Pain and inflammation management drugs

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created 6 months ago by Akosua_Ruby
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Pharmacology
Chapter 24
updated 6 months ago by Akosua_Ruby
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1

First generation NSAIDs

  • salicytates (aspirin)
  • para-chlorobenzoid acid derivatives
  • phenylacetic acids
  • propionic acid derivatives (ibuprofen)
  • fenamates
  • oxicams
2

selective COX-2 inhibitors (celecoxib)

  • second generation NSAIDs
  • drug of choice for severe arthritis
  • only COX-2 inhibitor
3

immune modulators (infliximab)

  • treating severe rheumatoid arthritis
  • immunomodulators disrupt inflammatory process and delay disease progression in severe RA
  • works by neutralizing the TNF that is a contributor to synovitis
4

uric acid biosynthesis inhibitors (allopurinol)

  • for treating gout
  • prophylactic for gout, chronic tophaceous gout
5

5 cardinal signs of inflammation are:

  • redness (erythema)
  • swelling
  • heat
  • pain
  • loss of function
6

cyclooxygenase (COX)

an enzyme responsible for converting arachidonic acid into prostaglandins

  • COX 1
  • COX 2
7

cox 1

  • protects stomach lining
  • decrease fever
  • promote platelet aggregation

aspirin is great for preventing blood clotting after an MI or stroke because it inhibits COX 1

8

what does first generation NSAIDs do to COX 1 and COX 2? why is that a problem

they inhibit COX 1 and COX 2. prevents blood clotting

  • risk for loss of protection of stomach lining
9

what was the first anti-inflammatory drug? what effects does it have on the GI?

aspirin. it has irritating GI effects.

  • GI bleeding
  • anorexia
  • dyspepsia
  • N/V
10

salicytates (ASA)

  • Derived from salicylic acid
  • prostaglandin inhibitor that decreases inflammatory process
  • can be used as an antiplatelet in cardiac/CVA patients
  • do NOT take with NSAIDs (decreases blood level and effectiveness of other drugs)
11

why is aspirin separate from NSAIDs?

  • it has different properties
  • high doses required, which leads to gastric distresss
12

enteric coding

goes around tablet that helps it to get down into the GI system before drug starts to break down

DO NOT CRUSH, CHEW, OR BREAK

13

Aspirin

  • MOA:
  • use
  • adverse effect
  • inhibition of prostaglandin synthesis, inhibition of hypothalamix heat-regulator
  • reduce pain/inflammation/fever; inhibit platelet aggregation;osteoarthritic, rheumatoid arthritis
  • tinnitus, GI bleed, agranulocytosis, hemolytic anemia, thrombocytopenia, hepatoxicity

SHOULD NOT BE GIVEN TO CHILDREN WITH FEVER

14

Reye's syndrome

  • linked to use of aspirin in children.
  • do not administer ASA to children who have presented with flu-like symptoms.
  • vomiting, lethargy, delirium, and coma
15

propionic acid derivative (ibuprofen and naproxen)

  • newer NSAID
  • stronger than ASA but less GI irritation
  • highly protein bound - increased risk for drug interactions
16

ibuprofen

  • MOA
  • use
  • adverse effects
  • inhibition of prostaglandin synthesis relieving pain and inflammation
  • to reduce inflammatory process; relieve pain; reduce fever; arthritic conditions
  • hearing loss, tinnitus, anemia, neutropenia, thrombocytopenia, nephrotoxicity, anaphylaxis
17

contraindications of ibuprofen

increase risk for reinfarction or death. increased risk for edema and fluid retention. NOT for patients who have had MI or CVA, because it doesn't have anticoagulant effect.

18

celecoxib

  • MOA
  • use
  • adverse effect
  • inhibits COX-2
  • osteoarthritis, rheumatoid arthritis, moderate to severe pain, ankylosing spondylithis
  • peripheal edema, bleeding, HTN, CVA
19

disease modifying antirheumatic drugs (DMARDS)

  • Used to control immunemediated arthritic pain
  • alleviates symptoms of RA
  • include immunosuppresants, immunomodulators, and antimalarials. effective in treating psoriasis
20

infliximab

  • MOA
  • use
  • adverse reactions
  • binds to TNF and blocks it from attaching to TNF on synovial cell surfaces; reduced infiltration of inflammatory cells and delays inflammatory process
  • RA, psoriatic arthritis, spondylitis, ulcerative colitis, crohn disease, psoriasis
  • severe infections, blood pressure fluctuation, seizures, elevated liver enzymes. steven-johnson syndrome, anemia
  • contraindications: heart failure
21

allopurinol

  • MOA
  • use
  • adverse reaction
  • inhibits final step of uric acid biosynthesis and therefore lowers serum uric acid levels
  • prophylactic for gout, chronic tophaceous gout
  • hepatic impairment, angioedema, hyperglycemia, hyperlipidemia