Ma'am jolina

• Analgesic


  Pain reliever
• Leukotrienes


  Involved in allergic reaction, receptor and asthma
• PGI2


  Vasodilation (dilate blood vessels), broncho dilation effect, inhibits platelet aggregation
• Prostaglandin (PGE2 & PGF2)


  Vasodilation, broncho dilation, inhibits platelet aggregation, cytoprotection (protect production of mucus, uterine contractions), lowers intraocular pressure
• Thromboxane A2 or TXA2


  Vasoconstriction (constrict blood vessels), promotes platelet aggregation
• LTD4 & C4


  Anaphylaxis (allergic reaction that is life threatening)
• COX inhibitors


  Drugs that inhibit the COX enzyme
• If there is a prostaglandin there is inflammation
• COX


  Cyclooxygenase enzyme
• NSAIDs


  Non-steroidal anti-inflammatory drugs that inhibit COX
• COX 1


  Produces prostaglandins that play roles in maintenance activities and cytoprotection, keep the blood vessel open
• COX 2


  Involved in pain, increased risk of stroke or heart attack, induce inflammatory cells in setting of inflammation, production of prostaglandin that sustain the inflammatory process
• Non-selective COX inhibitors increase the risk of bleeding due to ability to block COX 1, which can lead to gastrointestinal COX 1 bleeding</b>
• Non-selective COX inhibitors inhibit COX 1 and thus inhibit cytoprotection
• ASA


  Acetylsalicylic acid, ester type
• Aspilet


  Unhydrolyzed form of aspirin
• 4A's of Aspirin


  • Anti-inflammatory
  • Analgesic
  • Antipyretic (anti-fever, 0.3g - 25g/day)
  • Anti-platelet (doses not more than 325 milligrams)
• Mechanism of Action of Aspirin

  Inhibit prostaglandin
• All NSAIDs are weak acids
• Adverse effects of Aspirin

  • Hyperacidity (need to take NSAIDs on a full stomach)
  • Erosive gastritis
  • May lead to bleeding or ulceration
• NSAIDs and Salicylates can cause black stool
• NSAIDs can cause bronchospasm by constricting the bronchioles
• NSAIDs are not the same as Aspirin, NSAIDs are prescription drugs
• Chronic Salicylate Toxicity


  High Toxic Levels or Little Toxic Levels (can lead to renal failure)
• RA


  Rheumatoid arthritis
• Naprosyn test


  Test to see if fever is due to cancer
• Propionic acid derivatives


  Can cause nephrotoxicity and gastrointestinal irritation
• Acetic acid derivatives


  Inhibit COX 1 more than COX 2
• Indomethacin


  Can cause Barrett's syndrome (renal condition causing metabolic alkalosis), acute gouty arthritis
• Fenamates


  Can only be used for 5 days, more than 5 days can lead to nephrotoxicity
• 3A's of Diclofenac


  • Analgesic
  • Anti-Inflammatory
  • Antireptic
• Ketorolac


  Cannot be given for more than 5 days, can cause nephrotoxicity
• Acetaminophen (Paracetamol)


  Acetyl paraaminophenol
• Hepatoxicity & Doses of Acetaminophen

  Toxic at >150mg/kg body weight, safe at <6 capsules/tablets in a day, <650mg, <4g/day
• 3A's of Diflunisal


  • Analgesic
  • Anti-inflammatory
  • Antidiuretic
• Selective/Specific COX 2 inhibitors

  Drugs with 'coxib' at the end, no inhibition of platelet aggregation, black box warning as they may increase the rate of acute thrombotic events
• DMARDs


  Disease modifying antirheumatic drugs, used for rheumatologic diseases, 7.5 to 25mg/week per oral
• Thymidylate


  Increases thymidine, increases inflammation
• Methotrexate


  Inhibits the thymidylate synthase and amino imidazole carboxamide, given IV/IM, major side effect is gastrointestinal upset and oral ulceration (remedied by folic acid, folinic acid for 6 months)
• First line DMARD agents

  • Sulfasalazine or lecoborin (adverse effects: SJS, methotrexate, hydroxychloroquine (cardiotoxicity, anti-malarial compound))