Pharmacology Quiz: Diuretics and Medications
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Questions and Answers

What is the primary mechanism of action for the diuretic drug mentioned in the initial section of the text?

The diuretic drug inhibits the sodium-potassium-chloride cotransporters (NKCC2) in the nephron.

What are two common indications for using the diuretic described in the text?

Two common indications are hypertension and treatment for edema.

Identify three potential side effects of the diuretic drug discussed in the text.

Potential side effects include increased urination, electrolyte disturbance, and dehydration.

What is the mechanism of action for Sildenafil (Revatio, Viagra)?

<p>Sildenafil is a phosphodiesterase 5 inhibitor.</p> Signup and view all the answers

List two therapeutic uses of Sildenafil.

<p>Sildenafil is used for pulmonary arterial hypertension and erectile dysfunction.</p> Signup and view all the answers

What is the recommended route of administration for Sildenafil?

<p>Sildenafil is typically administered orally, but injectable formulations are also available.</p> Signup and view all the answers

What are two potential side effects of Sildenafil?

<p>Two potential side effects of Sildenafil include headache and flushing.</p> Signup and view all the answers

What is the primary indication for using Paracetamol (acetaminophen)?

<p>Paracetamol is primarily used as an antipyretic and painkiller for mild to moderate pain.</p> Signup and view all the answers

What is the mechanism of action of dexamethasone?

<p>Dexamethasone is a potent glucocorticoid with minimal to no mineralocorticoid activity. It exerts its anti-inflammatory effects by inhibiting phospholipase A2, which in turn inhibits prostaglandin and proinflammatory cytokines. It also increases capillary permeability, suppresses PMN migration, and increases surfactant synthesis.</p> Signup and view all the answers

What are the two common routes of administration for dexamethasone?

<p>Dexamethasone can be administered orally (tablet or syrup) and via injection (IV or IM).</p> Signup and view all the answers

List three common side effects associated with dexamethasone use.

<p>Some common side effects of dexamethasone include hiccups, gastric upset, easy bruising, sleeping problems, and weight gain.</p> Signup and view all the answers

What is the primary mechanism of action for furosemide (Lasix)?

<p>Furosemide acts as a diuretic by blocking the tubular reabsorption of sodium and chloride in the proximal and distal tubules, as well as the thick ascending loop of Henle.</p> Signup and view all the answers

Name four conditions that commonly respond well to treatment with ACE inhibitors (ACEi).

<p>ACE inhibitors are often used to treat hypertension, heart failure, prevent the progression of chronic kidney disease (CKD), and manage proteinuria.</p> Signup and view all the answers

Describe two primary mechanisms by which spironolactone exerts its therapeutic effects.

<p>Spironolactone acts as an aldosterone antagonist, blocking the action of aldosterone in the kidneys. It also exhibits anti-androgen properties, which can be useful in managing conditions like PCOS, acne, and hirsutism.</p> Signup and view all the answers

Compare and contrast the indications for use between ACE inhibitors and spironolactone.

<p>While both ACE inhibitors and spironolactone are commonly used to treat hypertension and heart failure, spironolactone has additional applications in managing conditions like nephrotic syndrome, ascites in cirrhosis, hypokalemia, hyperaldosteronism, and certain androgen-related disorders.</p> Signup and view all the answers

What are two common side effects associated with ACE inhibitor use?

<p>Some common side effects of ACE inhibitors include hypotension (low blood pressure), hyperkalemia (high potassium levels), dry cough, angioedema (swelling under the skin), skin rash, and altered taste.</p> Signup and view all the answers

Name three different conditions or situations that may benefit from the use of methylprednisolone.

<p>Methylprednisolone is often used to treat acute asthma, lupus nephritis, and acute exacerbations of multiple sclerosis (MS). It is also commonly used for autoimmune inflammatory disorders, including juvenile idiopathic arthritis, inflammatory bowel disease (IBD), connective tissue disorders, and systemic lupus erythematosus.</p> Signup and view all the answers

Explain how the renin-angiotensin-aldosterone system (RAAS) is involved in the regulation of blood pressure.

<p>The RAAS plays a crucial role in blood pressure regulation. When blood pressure falls, the kidneys release renin. Renin converts angiotensinogen to angiotensin I. Angiotensin I is then converted to angiotensin II by angiotensin-converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor, increasing blood pressure. It also stimulates the release of aldosterone, which promotes sodium and water retention, further increasing blood pressure.</p> Signup and view all the answers

What are the primary side effects associated with increasing the dose of long-acting insulin at night?

<p>The primary side effects include hypoglycemia, hypokalemia, weight gain, hypersensitivity reactions, and injection site complications.</p> Signup and view all the answers

How does thyroid hormone affect the metabolic rate in different tissues?

<p>Thyroid hormone increases the metabolic rate of cells in all tissues.</p> Signup and view all the answers

What is the role of Levothyroxine in treating hypothyroidism?

<p>Levothyroxine acts as a replacement for the deficient thyroid hormone thyroxine (T4).</p> Signup and view all the answers

Describe the conversion process of T4 in the body.

<p>In the liver and kidney, T4 is converted to T3, the active metabolite.</p> Signup and view all the answers

List two common side effects of Levothyroxine.

<p>Common side effects include palpitations and nervousness.</p> Signup and view all the answers

What is the main function of corticosteroids in the body?

<p>Corticosteroids regulate stress response, inflammation, and metabolism of proteins and carbohydrates.</p> Signup and view all the answers

What are common routes of administration for Levothyroxine?

<p>Levothyroxine can be administered orally in tablets, capsules, or powder, and intravenously via vial.</p> Signup and view all the answers

Identify one side effect from the use of corticosteroids.

<p>One side effect is heat intolerance.</p> Signup and view all the answers

Describe the primary role of insulin in the body and how it affects glucose metabolism.

<p>Insulin is a hormone produced by the pancreas that plays a key role in regulating glucose metabolism. It promotes the uptake of glucose from the blood into various tissues, like liver, fat, and skeletal muscle cells. This absorbed glucose is then converted into glycogen for storage (glycogenesis) or into fats (triglycerides) through lipogenesis. Insulin also inhibits glucose production and secretion from the liver, ultimately helping to maintain normal blood sugar levels.</p> Signup and view all the answers

Why is insulin necessary for individuals diagnosed with type 1 diabetes mellitus?

<p>Individuals with type 1 diabetes mellitus lack the ability to produce insulin due to the destruction of the beta cells in their pancreas. Therefore, insulin supplementation is crucial for these individuals to regulate their blood glucose levels and prevent complications associated with uncontrolled diabetes.</p> Signup and view all the answers

What are the different routes of administration for insulin?

<p>Insulin can be administered through several routes, including subcutaneous injections, intravenous injections, intramuscular injections, intraperitoneal injections, inhalers, and personal insulin pumps.</p> Signup and view all the answers

Describe the 'honeymoon phase' in type 1 diabetes mellitus and explain its significance.

<p>The 'honeymoon phase' in type 1 diabetes mellitus refers to a period, often occurring shortly after insulin therapy initiation, where insulin requirements decrease transiently. This may involve needing less than 0.5 units of insulin per kilogram of body weight per day, along with a HbA1c level below 7%. However, this phase is temporary and the need for insulin will eventually return. Therefore, it's crucial to advise families about the transient nature of the honeymoon phase to avoid false hope and ensure a realistic understanding of the disease's long-term management.</p> Signup and view all the answers

How can ketoacidosis at presentation affect the likelihood of a remission phase in type 1 diabetes mellitus?

<p>Individuals with type 1 diabetes who present with ketoacidosis and are diagnosed at a young age have a reduced likelihood of experiencing a honeymoon phase. This is primarily due to the severity of the initial disease presentation and the underlying immune response that led to the destruction of beta cells.</p> Signup and view all the answers

Explain the concept of the Somogyi phenomenon and describe its possible treatment.

<p>The Somogyi phenomenon, primarily seen in children receiving high doses of long-acting insulin at night, refers to a pattern of late-night hypoglycemia followed by early morning hyperglycemia. This occurs due to the body's counter-regulatory hormone response to the hypoglycemia, ultimately leading to an elevation in blood glucose levels in the morning. Treatment often involves reducing the dose of long-acting insulin administered at night to prevent the initial hypoglycemic episode and subsequent hyperglycemia.</p> Signup and view all the answers

What is the dawn phenomenon and how does it differ from the Somogyi phenomenon?

<p>The dawn phenomenon, observed in children receiving normal doses of insulin at night and maintaining normal midnight glucose levels (normoglycemia), refers to a pattern of early morning hyperglycemia. This elevation in blood glucose is usually caused by the normal increase in counter-regulatory hormones during the early morning hours. The dawn phenomenon differs from the Somogyi phenomenon because it does not involve a preceding hypoglycemic episode. It's a normal physiological response, while the Somogyi phenomenon is a consequence of insulin therapy.</p> Signup and view all the answers

What is a potential treatment for the dawn phenomenon?

<p>While the underlying cause of the dawn phenomenon is a normal physiological process, adjusting insulin doses can help manage morning hyperglycemia. An appropriately timed pre-dawn insulin dose or a slight increase in evening insulin can help prevent the early morning surge in blood glucose.</p> Signup and view all the answers

Flashcards

Furosemide (Lasix): Mechanism of Action

Furosemide is a diuretic that works by blocking the reabsorption of sodium and chloride in the kidneys, leading to increased urine production.

Furosemide (Lasix): Indications

Furosemide is used to treat fluid build-up (edema) in various conditions, including heart failure, liver disease, and kidney disease. It also helps lower blood pressure.

Furosemide (Lasix): Route of Administration

Furosemide is typically administered orally as a tablet or solution. In some cases, it can also be given intravenously.

Furosemide (Lasix): Side Effects

Common side effects of furosemide include dehydration, low potassium levels, ear ringing, and dizziness. Some individuals may also experience changes in urine color or volume.

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Role of Thyroid Hormone in Development

Thyroid hormone plays a crucial role in the growth and development of all tissues, especially in fetuses and newborns, including bones and the brain.

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What is Levothyroxine?

Levothyroxine is a synthetic form of thyroxine (T4), a crucial thyroid hormone. It acts as a replacement for natural thyroxine in cases of hypothyroidism, helping the body function properly.

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How does Levothyroxine Work?

Levothyroxine mimics the actions of naturally produced thyroxine. It's converted to T3, the active form of the hormone, in the liver and kidneys. This process helps regulate metabolism and maintain overall health.

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What are Corticosteroids?

Corticosteroids, both natural and synthetic, are produced in the adrenal cortex. They play a vital role in various bodily functions, including stress response, inflammation regulation, and protein and carbohydrate metabolism.

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What are the Properties of Corticosteroids?

Corticosteroids possess potent anti-inflammatory, immunosuppressive, and anti-neoplastic properties. They are commonly used to treat various conditions related to inflammation, immune system disorders, and certain types of cancer.

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Examples of Corticosteroids

Hydrocortisone and Prednisone are examples of corticosteroids commonly used in medical practice. They are synthetic analogs of natural hormones.

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How is Levothyroxine Administered?

Levothyroxine is typically administered orally in the form of tablets, capsules, or powder. It can also be given intravenously, but this is less common.

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What are Potential Side Effects of Levothyroxine?

Possible side effects of Levothyroxine include: palpitations (fast heartbeat), nervousness, headache, insomnia, sweating (diaphoresis), irregular blood sugar (hyperglycemia), low cholesterol (hypocholesterolemia), nausea, vomiting, diarrhea, weight loss, and heat intolerance.

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What is insulin?

Insulin is a hormone produced by the pancreas that regulates the body's metabolism of carbohydrates, fats, and proteins. It helps glucose enter cells for energy.

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What is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease where the body's immune system destroys insulin-producing cells in the pancreas, leading to a deficiency in insulin production.

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What is Type 2 Diabetes?

Type 2 diabetes occurs when the body becomes resistant to insulin, meaning the cells don't respond to insulin as they should, leading to high blood sugar levels.

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What is the honeymoon phase in Type 1 diabetes?

The 'honeymoon phase' in Type 1 diabetes refers to a period after starting insulin treatment where insulin requirements temporarily decrease. This can create a false sense that the diabetes is improving.

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What is the Somogyi phenomenon?

The Somogyi phenomenon refers to a rebound hyperglycemia (high blood sugar) that occurs after a period of nighttime hypoglycemia (low blood sugar) in children with type 1 diabetes. This can happen when the insulin dose is too high.

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What is the Dawn phenomenon?

Dawn phenomenon refers to a gradual rise in blood glucose levels in the morning, even with a normal insulin dose and blood sugar levels at night. This is due to the normal release of counter-regulatory hormones like cortisol in the early morning hours.

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How is insulin delivered?

Insulin injections are the most common way to deliver insulin, but it can also be administered through inhalers or a personal insulin pump.

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How does insulin affect the liver?

High levels of insulin strongly inhibit the liver's production and secretion of glucose.

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Loop Diuretics

A type of diuretic that works by inhibiting the sodium-potassium-chloride cotransporter (NKCC2) in the nephron, leading to increased excretion of water, sodium, and other electrolytes.

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Congestive Heart Failure

A condition where the heart is unable to pump blood effectively, leading to fluid buildup in the body.

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Sildenafil (Viagra)

A drug that blocks the enzyme phosphodiesterase 5, leading to increased levels of cyclic guanosine monophosphate (cGMP) and relaxation of smooth muscle, particularly in the penis.

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Nonsteroidal Anti-inflammatory Drug (NSAID)

A type of drug that inhibits the cyclooxygenase (COX) enzyme, reducing the production of prostaglandins, which are involved in inflammation and pain.

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Paracetamol (Acetaminophen)

A medication used to reduce fever and relieve mild to moderate pain. It's known for its ability to lower body temperature and ease aches and pains.

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Ibuprofen

A specific type of NSAID that selectively inhibits the COX-1 and COX-2 enzymes, reducing inflammation and relieving pain.

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Diclofenac

A medication that acts as a non-selective COX inhibitor, reducing inflammation and relieving pain.

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Increased Urination (Diuresis)

A common condition that can occur with certain medications, often due to increased fluid excretion, and can lead to dehydration and electrolyte imbalances.

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Study Notes

Insulin

  • Insulin is a peptide hormone made by beta cells in the pancreatic islets.
  • It's the primary anabolic hormone in the body, regulating carbohydrate, fat, and protein metabolism.
  • Insulin promotes glucose uptake by liver, fat, and muscle cells.
  • Absorbed glucose is stored as glycogen via glycogenesis or converted to fat (triglycerides) via lipogenesis.
  • Glucose production and secretion by the liver are significantly inhibited by high insulin concentrations.

Insulin Indications

  • Primarily used to replace missing insulin secretion in type 1 diabetes.
  • Also used in type 2 diabetes to supplement insufficient insulin.

Insulin Routes of Administration

  • Injections (subcutaneous, intravenous, intramuscular, intraperitoneal)
  • Inhaler.
  • Personal insulin pump.

Insulin Regimens

  • 50% of daily dose is rapid-acting insulin (e.g., NovoRapid)
  • Delivered in pre-meal boluses.
  • Remaining 50% is long-acting insulin (e.g., Lantus).
  • Administered as a single evening injection.

Partial Remission (Honeymoon Phase) in Type 1 Diabetes

  • Insulin requirements may temporarily decrease after starting treatment.
  • Defined as requiring less than 0.5 units of insulin per kg of body weight per day, with an HbA1c < 7%.
  • Ketoacidosis at diagnosis, and younger age, are associated with a reduced likelihood of remission.
  • Important to advise patients and families about the temporary nature of this phase to avoid false hope of spontaneous recovery.
  • Treatment often involves reducing insulin dosage accordingly.

Somogyi Phenomenon

  • Children with high doses of bedtime long-acting insulin may experience hypoglycemia late at night (3–4 AM).
  • This triggers the release of counter-regulatory hormones, leading to rebound hyperglycemia in the early morning.
  • Treatment involves reducing the dose of long-acting insulin at night.

Dawn Phenomenon

  • Children with normal insulin doses, experiencing normal overnight glucose levels, sometimes present with early morning hyperglycemia due to a rise in counter-regulatory hormones.
  • Treatment: Increasing the dose of long-acting insulin at night.

Insulin Side Effects

  • Hypoglycemia.
  • Hypokalemia.
  • Weight gain.
  • Hypersensitivity reactions (anaphylaxis).
  • Injection site complications (lipodystrophy, redness, itching, infection).

Thyroid Hormone (Thyroxine - T4)

  • The thyroid hormone, primarily T4, controls the metabolic rate of all cells in the body.
  • Important for fetal and newborn growth and development, particularly affecting bones and the brain.
  • In adults, this hormone helps maintain brain function, food metabolism, and body temperature.

Levothyroxine

  • Synthetic form of T4.
  • Used as a replacement for T4 in deficiency syndromes, such as hypothyroidism.
  • A tetra-iodo-tyrosine derivative.

Levothyroxine Mechanism of Action

  • Acts in a similar manner to the naturally produced thyroid hormone.
  • T4 is converted to the active form, T3, in the liver and kidneys.
  • Levothyroxine simulates the action of natural thyroxine.

Levothyroxine Route of Administration

  • Oral (tablets, capsules, powder).
  • Intravenous (vial).

Levothyroxine Side Effects

  • Cardiovascular (palpitations).
  • Nervous system (nervousness, headache, insomnia).
  • Skin (sweating).
  • Endocrine (irregular hyperglycemia, hypo-cholesterolemia).
  • Gastrointestinal (nausea, vomiting, diarrhea).
  • Metabolic (weight loss, heat intolerance).

Steroids (Hydrocortisone & Prednisone)

  • Steroid hormones, produced by the adrenal cortex, regulate stress response, inflammation, and protein/carbohydrate metabolism.
  • Synthetic analogues of these hormones are also used clinically.

Steroid Mechanism of Action

  • Steroids primarily enter cells and bind to cytosolic receptors that transport them to the nucleus.
  • The steroid-receptor complex alters gene expression.
  • Tissue-specific responses are a result of the diverse protein regulators present in each tissue type, managing interactions between the hormone-receptor complex and specific response elements.

Steroid Routes of Administration

  • Parenteral (IV, IM, intra-articular).
  • Oral.
  • Inhalation.
  • Topical.
  • Rectal.

Steroid Indications

  • Arthritis and Systemic Lupus Erythematosus (SLE).
  • Inflammatory bowel disease (Crohn's disease, ulcerative colitis).
  • Blood disorders (Idiopathic Thrombocytopenic Purpura - ITP).
  • Asthma.
  • Adrenocortical insufficiency.
  • Nephrotic syndrome.
  • Acute childhood leukemia.
  • Post-transplant immunosuppression.

Steroid Side Effects

  • Osteoporosis.
  • Hypertension.
  • Psychosis, irritability.
  • Hyperglycemia.
  • Impaired wound healing.
  • Depressed immunity, higher susceptibility to infection.
  • Skin drying, thinning.

Dexamethasone & Methylprednisolone

  • Potent glucocorticoids with minimal mineralocorticoid activity.
  • Used for their potent anti-inflammatory properties by inhibiting phospholipase A2, decreasing inflammatory cytokines, and increasing capillary permeability.

Dexamethasone & Methylprednisolone Mechanism of Action

  • Act by blocking various inflammatory pathways, primarily by inhibiting the synthesis and activity of prostaglandins.

Dexamethasone & Methylprednisolone Indications

  • Respiratory issues (airway edema, croup, respiratory distress syndrome).
  • Adrenal cortical hyperfunction tests.
  • Immune thrombocytopenic purpura (ITP).
  • Central nervous system conditions (meningitis, cerebral edema with space-occupying lesions, spinal cord compression).
  • Inflammation in general

Dexamethasone & Methylprednisolone Routes of Administration

  • Oral (tablets, syrup).
  • Intravenous (IV).
  • Intramuscular (IM).

Dexamethasone & Methylprednisolone Side Effects

  • Hiccups.
  • Gastric upset.
  • Easy bruising.
  • Sleep disturbances.
  • Weight gain.

Methylprednisolone Mechanism of Action

  • A potent glucocorticoid with minimal mineralocorticoid activity.
  • Inhibits inflammatory cytokine cascades and T cell activation.
  • Decreases immune cell extravasation into the central nervous system.

Methylprednisolone Indications

  • Acute Asthma
  • Lupus nephritis
  • Acute exacerbation of multiple sclerosis (MS).
  • Autoimmune inflammatory disorders (e.g., juvenile idiopathic arthritis, inflammatory bowel disease (IBD), connective tissue disorders, systemic lupus erythematosus).

Methylprednisolone Routes of Administration

  • Oral tablets.
  • Intravenous (IV) injections.
  • Intramuscular (IM) injections.

Methylprednisolone Side Effects

  • Nausea and/or vomiting.
  • Heartburn.
  • Headache.
  • Sweating.
  • Acne.
  • Insomnia.

Furosemide (Lasix)

  • A loop diuretic.
  • Blocks sodium and chloride reabsorption, as well as increasing the excretion of water and electrolytes (sodium, chloride, potassium, magnesium, calcium, hydrogen).

Furosemide Indications

  • Hypertension.
  • Edema (acute pulmonary edema, congestive heart failure, hepatic cirrhosis complicated by ascites, nephrotic syndrome).
  • Hypercalcemia - increasing calcium excretion.
  • Hyperkalemia - increasing potassium excretion.
  • Acute renal failure.

Furosemide Routes of Administration

  • Oral tablets.
  • Intravenous (IV) injections.
  • Intramuscular (IM) injections.

Furosemide Side Effects

  • Increased urination, thirst, dehydration.
  • Electrolyte imbalances.
  • Diarrhea, nausea, vomiting, loss of appetite.
  • Rapid weight loss.
  • Fever, itching or rash - allergic reactions.
  • Ototoxicity.

Sildenafil (Revatio, Viagra)

  • A phosphodiesterase 5 inhibitor.
  • Enhances the effects of nitric oxide, leading to relaxation of smooth muscle in the corpus cavernosum.

Sildenafil Indications

  • Pulmonary arterial hypertension.
  • Erectile dysfunction.

Sildenafil Routes of Administration

  • Oral.
  • Injectable.

Sildenafil Side Effects

  • Headache.
  • Flushing.
  • Impaired vision.
  • Myocardial infarction (MI).
  • Ventricular arrhythmias.

Paracetamol (Acetaminophen)

  • Analgesic (mild to moderate pain relief) and antipyretic (fever reducer).
  • Primarily used for pain relief associated with headache, muscle ache, sore throat, back pain, toothache, and menstrual cramps.
  • Works by blocking the formation of prostaglandins in the central nervous system.

Paracetamol Routes of Administration

  • Oral (syrup, tablets, chewable tablets).
  • Rectal (suppositories).
  • Intramuscular (IM) injection.
  • Intravenous (IV) infusion.

Paracetamol Side Effects

  • Very safe, but overdoses can lead to potentially serious liver damage (hepatotoxicity).
  • Allergy (very rare).

Ibuprofen

  • Non-selective COX inhibitor.
  • Anti-inflammatory, analgesic (pain reliever), and antipyretic.

Ibuprofen Mechanism of Action

  • Inhibits the enzyme cyclooxygenase (COX), decreasing prostaglandin synthesis; primarily COX-1 and COX-2.

Ibuprofen Routes of Administration

  • Oral (tablets, syrup, capsules, chewable tablets).
  • Rectal suppositories.
  • Topical.
  • Intravenous (IV infusion).

Ibuprofen Side Effects

  • Constipation/diarrhea.
  • Potential kidney damage.
  • Stomach pain/bloating.
  • Dizziness.
  • Nervousness.
  • Ringing in the ears.

Diclofenac

  • Non-steroidal anti-inflammatory drug (NSAID); inhibits prostaglandin synthesis via COX-1 and COX-2 inhibition.

Diclofenac Indications

  • Pain relief.
  • Fever reduction.

Diclofenac Routes of Administration

  • Oral (tablets, solutions).
  • Injections.
  • Gels.

Diclofenac Side Effects

  • Stomach ache/gastric ulceration.
  • Elevated serum aminotransferase levels.
  • Renal impairment.
  • Fluid retention, leading to hypertension.

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