Clearance

NSAIDs can inhibit the breakdown of certain drugs by the body, leading to higher levels of these drugs in the blood.

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NSAID Gastrointestinal Toxicity

Prostaglandins are chemicals that protect the stomach lining. NSAIDs block their production, leading to stomach irritation and ulcers.

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NSAID Gastrointestinal Bleeding

NSAIDs can cause bleeding in the gastrointestinal tract, ranging from minor bleeding to severe hemorrhage.

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What is an NSAID?

A nonsteroidal anti-inflammatory drug commonly used to treat pain, fever and inflammation.

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What is a major clinical use for aspirin?

Aspirin is used to prevent strokes and heart attacks by inhibiting platelet aggregation.

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What is aspirin hypersensitivity?

Aspirin can cause hypersensitivity reactions in some individuals, leading to asthma, skin reactions, and even anaphylaxis.

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Give examples of NSAIDs used for inflammatory bowel disease.

Sulfasalazine, olsalazine, and 5-aminosalicylate are NSAIDs used primarily for the treatment of inflammatory bowel disease.

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List some common NSAIDs from the proprionic acid class.

Ibuprofen, naproxen, ketoprofen, flurbiprofen, oxaprozin, and fenoprofen are NSAIDs often used for osteoarthritis, rheumatoid arthritis, dysmenorrhea, and pain.

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What factors enhance aspirin absorption?

The presence of metoclopramide or caffeine increases the absorption of aspirin in the body.

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What drug inhibits aspirin absorption?

Valproate can inhibit the absorption of aspirin in the body.

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When are NSAIDs contraindicated?

NSAIDS should be contraindicated in patients with NSAID allergies, peptic ulcer disease, inflammatory gastrointestinal diseases, history of gastrointestinal disease, or GI bleeding.

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Acetaminophen

A nonsteroidal anti-inflammatory drug (NSAID) used for pain relief and fever reduction. It is known for its effectiveness and low cost but can cause liver damage if taken in excessive doses.

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COX-2 Specific Inhibitors

A group of drugs that selectively inhibit COX-2, an enzyme involved in inflammation. They are used to relieve pain and reduce inflammation, but may have increased risk of cardiovascular events.

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Celecoxib

One of the COX-2 inhibitors, used for conditions like arthritis, menstrual cramps, and acute pain. However, it carries a risk of cardiovascular events and should be used with caution.

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Valdecoxib

Another COX-2 inhibitor commonly used for arthritis, menstrual cramps, and pain. It also carries a risk of cardiovascular events and potential kidney problems.

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Rofecoxib

A COX-2 inhibitor used primarily for acute pain management. It also poses a risk of cardiovascular events and should be used with caution.

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Ankylosing Spondylitis

A chronic inflammatory disease primarily affecting the spine, causing stiffness and pain.

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NSAIDs

A group of medications that work by reducing pain and inflammation.

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NSAIDs in Renal Disease

Some NSAIDs are best avoided by patients affected by kidney issues because they may be unsafe to administer.

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NSAIDs & Antacids

Absorption of certain NSAIDs can be slowed by using antacids.

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NSAIDs & Warfarin

Certain NSAIDs may increase the risk of bleeding when combined with warfarin.

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Aspirin Administration

Aspirin, a common NSAID, can be given through injections (parenterally).

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Combined NSAID Use

Combining certain NSAIDs can increase unwanted side effects due to the overlapping nature of their mechanisms.

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NSAIDs & Corneal Health

For patients with corneal issues, certain NSAIDs are contraindicated, mainly because they can increase the risk of corneal problems.

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What are cytokine antagonists?

A type of medication that blocks the action of a protein called TNF-alpha, which plays a key role in inflammation.

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What is hypersensitivity?

A common side effect of TNF-alpha inhibitors, particularly involving joints or skin.

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What is immunosuppression?

A common adverse effect of TNF-alpha inhibitors, potentially leading to serious infections.

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What is pancytopenia?

A serious side effect of TNF-alpha inhibitors, involving the production of blood cells.

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What is Etanercept?

A TNF-alpha inhibitor used frequently in the treatment of various autoimmune diseases.

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What is Adalimumab?

A TNF-alpha inhibitor often preferred in patients with severe rheumatoid arthritis.

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What is Infliximab?

A TNF-alpha inhibitor requiring intravenous administration, and typically used in combination with methotrexate.

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What is Anakinra?

A cytokine antagonist that specifically inhibits the action of interleukin-1, another key player in inflammatory processes.

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Study Notes

Anti-Inflammatory Drugs

  • Inflammation is partly mediated by prostaglandins produced by the cyclooxygenase pathway.
  • NSAIDs inhibit this pathway and act as anti-inflammatory, antipyretic, and analgesic agents.
  • NSAIDs are generally non-specific, causing numerous side effects. More specific treatments like COX-2 inhibitors and anti-cytokine agents are being investigated.

Prostaglandins

  • All body cells can synthesize prostaglandins.
  • Inflammatory stimuli cause arachidonic acid (AA) release from plasma phospholipids by phospholipase A2.
  • Cyclooxygenase metabolizes AA into PGH2, which then forms PGD2, PGE2, PGF2α, PGI2, or TXA2 via specific enzymes.
  • Prostaglandins have physiologic and pathologic functions:
    • Physiologic: temperature regulation, bronchial tone, cytoprotection (gastric and renal mucosa), intestinal motility, myometrial tone, semen viability (some, like PGE1, have anti-inflammatory effects), renin secretion.
    • Pathologic: fever, asthma, ulcers, diarrhea, dysmenorrhea, inflammation, bone erosion, and pain (possibly from PGD2).
    • Specific inflammatory functions: PGI2 inhibits platelet aggregation, causes vasodilation, and increases vascular permeability (edema); PGE2 causes pain, hyperalgesia, and heat; increases vasodilation and bronchoconstriction; acts synergistically with other inflammatory mediators (like histamine, complement, and LTB4); and TXA2 promotes platelet aggregation, vasoconstriction, and bronchoconstriction.

Cyclooxygenase (COX) Enzymes

  • Two forms of COX exist: COX-1 and COX-2.
  • Though they catalyze the same reaction, their expression, functions, and properties differ significantly.
  • COX-1 is constitutive and found ubiquitously; COX-2 is inducible and found at inflammatory sites.
  • COX-1 plays a 'housekeeping' role, maintaining blood flow, vascular homeostasis, renal function, intestinal health, and platelet function.
  • COX-2's pro-inflammatory actions include pain, fever, leukocyte proliferation, and inflammation (in macrophages and rheumatoid arthritis joints). It also has mitogenic functions involved in renal genesis and reproduction.

NSAIDs

  • Most NSAIDs are polycyclic carboxylic acid derivatives.
  • Different types include salicylates (aspirin), acetic acids (indomethacin), propionic acids (ibuprofen), fenamic acids (meclofenamate), enolic acids (piroxicam), and ketones (nabumetone).
  • NSAIDs block arachidonic acid access and inhibit COX enzyme pathways for reducing inflammation.
  • General effects: analgesia, antipyrexia, anti-inflammation, and anti-thrombotic. COX-2 selective inhibitors avoid effects on COX-1 (which impacts the GI tract and platelets).

NSAID Toxicity

  • NSAIDs can affect the gastrointestinal, central nervous system, hepatic, renal, hematologic, and skin systems.
  • GI toxicity: NSAIDs can cause gastric irritation, exacerbate peptic ulcers, induce mucosal lesions, suppress gastric acid secretion, maintain gastric mucosal barrier, etc. Specific risk factors include high doses, older age, and concurrent steroid use.

COX-2 Selective Inhibitors

  • Coxibs (e.g., celecoxib, valdecoxib) preferentially block COX-2.
  • Potential benefits of reduced gastrointestinal side effects.
  • Concerns about cardiovascular risk associated with some COX-2 selective inhibitors, particularly rofecoxib (removed from market).

Glucocorticoids

  • Glucocorticoids are 21-carbon steroid molecules with various physiologic and metabolic effects. Cortisol (hydrocortisone) is a primary glucocorticoid.
  • Activity depends on a hydroxyl group at carbon 11. Glucocorticoid preparations for topical use are already hydroxylated at C-11, bypassing hepatic transformation.
  • Varying potency and duration of action are clinically important factors in their use.

Cytokine Antagonists

  • Cytokine antagonists (e.g., etanercept, adalimumab, infliximab, anakinra) modulate immune responses and target specific cytokines.
  • Used for conditions like rheumatoid arthritis, psoriatic arthritis, and Crohn's disease.

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