Inflammation and Immune Response Quiz
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Questions and Answers

Which of the following is a pharmacological action of aspirin?

  • Increased reabsorption of chloride
  • Inhibition of PG-induced secretion of renin
  • Promotion of hyperkalemia
  • Inhibition of antigen-antibody reactions (correct)

    • What is the mechanism of action of aspirin?

  • Stabilization of capillary permeability
  • Formation of 15-epi-lipoxins
  • Inhibition of COX-1 and COX-2 activity (correct)
  • Acetylation of COX-2 leading to anti-inflammatory actions

    • Which of the following is a shared use of NSAIDs?

  • Induction of labor
  • Prevention of postpartum hemorrhage
  • Management of musculoskeletal pain (correct)
  • Treatment of hypertension

    • What is the effect of NSAIDs on renal function in patients with congestive heart failure?

    <p>Decrease in glomerular filtration rate</p> Signup and view all the answers

    Which of the following is a shared drug interaction with NSAIDs?

    <p>Increased renal excretion of lithium</p> Signup and view all the answers

    What is the effect of salicylates on body temperature?

    <p>Return to normal in the presence of salicylates</p> Signup and view all the answers

    Which of the following is a pharmacokinetic property of salicylates?

    <p>Predominantly bound to plasma proteins</p> Signup and view all the answers

    What is the distribution of salicylates in the body?

    <p>Wide distribution throughout body tissues</p> Signup and view all the answers

    What is the effect of chronic use of high doses of NSAIDs?

    <p>Promotion of analgesic nephropathy</p> Signup and view all the answers

    What is the plasma half-life of salicylate after a large dose?

    <p>15-30 hours</p> Signup and view all the answers

    Which of the following is NOT a cause of inflammation?

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

    Which of the following is a chemical mediator of inflammation?

    <p>Platelet-activating factor (PAF)</p> Signup and view all the answers

    What is the process of inflammation characterized by?

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

    Which of the following can cause fever?

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

    What triggers the initial phase of the thermoregulatory response?

    <p>Ceramide release</p> Signup and view all the answers

    Which of the following is NOT a chemical mediator of inflammation?

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

    What are the damage- and pathogen-associated molecules recognized by cells charged with immune surveillance?

    <p>Others: endothelial intercellular adhesion molecule-1 (ICAM-1), oxygen radicals and nitric oxide</p> Signup and view all the answers

    Which of the following is an immunologic mediator of inflammation?

    <p>Tumor necrosis factor (TNF)</p> Signup and view all the answers

    What is the immune system's protective response to injurious stimulus called?

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

    Which of the following is NOT a consequence of chronic inflammation?

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

    Which enzyme is involved in the induction of cyclooxygenase (COX-2) during the late phase response?

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

    Which receptors does PGE2 act on to trigger the hypothalamus to elevate body temperature?

    <p>EP receptors on thermosensitive neurons</p> Signup and view all the answers

    Which of the following is NOT a stimulus that can activate nociceptors?

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

    Which neuropeptides may be involved in the generation of pain?

    <p>Substance P and calcitonin gene-related peptide (CGRP)</p> Signup and view all the answers

    Which prostaglandins reduce the threshold of stimulation of nociceptors leading to peripheral sensitization?

    <p>PGE2 and PGD2</p> Signup and view all the answers

    Which tissues are commonly affected by rheumatoid arthritis (RA)?

    <p>Joints, skin, lungs, muscle, and CVS</p> Signup and view all the answers

    What is the first joint tissue affected in rheumatoid arthritis?

    <p>Synovial membrane</p> Signup and view all the answers

    What is the mechanism of action of non-selective NSAIDs?

    <p>Inhibit both COX-1 and COX-2</p> Signup and view all the answers

    What is the shared pharmacological action of NSAIDs on the cardiovascular system?

    <p>Decreased release of vasodilator PGE2 and PGI2</p> Signup and view all the answers

    What is the side effect of NSAIDs on the gastric mucosa?

    <p>Inhibition of COX-1 in gastric epithelial cells</p> Signup and view all the answers

    Which of the following NSAIDs has the longest half-life?

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

    Which NSAID is 20 times more potent than aspirin in inhibiting COX?

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

    Which NSAID directly inhibits leukocyte function?

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

    Which NSAID causes less severe gastrointestinal effects than aspirin?

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

    Which NSAID is a ketone prodrug converted to an active metabolite in the liver?

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

    Which NSAID has a preferential activity against COX-2?

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

    Which NSAID is the only FDA approved drug in the COX-2 selective inhibitors class?

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

    Which of the following is a non-selective NSAID?

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

    What is the primary respiratory effect of salicylates in medium to large doses?

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

    What is the compensatory response to the initial respiratory alkalosis caused by therapeutic doses of salicylates?

    <p>Increased renal excretion of bicarbonate</p> Signup and view all the answers

    What is the mechanism of increased O2 consumption and CO2 production in skeletal muscle caused by salicylates?

    <p>Uncoupling of oxidative phosphorylation</p> Signup and view all the answers

    What is the effect of salicylates on plasma CO2 tension (PCO2) in anti-inflammatory doses?

    <p>PCO2 decreases slightly</p> Signup and view all the answers

    What is the shared side effect of non-selective NSAIDs on the gastric mucosa?

    <p>Gastric ulcers</p> Signup and view all the answers

    What is the effect of salicylates on acid-base and electrolyte balance?

    <p>Increased renal excretion of bicarbonate</p> Signup and view all the answers

    Which of the following is a characteristic of salicylism, a mild form of salicylate intoxication?

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

    Which of the following is a consequence of salicylate-induced sweating and hyperventilation?

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

    What is the reversible hepatic injury caused by large doses of salicylates called?

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

    What is the effect of a single dose of aspirin on bleeding time in normal individuals?

    <p>Prolongs bleeding time for 4-7 days</p> Signup and view all the answers

    What is the primary mechanism of gastric damage caused by salicylates?

    <p>Inhibition of prostaglandin synthesis</p> Signup and view all the answers

    What is the effect of low doses of salicylates on urate excretion?

    <p>Decreases urate excretion</p> Signup and view all the answers

    What are the neurological effects of high doses of salicylates?

    <p>Stimulation followed by depression</p> Signup and view all the answers

    Which of the following is an inhibitor of Janus kinase?

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

    Which of the following is a common side effect of hydroxychloroquine?

    <p>Skin rash</p> Signup and view all the answers

    Which of the following is a disease-modifying anti-rheumatic drug (DMARD) used as monotherapy or in combination with methotrexate?

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

    Which cytokines are involved in the pathogenesis of rheumatoid arthritis?

    <p>IL-1 and TNFα</p> Signup and view all the answers

    Which of the following drugs can decrease signs and symptoms of rheumatoid arthritis, reduce structural damage progression, and improve physical conditions of patients?

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

    Which of the following is a common side effect associated with rheumatoid arthritis therapy?

    <p>Mucosal ulceration</p> Signup and view all the answers

    Which of the following is an immunomodulatory drug that inhibits the activity of autoimmune lymphocytes?

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

    Which of the following is a shared side effect of methotrexate and leflunomide?

    <p>GI upset</p> Signup and view all the answers

    Which of the following is a recombinant monoclonal antibody used to reduce signs and symptoms of moderate to severe rheumatoid arthritis?

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

    Which enzyme is inhibited by non-selective NSAIDs?

    <p>Both COX-1 and COX-2</p> Signup and view all the answers

    Which type of NSAIDs is more selective in inhibiting COX-2?

    <p>COX-2 selective inhibitors</p> Signup and view all the answers

    Which NSAID is commonly used as an opioid-sparing agent in certain acute trauma cases?

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

    Which NSAID has the brand name 'Celebrex'?

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

    Which NSAID has the generic name 'Naprosyn'?

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

    Which NSAID is commonly known as 'Motrin' and 'Advil'?

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

    Which of the following is the first biotechnology-derived drug for the reduction of signs and symptoms of moderate to severe active rheumatoid arthritis in patients who have not adequately responded to one or more of the synthetic DMARDs?

    <p>Burenex®</p> Signup and view all the answers

    Which of the following alkaloids is represented in the highest percentage in opium?

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

    Which of the following receptors do opioids mainly bind to in order to control pain and pleasurable and addictive behavior?

    <p>Mu receptors</p> Signup and view all the answers

    Which of the following is the prototype receptor mu agonist?

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

    Which of the following is the structure of morphine that exhibits a high degree of stereoselectivity of analgesic?

    <p>Centers of chirality</p> Signup and view all the answers

    Which of the following is a physiochemical property of morphine?

    <p>Amphoteric substance</p> Signup and view all the answers

    Which of the following is NOT a characteristic of COX-1?

    <p>It is involved in inflammation</p> Signup and view all the answers

    Which of the following is a characteristic of COX-2 selective NSAIDs?

    <p>They provide anti-inflammatory relief without compromising the gastric mucosa</p> Signup and view all the answers

    What is the predominate form of acetaminophen (pKa,9.7) at physiological pH?

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

    What is the primary metabolite of acetaminophen in children?

    <p>O-sulfate</p> Signup and view all the answers

    What is the primary mechanism of action of diclofenac?

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

    What is the bioavailability of diclofenac on oral administration?

    <p>50-60%</p> Signup and view all the answers

    Which is the most active isomeric form of the opioid receptor?

    <p>Levorotatory enantiomorph with stereochemistry 5®, 6(S), 9)R), 13(S) and 14(R)</p> Signup and view all the answers

    Which conformation is 10 times more potent than the B/C trans conformation?

    <p>B/C cis conformation</p> Signup and view all the answers

    What is the pharmacophore for opioid analgesic activity?

    <p>4-phenylpiperidine structure</p> Signup and view all the answers

    What is the precursor for heroin, hydromorphone, and oxymorphone?

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

    What is the 3,6 diacetylated form of morphine?

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

    What is the enzyme responsible for the O-demethylation of codeine?

    <p>Cytochrome P450 CYP2D6</p> Signup and view all the answers

    Which enzyme is responsible for the metabolism of diclofenac to its major metabolite via CYP3A4?

    <p>CYP3A4</p> Signup and view all the answers

    What is the major metabolite of diclofenac formed via CYP3A4?

    <p>4’-hydroxy derivative</p> Signup and view all the answers

    Which enzyme is responsible for the formation of 5’-hydroxy, 3’-hydroxy, and 4’,5’-dihydroxy metabolites of diclofenac?

    <p>CYP2C9</p> Signup and view all the answers

    What percentage of the dose of diclofenac is excreted as the 4’-hydroxy derivative?

    <p>20-30%</p> Signup and view all the answers

    What is the preferred conformation of the N-p-chlorobenzoyl group in indomethacin?

    <p>The chlorophenyl ring is oriented away from the 2-methyl group</p> Signup and view all the answers

    Which enzyme is responsible for the 5-O-demethylation of indomethacin?

    <p>CYP2C9</p> Signup and view all the answers

    Study Notes

    Pharmacological Actions of Aspirin and NSAIDs

    • Aspirin's pharmacological action is to inhibit cyclooxygenase (COX), which leads to the inhibition of prostaglandin synthesis.
    • The mechanism of action of aspirin is to irreversibly acetylate COX, thereby inhibiting its activity.

    NSAIDs

    • Shared use of NSAIDs: to relieve pain, reduce inflammation, and lower fever.
    • Effect of NSAIDs on renal function in patients with congestive heart failure: NSAIDs can reduce renal function and exacerbate congestive heart failure.
    • Shared drug interaction with NSAIDs: NSAIDs can interact with anticoagulants, increasing the risk of bleeding.

    Salicylates

    • Effect of salicylates on body temperature: salicylates can increase body temperature by stimulating the hypothalamus.
    • Pharmacokinetic property of salicylates: salicylates have a nonlinear plasma half-life, which increases with dose.
    • Distribution of salicylates in the body: salicylates are distributed widely in the body, with high concentrations in the liver, kidneys, and lungs.

    Inflammation

    • Process of inflammation: characterized by increased blood flow, increased permeability, and infiltration of white blood cells.
    • Chemical mediators of inflammation: include histamine, bradykinin, and prostaglandins.
    • Damage- and pathogen-associated molecules recognized by cells charged with immune surveillance: include PAMPs (pathogen-associated molecular patterns) and DAMPs (damage-associated molecular patterns).

    Immune Response

    • Immune system's protective response to injurious stimulus: characterized by inflammation, which is triggered by the activation of immune cells.
    • Consequence of chronic inflammation: can lead to tissue damage and disease.

    Rheumatoid Arthritis

    • Tissues commonly affected by rheumatoid arthritis (RA): synovial joints, particularly the hands and feet.
    • First joint tissue affected in rheumatoid arthritis: the synovial membrane.
    • Mechanism of action of non-selective NSAIDs: inhibit COX-1 and COX-2, leading to the inhibition of prostaglandin synthesis.
    • Shared pharmacological action of NSAIDs on the cardiovascular system: can increase blood pressure and cardiovascular risk.

    Specific NSAIDs

    • Aspirin: inhibits COX-1 and COX-2, with a long half-life.
    • Indomethacin: has a high potency and is used to treat acute gout and rheumatoid arthritis.
    • Diclofenac: has a high potency and is used to treat pain, inflammation, and fever.
    • Celecoxib: is a COX-2 selective inhibitor, used to treat rheumatoid arthritis and osteoarthritis.
    • Naproxen: has a long half-life and is used to treat pain, inflammation, and fever.

    Opioids

    • Receptors opioids mainly bind to: mu, kappa, and delta receptors.
    • Prototype receptor mu agonist: morphine.
    • Structure of morphine: exhibits a high degree of stereoselectivity of analgesic activity.
    • Physiochemical property of morphine: has a high lipophilicity.

    Acetaminophen

    • Primary metabolite of acetaminophen in children: glucuronide.
    • Mechanism of action of acetaminophen: inhibits COX-3, leading to the inhibition of prostaglandin synthesis.
    • Predominant form of acetaminophen at physiological pH: anionic form.

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    Description

    Test your knowledge on the pathophysiology of inflammation and the causes of an inflammatory response. Learn about the immune system's protective response to infectious agents, noxious chemicals, thermal or physical trauma, and more. Explore the recognition of damage- and pathogen-associated molecules by immune surveillance cells.

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