anti-inflamm

salicylates

Aspirin* - most effective/least safe

if peptic ulcers- MISOPROSTOL/ Mesalamine

Sodium- Salicylate

hypersent in middle-aged with asthma, nasal polyps, urticaria

neprophaphy 4th 5th decarde more in F,

cumulative amount is most impor not durance

REYES syndrome - (odd symptoms intitnally resp infection) NO ASPRIN WITH VIRAL INFECTION - CHILD

DONT TAKE ALCOHOL - gastic
WARAFIN - enhanced
no G6PD!

Propionic Acid Derivatives

COX-1 & 2

Ibuprofen*
Ketoprofen - LOX
Naproxen - stops PMN

Acetic Acid Derivatives

Diclofenac - o2 radicals
-TREAT eye inflam, LT RA, ALK Spondyl

Ketorolac - greatest analegeic agent
ADVERSE : LT - pep ulcer

Oxicams

Piroxicam* - COX 1, o2 radicals
-once a day, long t1/2
-MOST potent anti-inflam
...RH, AK, GOUT,

Meloxicam - COX -2 mainly

Indole Derivatives

Indomethacin* - COX 1, PLA2, STOP PMN, T & B

dont use as analgesic/antipyertic - TOXIC

Selective COX-2 Inhibitors

Celecoxib*

-time dept

-no plate aggreg affect

...few side affects for RH osteroarth
Low Gastic ulcer

Analgesic-Antipyretic Drugs

Acetaminophen - CENTRAL

no peripherial inhib of PG syn...GOOD FOR HEMOPHILAICS

diminish pain, indept from the cause w/o alterting the consciouness

TOXIC metabolite - NAPQI

POTENT FOR CNS COX INHIB

Good for Fever in pt that is deleterious/distressing

-250 mg children fatal

Acetylcystein admin - protects hepatotox for NAPQI

ALCOHOL Makes poisining worse..bc expresses CYP2E1 ..which makes more metabolite

Anti-Inflammatory Steroids (Glucocorticoids)

-sone

USES...

ENDOCRINE DISORDER
CAH - Feedback inhib ACTH

use - determine by tiral and error

synthetic better - due to na+ retaining

single dose OK, harmful LT

w/ cortisone...will have some adrenal supression post withdrawl

therapy = symptomatic not curative, except ADRENAL insuff

inhib HISTAMINE, IL-2 (leukocyte migration), PLA2, COX2. ALL INHIBITED

SIDE EFFECTS
-WT gain, glucose intol, retard wound healling, mood change,

NSAIDS

relief of pain for acute and chronic

inhibit COX enz...mostly reversible expect ASPRIN

inhibit PG & TX not LT, most block Cox 1 and 2

negligbile effects on proliferative phase of inflam (fibrotic repairing not affected)

no effect on specific immune response

glucocorticoids

power anti-inflam
not good LT

diffuse across CM
-inhibits early and late phases inflam

inhibits
1. PG and LT (PLA2),
2. post cap perm (inhib histamine/kinin)
3. inhib complement

STRONG CELLULAR IMMUNITY inhib

stimulates IgG catabolism

FLUDROCORTISON - HIGH Na rention

Bethamethasone/Dexamethasone - high Anti-inflam, duration

Dexameth - diff diag of Cushing syndrome, cortisol reduced if u have cush

NSAIDS - analgesic

inhibit PG syn at the perif actions

or central @ hypothalmic level

do not change nml body temp (reduce fever)
-cant stop fever with direct PG inject into hypoThal, uncoupling, heat stroke

fever

PGE1 & PGE2

broncodialation

PGE1,2
PEGI2

increased uterine contractillty

TXA2, PGF2a

TXA2

platelet aggreg

early phase of inflam

PGE2, PGI2, PGD2

protection against ulcers

PGE1, PGE2, PGI2

increaed Na/water clearance

PGE1, PGE2, PGI2

COX 1

Indomethacin, Piroxicam

cox 2

Celecoxib (exclusively), Meloxicam (mainly)

COX-1 and COX-2 Inhibitors

Ibuprofen, Naproxen, Diclofenac

cox2

anti-infamitory