BMS 150 Week 5: Anti-Inflammatory Medications
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Questions and Answers

What is a recommended way to reduce the risk of GI damage when taking an NSAID?

  • Taking the NSAID with a medication that stimulates the release of cortisol
  • Taking the NSAID with an antacid that reduces the risk of GI damage (correct)
  • Taking the NSAID with a medication that inhibits prostaglandin receptors in the GI tract
  • Taking the NSAID with an antihistamine

    • What is a potential long-term effect of taking glucocorticoids?

  • Increased glucose availability
  • Increased ACTH production
  • Atrophy of the adrenal cortex (correct)
  • Decreased insulin resistance

    • What is a therapeutic use of glucocorticoids?

  • Treatment of hypertension
  • Relief of inflammation in autoimmune disease (correct)
  • Treatment of diabetes
  • Treatment of cancer

    • What is a mechanism of action of glucocorticoids?

    <p>Block of PLA2</p> Signup and view all the answers

    What is a potential side effect of long-term glucocorticoid use?

    <p>Immunosuppression</p> Signup and view all the answers

    Why should glucocorticoids be used for short periods of time?

    <p>Because they do not change disease activity in autoimmune disease</p> Signup and view all the answers

    What is a potential concern when discontinuing long-term glucocorticoid use?

    <p>Atrophy of the adrenal cortex</p> Signup and view all the answers

    What is a route of administration for glucocorticoids?

    <p>All of the above</p> Signup and view all the answers

    What is the primary mechanism of action of NSAIDs?

    <p>Blocking cyclooxygenase at both central and peripheral sites</p> Signup and view all the answers

    What is the effect of NSAIDs on platelet activation?

    <p>Decrease platelet activation</p> Signup and view all the answers

    What is the result of blockade of prostaglandin formation by NSAIDs?

    <p>Moderate anti-inflammatory, analgesic, and anti-pyretic effects</p> Signup and view all the answers

    Which of the following is NOT a site of action of NSAIDs?

    <p>Muscle tissue</p> Signup and view all the answers

    What is the effect of PGI2 on platelets?

    <p>Inhibition of platelet aggregation</p> Signup and view all the answers

    What is the function of PGE2 in the kidney?

    <p>Promotion of renal blood flow</p> Signup and view all the answers

    Which of the following is a unique feature of aspirin compared to other NSAIDs?

    <p>It is therapeutically effective in hematology</p> Signup and view all the answers

    What is the result of glucocorticoid action on phospholipase A2?

    <p>Inhibition of phospholipase A2</p> Signup and view all the answers

    What is a potential consequence of stopping glucocorticoid medication abruptly?

    <p>Adrenal crisis</p> Signup and view all the answers

    What is a common adverse effect of glucocorticoids on the musculoskeletal system?

    <p>All of the above</p> Signup and view all the answers

    Which type of glucocorticoids is less likely to exhibit systemic side effects?

    <p>Local glucocorticoids</p> Signup and view all the answers

    What is the purpose of passive immunization?

    <p>To provide immediate humoral immunity</p> Signup and view all the answers

    What happens to the antibodies acquired through passive immunization?

    <p>They are removed after 2-3 months</p> Signup and view all the answers

    What is the primary difference between active and passive immunization?

    <p>The production of memory cells</p> Signup and view all the answers

    Why are some vaccines given frequently?

    <p>To boost immunity</p> Signup and view all the answers

    What is a common reason for using passive immunization?

    <p>In situations where humoral immunity is needed immediately</p> Signup and view all the answers

    What is the main reason why effective protection against certain organisms depends on adequate titres of antibodies present BEFORE the infection occurs?

    <p>The organism divides quickly, resulting in rapid symptoms.</p> Signup and view all the answers

    Live attenuated vaccines are given to elicit what type of response?

    <p>A stronger immune response</p> Signup and view all the answers

    What is a disadvantage of live attenuated vaccines?

    <p>They can mutate into more virulent forms.</p> Signup and view all the answers

    What is an advantage of inactivated vaccines?

    <p>They are stable and do not require refrigeration.</p> Signup and view all the answers

    What type of vaccine is used against diseases such as diphtheria and tetanus?

    <p>Purified macromolecules (toxoids)</p> Signup and view all the answers

    What is the advantage of conjugate and subunit vaccines?

    <p>They take advantage of the immunogenicity of protein combinations.</p> Signup and view all the answers

    What is a characteristic of purified macromolecules (toxoids)?

    <p>The immune system develops antibodies that immediately bind to toxins.</p> Signup and view all the answers

    What is a disadvantage of purified macromolecules (toxoids)?

    <p>They are expensive to develop.</p> Signup and view all the answers

    What is an advantage of mRNA vaccines compared to live attenuated viruses?

    <p>there is pretty much zero chance of mRNA disrupting the genome of any cell</p> Signup and view all the answers

    What was a problem with mRNA vaccines that were tested in the past?

    <p>They didn't induce an immune response</p> Signup and view all the answers

    What was a reason why mRNA would go double-stranded and activate TLRs?

    <p>The mRNA was not modified to look like eukaryotic mRNA</p> Signup and view all the answers

    What is a current challenge in producing mRNA vaccines?

    <p>There are tricky challenges to producing them</p> Signup and view all the answers

    What is a theoretical advantage of mRNA vaccines?

    <p>They offer a greater degree of control over the immune response</p> Signup and view all the answers

    What modification is made to mRNA vaccines to prevent them from being recognized as foreign?

    <p>Some uridines are modified to look more eukaryotic</p> Signup and view all the answers

    What is the most common type of spondyloarthropathy?

    <p>Ankylosing spondylitis</p> Signup and view all the answers

    What is the term used to describe Systemic Lupus Erythematosus due to its diverse range of presentations and affected organs?

    <p>The disease of 1000 faces</p> Signup and view all the answers

    What is the term for the fusion of a joint, usually through osteophyte formation and calcification of an inflamed synovial joint?

    <p>Ankylosing</p> Signup and view all the answers

    Which of the following autoantibodies is specific to Systemic Lupus Erythematosus?

    <p>All of the above</p> Signup and view all the answers

    What is the prevalence of ankylosing spondylitis in Caucasians?

    <p>0.1-1%</p> Signup and view all the answers

    What is the estimated prevalence of Systemic Lupus Erythematosus?

    <p>1/2500</p> Signup and view all the answers

    What is the percentage of people with ankylosing spondylitis who have the HLA-B27 haplotype?

    <p>90% or higher</p> Signup and view all the answers

    What is a known genetic predisposition to Systemic Lupus Erythematosus?

    <p>All of the above</p> Signup and view all the answers

    What is a potential mechanism of molecular mimicry in ankylosing spondylitis?

    <p>Antigen-binding subtypes of HLA-B27 resemble certain molecules of Klebsiella pneumonia</p> Signup and view all the answers

    What is the term for inflammation of the intervertebral joints?

    <p>Spondylitis</p> Signup and view all the answers

    Which of the following exogenous factors can contribute to the development of Systemic Lupus Erythematosus?

    <p>All of the above</p> Signup and view all the answers

    What is a possible mechanism of self-tolerance failure in Systemic Lupus Erythematosus?

    <p>All of the above</p> Signup and view all the answers

    What is the percentage of healthy whites who are HLA-B27 positive?

    <p>8%</p> Signup and view all the answers

    What is a characteristic of the immune response in Systemic Lupus Erythematosus?

    <p>Type I interferon response</p> Signup and view all the answers

    Which type of arthritis is associated with psoriasis?

    <p>Psoriatic arthritis</p> Signup and view all the answers

    What is the primary role of deficient C1q in the pathogenesis of Systemic Lupus Erythematosus?

    <p>Clearing apoptotic cells</p> Signup and view all the answers

    Which of the following is a common manifestation of ankylosing spondylitis?

    <p>Inflammation of the sacroiliac joint</p> Signup and view all the answers

    What is a characteristic feature of reactive arthritis?

    <p>Asymmetrical joint involvement</p> Signup and view all the answers

    What is a common extra-articular manifestation of ankylosing spondylitis?

    <p>Acute uveitis</p> Signup and view all the answers

    What is a characteristic feature of psoriatic arthritis?

    <p>Asymmetrical joint involvement</p> Signup and view all the answers

    What is a common feature of dactylitis?

    <p>Destruction of the joint and bones of the digit</p> Signup and view all the answers

    What is the estimated prevalence of psoriasis?

    <p>1% of the population</p> Signup and view all the answers

    What is a characteristic feature of ankylosing spondylitis?

    <p>Bony ankylosis of the intervertebral joints</p> Signup and view all the answers

    What is a common feature of reactive arthritis?

    <p>Strong association with HLA-B27</p> Signup and view all the answers

    What is a characteristic feature of enthesitis?

    <p>Inflammation of the tendinous or ligamentous insertion sites</p> Signup and view all the answers

    What is a common treatment for ankylosing spondylitis?

    <p>All of the above</p> Signup and view all the answers

    What type of hypersensitivity is involved in immune complex damage in the glomerulus and small blood vessels?

    <p>Type III</p> Signup and view all the answers

    What is the most common hematologic problem in SLE patients?

    <p>Anemia</p> Signup and view all the answers

    What is the characteristic of the rash in SLE patients?

    <p>It is worsened by sunlight</p> Signup and view all the answers

    What is the cardiovascular complication of SLE?

    <p>All of the above</p> Signup and view all the answers

    What is the nervous system complication of SLE?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of the spleen in SLE patients?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of renal involvement in SLE?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of discoid lupus?

    <p>It is a skin manifestation of lupus with few to no systemic symptoms</p> Signup and view all the answers

    What is the clinical course of SLE?

    <p>It is characterized by a progression of remissions and flares</p> Signup and view all the answers

    What is the most common cause of death in SLE patients?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    NSAIDs

    • NSAID: Non-Steroidal Anti-Inflammatory Drug
    • General mechanism: Block cyclooxygenase at both central and peripheral sites
    • Blocks formation of prostaglandins (PGs) and thromboxane
    • Results in moderate anti-inflammatory, analgesic, and anti-pyretic effects
    • Blockade of thromboxane causes inhibition of platelet activation
    • Decreases likelihood of formation of clots

    PG/TX Overview

    • PGI2: Vasodilation and inhibition of platelet aggregation
    • PGE2: Promotes renal blood flow and gastric protection
    • TXA2: Vasoconstriction and platelet activation
    • PGI2 and PGE2: Vasodilation and inhibition of platelet aggregation
    • PG effects on different organs:
      • Endothelium: Vasodilation and inhibition of platelet aggregation
      • Kidney: Promotes renal blood flow
      • Stomach: Gastric protection
      • Platelets: Inhibition of platelet activation
      • Macrophages and WBCs: Vasodilation and inhibition of platelet aggregation

    Glucocorticoids

    • Mechanism of action: Block of PLA2
    • Inhibit leukocyte migration and reduce pro-inflammatory cytokine production
    • Therapeutic uses:
      • Relief of inflammation or flares in autoimmune disease
      • Treatment of allergies
    • Routes of administration: Inhaled, oral, injected, or topical

    Side Effects of Glucocorticoids

    • Immunosuppression: Increased risk of infection and delayed wound healing
    • Metabolic: Ulcers in GI tract, muscle weakness, fat redistribution, hyperlipidemia, and hyperglycemia
    • Neurologic: Irritability, euphoria, and psychosis in some cases
    • Bone effects: Reduced bone formation, increased bone resorption, and interference with metabolic actions of vitamin D

    Vaccination and Therapeutic Antibody Concepts

    • Passive immunization: Transfer of antibodies from a source outside the patient
    • Active immunization: Administration of a weakened microbe or portion of a microbe to produce memory cells
    • Vaccine types:
      • Live attenuated: Stronger immune response, but may mutate into more virulent forms
      • Inactivated: Stable, safer, but may have weaker immune response
      • Purified macromolecules: Toxoids, conjugates, and subunit vaccines
    • mRNA vaccines:
      • Easy to make and specific for the exact protein antigen
      • Zero chance of disrupting the genome
      • Greater control over the immune response
      • Challenges: Production, instability, and immune over-reaction

    Systemic Lupus Erythematosus (SLE)

    • Definition: A systemic autoimmune disorder characterized by a number of auto-antibodies, specifically antibodies against nuclear components (ANA).
    • Epidemiology:
      • Prevalence: ~1/2500
      • Onset: typically in 20's and 30's
      • Women:men ratio: 9:1
      • More common in Hispanic, African heritage
    • Pathogenesis:
      • Auto-antibodies against nuclear components, RBCs, platelets, WBCs, and phospholipid-associated proteins
      • Failure of self-tolerance, inadequate clearance of self-antigens, and presence of autoreactive T-cells and B-cells
      • Environment: UV light worsens dermatologic symptoms
    • Clinical Features:
      • Hematologic: anemia, thrombocytopenia, lymphopenia
      • Arthritis: inflammation of synovium, non-erosive, and non-ankylosing
      • Skin: malar rash, urticaria, bullae, maculopapular lesions, and ulcerations
      • Cardiovascular: myocarditis, valvular damage, and worsened atherosclerosis
      • Nervous system: difficulties in memory and reasoning, mood disorders, headaches, seizures, and psychosis
      • Renal: range of complicated renal pathologies, including immune complex deposition, and kidney failure
    • Discoid Lupus:
      • Skin manifestations of lupus with few to no systemic symptoms
      • Discoid lesion: skin plaques with varying degrees of edema, erythema, scaliness, follicular plugging, and skin atrophy

    Seronegative Spondyloarthropathies

    • Definition: A group of disorders characterized by:
      • Lack of serum markers (e.g., Rheumatoid Factor, ANA, dsDNA)
      • Association with HLA-B27
      • Inflammation of synovial joints, usually involving inflammatory back pain
    • Types:
      • Ankylosing Spondylitis (AS)
      • Reactive Arthritis (ReA)
      • Psoriatic Arthritis (PsA)
      • Arthritis associated with Inflammatory Bowel Disease (IBD)

    Ankylosing Spondylitis (AS)

    • Definition:
      • Ankylosing: fusion of a joint through osteophyte formation and calcification of an inflamed synovial joint
      • Spondylitis: inflammation of the intervertebral joints
    • Epidemiology:
      • Prevalence: 0.1-1% of population
      • More common in Caucasians
      • 2-3 times more common in men
    • Pathogenesis:
      • Etiology: HLA-B27, genes located around that locus, and molecular mimicry
      • Pathological findings: chronic inflammation, joint erosion, fibrosis, and ossification of the joint capsule
    • Clinical Features:
      • Insidious onset of low back pain
      • Onset of symptoms in those younger than 40 years
      • Presence of symptoms for more than 3 months
      • Symptoms worse in the morning or with inactivity
      • Improvement of symptoms with exercise
      • Pain is typically poorly localized to the lower back and gluteal region
      • Enthesitis, inflammatory joint pain, and extra-articular findings (e.g., acute uveitis, aortitis)

    Reactive Arthritis (ReA)

    • Definition:
      • Post-urethritis and enteritis-associated arthritis
      • Strongly associated with HLA-B27
      • More common in men
    • Pathological findings:
      • Synovitis, which can result in severe destruction of the joint surface and underlying bone
      • Ossification of tendino-ligamentous insertion points
    • Epidemiology:
      • Could be as high as 1% of chlamydial urethritis or bacterial gastroenteritis (especially Campylobacter and Shigella infections)
    • Clinical Features:
      • Joint stiffness and pain, typically presenting symptoms
      • Lower back, ankles, knees, feet, and interphalangeal joints affected
      • Enthesitis, dactylitis, and chronic disease in some cases

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    Description

    This quiz covers the pathophysiology of inflammation and the use of NSAIDs and Glucocorticoids as anti-inflammatory medications. It includes topics such as membrane phospholipids, phospholipase A2, and the effects of glucocorticoids on inflammation.

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