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Questions and Answers

What is the primary pharmacological action of NSAIDs?

  • Antipyretic (correct)
  • Hormonal
  • Antibiotic
  • Antiviral
  • How do NSAIDs achieve their analgesic effect?

  • By enhancing nociceptor sensitivity
  • By inhibiting COX-1 only
  • By reducing serotonin levels
  • By blocking prostaglandin synthesis (correct)
  • In what clinical scenarios are NSAIDs particularly effective?

  • Chronic respiratory diseases
  • Major psychiatric disorders
  • Inflammatory conditions and mild to moderate pain (correct)
  • Severe infections
  • Which of the following actions do prostaglandins NOT mediate?

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

    Which COX enzyme is primarily inhibited by NSAIDs to reduce inflammation?

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

    What is the primary mechanism of action for non-opioid analgesics?

    <p>Inhibition of cyclooxygenase (COX) enzymes</p> Signup and view all the answers

    Which type of COX enzyme is primarily associated with pain and fever regulation?

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

    Which physiological function is NOT associated with COX-1?

    <p>Mediating inflammation</p> Signup and view all the answers

    What effect does the inducible COX enzyme have in the inflammatory response?

    <p>Mediates inflammation and pain</p> Signup and view all the answers

    Why are non-opioid analgesics favored over opioids in some cases?

    <p>They have a lower risk of addiction</p> Signup and view all the answers

    Study Notes

    Non-Opioid Analgesics

    • Non-opioid analgesics, particularly NSAIDs, are frequently used for pain, inflammation, and fever.
    • Their primary mechanism involves inhibiting COX enzymes, which are essential for converting arachidonic acid into prostaglandins, thromboxanes, and leukotrienes.
    • NSAIDs do not carry the risk of addiction or respiratory depression associated with opioid analgesics.

    COX Enzymes

    • There are two main types of COX enzymes: COX-1 and COX-2.
    • COX-1 is constitutively expressed throughout various tissues, including the stomach, kidneys, and platelets.
    • COX-2 is mainly expressed in the central nervous system, and its expression is upregulated in response to inflammation.
    • COX-1 plays important physiological roles, such as protecting the stomach, promoting platelet aggregation for blood clotting, and maintaining renal function.
    • COX-2 is primarily involved in mediating inflammation, pain, and fever.
    • There is a variant of COX-1, mainly expressed in the central nervous system, which is believed to be a potential target for analgesic and antipyretic drugs like acetaminophen.

    Pharmacological Actions of NSAIDs

    • NSAIDs exhibit anti-inflammatory, analgesic, and antipyretic effects.
    • These effects stem from their inhibition of prostaglandin synthesis.

    Anti-Inflammatory Action

    • Pro-inflammatory prostaglandins are produced by COX-2, leading to vasodilation, edema, and pain.
    • NSAIDs inhibit COX-2, reducing pro-inflammatory prostaglandin production, thus decreasing inflammation and pain.

    Analgesic Effect

    • Prostaglandins sensitize peripheral nociceptors to painful stimuli, enhancing pain perception.
    • NSAIDs decrease nociceptor sensitivity by reducing peripheral prostaglandin synthesis.
    • They also block prostaglandin synthesis in the spinal cord, reducing pain transmission from peripheral nerves to the central nervous system.

    Antipyretic Effect

    • Fever results from pyrogens stimulating IL-1 release by activated immune cells during infections or inflammation.
    • IL-1 stimulates PGE2 production, raising the body temperature set point.
    • NSAIDs inhibit COX enzymes in the hypothalamus, reducing PGE2 synthesis, lowering the hypothalamic set point, and reducing fever.

    Gastrointestinal (GI) Effects

    • COX-1-derived prostaglandins protect the gastric mucosa by stimulating mucus and bicarbonate secretion, and reducing gastric acid production.
    • NSAID inhibition of COX-1 can lead to:
      • Reduced protective effects
      • Increased gastric acid secretion
      • Reduced mucus production
      • Increased risk of gastric ulcers.

    Renal Effects

    • Prostaglandins maintain renal blood flow and glomerular filtration.
    • NSAIDs can reduce prostaglandin-mediated vasodilation, potentially decreasing renal blood flow and glomerular filtration.
    • This can lead to acute kidney injury in susceptible patients.

    Bronchial Effects

    • COX-1 inhibition can increase leukotriene production, causing bronchoconstriction in susceptible individuals.
    • NSAIDs can exacerbate bronchial constriction in patients with asthma or known NSAID sensitivity.

    Hematological Effects

    • NSAIDs can inhibit COX-1, reducing the production of TXA2, leading to decreased platelet aggregation and an increased risk of bleeding.
    • NSAID use should be managed carefully, especially in settings where bleeding is a concern.

    General Adverse Effects

    • NSAID use can lead to:
      • Gastrointestinal issues: Dyspepsia, nausea, vomiting, ulcers, and GI bleeding.
      • Cardiovascular effects: Fluid retention, hypertension, increased risk of cardiovascular events (including myocardial infarction and stroke).
      • Renal effects: Impairment of renal function, leading to conditions like acute kidney injury, hyperkalemia, and proteinuria.
      • Hepatic effects: Hepatotoxicity (rare but possible with prolonged use).
      • Hematologic effects: Risk of bleeding, thrombocytopenia, neutropenia, and aplastic anemia.
      • Respiratory effects: Trigger asthma in sensitive individuals, especially those with aspirin-exacerbated respiratory disease (AERD).
      • Dermatologic effects: Skin reactions, including rashes and pruritus.

    Contraindications

    • NSAIDs should be avoided or used cautiously in patients with:
      • Peptic Ulcer Disease: Increased risk of GI bleeding and ulceration.
      • History of GI Bleeding: Especially with non-selective NSAIDs, which increase the risk of GI hemorrhage.
      • Cardiovascular Disease: Increased risk of cardiovascular events, particularly with COX-2 inhibitors.
      • Chronic Kidney Disease (CKD): NSAIDs can worsen renal function.
      • Liver Disease: Potential for hepatotoxicity.

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