31. Anti-inflammatory drugs
1.) A 36-year-old man reports to his primary care physician complaining of pain, bruising, swelling, and tenderness in his left shoulder after flipping over the handlebars of his bike while out riding the day before. Imaging studies are negative for the presence of any fractures. The physician injects the patient with an anti-inflammatory drug that functions by altering the gene expression of pro-inflammatory cells. The physician also prescribes an oral anti-inflammatory drug that competitively inhibits both COX-1 and COX-2-mediated prostaglandin production. What two drugs was the patient given? (Injected drug 1st; oral drug 2nd) A) Prednisone; celecoxib B) Aspirin; prednisolone C) Hydrocortisone; dexamethasone D) Naproxen; indomethacin E) Ketorolac; diclofenac F) Triamcinolone; ibuprofen
1) F is the correct answer. Triamcinolone is a glucocorticoid and the mechanism of action of this class of drugs is the regulation of gene expression of its target cells. Ibuprofen is an NSAID that competitively inhibits both COX-1 and COX-2. A is incorrect because celecoxib is specific for COX-2 only
10) A 6-year-old girl is rushed to the emergency department after ingesting over 10 tablets of one of her parent's over-the-counter medications. The attending physician orders the immediate administration of activated charcoal and N-acetylcysteine. Which of the following drugs did the patient most likely overdose on? A) Aspirin B) Ketorolac C) Acetaminophen D) Piroxicam E) Cortisone F) Dexamethasone
10) C is the correct answer. Administration of activated charcoal and NAC are the primary therapeutic strategies for the treatment of acetaminophen poising.
11) Three female patients of the same age are administered various doses of dexamethasone followed by measurement of their serum cortisol levels. The results are presented here: effect of low dose Dexamethasone on Cortisol serum level, Effect of high dose Dexamethasone onCortisol serum level, pt 1: Decreased Decreased pt 2: Unchanged Unchanged pt 3: Unchanged Decreased Based on these results, what would be the most likely diagnosis for each patient? A) 1—Ectopic ACTH-producing small cell lung cancer; 2—Healthy; 3—Neuroblastoma (arising in adrenal medulla) B) 1—Healthy; 2—Adrenocortical carcinoma; 3—Pituitary adenoma C) 1—Pheochromocytoma; 2—Adrenocortical carcinoma; 3—Healthy D) 1—Healthy; 2—Pituitary adenoma; 3—Ectopic ACTH-producing medullary thyroid carcinoma E) 1—Adrenocortical carcinoma; 2—Neuroblastoma (arising in adrenal medulla); 3—Healthy
11) B is the correct answer. Patient 1 is healthy, so administration of any dose of dexamethasone causes a drop in the production of endogenous cortisol. Patient 2 is suffering with Cushing syndrome caused by a cortisol-producing adrenal tumor. Thus, the endogenous production of cortisol shows no decrease even in the presence of high-dose dexamethasone. Patient 3 is suffering with Cushing disease caused by an ACTH-producing pituitary adenoma. Thus, when the patient is treated with high-dose dexamethasone this is sufficient to reinitiate the negative feedback loop to prevent further ACTH production, leading to a decrease in endogenous cortisol production. Low-dose dexamethasone is not sufficient to reinitiate this feedback mechanism.
12) A 37-year-old woman is scheduled to have an impacted wisdom tooth removed. On the day of the surgery, the patient tells the dentist that she has been taking an analgesic agent for the past 3 days to relieve the pain resulting from a recent sprained ankle. The dentist promptly reschedules the surgery 8 days later and tells the patient to stop taking that particular agent. Which drug was the patient most likely taking? A) Ibuprofen B) Acetaminophen C) Piroxicam D) Aspirin E) Naproxen
12) D is the correct answer. Aspirin is an irreversible inhibitor of the COX enzymes. When this inhibition occurs within a particular platelet that platelet's primary physiological activity (coagulation) is permanently lost because platelets are unable to synthesize new COX enzymes. Thus, this patient is at risk of serious bleeding if she undergoes any type of surgical procedure for several days after taking an antiplatelet dose of aspirin.
13) A 5-year-old girl suffering with the flu is prescribed an oral antipyretic agent. This drug undergoes metabolism into the toxic metabolite N-acetyl-p-benzoquinone, which is inactivated in the liver through the action of glutathione. Which of the following drugs was the patient prescribed? A) Acetaminophen B) Aspirin C) Naproxen D) Methylprednisolone E) Ibuprofen F) Betamethasone
13) A is the correct answer. Acetaminophen, ibuprofen, and naproxen are safe to use as an antipyretic agent in children suffering with viral infections. Only acetaminophen, however, is metabolized into NAPQI.
14) A 34-year-old woman recently diagnosed with Addison disease is started on supplementation therapy with an intermediate-acting glucocorticoid that is administered as a prodrug. Which of the following drugs was prescribed to the patient? A) Prednisolone B) Prednisone C) Methylprednisolone D) Dexamethasone E) Triamcinolone F) Hydrocortisone
14) B is the correct answer. Prednisone is a prodrug that must be converted in the body to the active form, which is prednisolone.
15) A 62-year-old woman dies shortly after arriving at the emergency department. History reveals that the patient suffered from a variety of inflammatory and autoimmune-related disorders for which she had been undergoing long term pharmacological therapy. The patient's adult daughter reveals that her mother was visiting her from out-of-town and had apparently forgot to pack all of her medication. The patient's untimely death more than likely resulted from failure to take which of the following drugs? A) Celecoxib B) Aspirin C) Piroxicam D) Betamethasone E) Indomethacin F) Ketorolac
15) D is the correct answer. Abrupt withdrawal of long-term glucocorticoid therapy has the potential to cause patients to suffer potentially fatal adrenal insufficiency, as was the case with this patient.
16) A 67-year-old woman is brought to the emergency department in a mentally confused state. The patient displays a respiratory rate of 32/min, profuse sweating, and intermittent vomiting. Her daughter tells the attending physician that her mother was complaining about dizziness and ringing ears earlier that day. The patient's history reveals that she has been heavily selfmedicating for the past several days with an over-the-counter analgesic (which she has used for years) in order to reduce the pain associated with her rheumatoid arthritis. Which of the following drug adverse effects is the woman most likely suffering from? A) Salicylate-related GI toxicity B) Reye Syndrome C) Analgesic Nephropathy D) Salicylism E) Salicylate Hypersensitivity
16) D is the correct answer. The patient is suffering from salicylism or mild salicylate intoxication. Her signs and symptoms are consistent with this diagnosis, particularly the hyperventilation, which results from salicylate-mediated stimulation of the medullary respiratory center. If this had been serious salicylate intoxication the patient would most likely present with respiratory depression.
17) A 23-year-old man undergoes corneal refractive surgery. Following the procedure, the man is prescribed an ophthalmic preparation of an anti-inflammatory drug to help prevent postoperative pain and inflammation. Which of the following drugs was the patient most likely prescribed? A) Acetaminophen B) Indomethacin C) Triamcinolone D) Diclofenac E) Naproxen
17) D is the correct answer. Ophthalmically administered diclofenac is indicated for this clinical purpose.
18) A 55-year-old man with a history of nephrogenic diabetes insipidus is prescribed an oral drug that helps to manage this condition by reducing solute delivery to distal tubules and reducing urine volume. What is the mechanism of action of the drug that was most likely prescribed to this patient? A) Competitive inhibition of COX-1 and COX-2 B) Transcriptional regulation of gene expression C) Translational regulation of gene expression D) Irreversible inhibition of COX-1 and COX-2 E) Competitive inhibition of COX-2 only
18) A is the correct answer. Indomethacin is the primary anti-inflammatory drug utilized for this condition for the reasons stated in the question stem (also ibuprofen). Indomethacin functions as a nonselective COX competitive inhibitor.
19) A group of laboratory animals are all administered the same experimental agent, and it displays the following characteristics: Competitive inhibition of COX-1 and COX-2 centrally Possesses analgesic action Possesses antipyretic action No anti-inflammatory action No anticoagulation action Does not induce gastric bleeding Undergoes significant hepatic metabolism Which of the following drugs does this experimental agent most resemble? A) Indomethacin B) Cortisone C) Methylprednisolone D) Acetaminophen E) Piroxicam F) Aspirin
19) D is the correct answer. Acetaminophen displays all of the listed characteristics, primarily because it only inhibits COX enzymes in the CNS, not in the periphery.
2) A 34-year-old woman is diagnosed with Cushing disease caused by a pituitary adenoma following a diagnostic procedure that utilized a pharmacological agent. To which of the following drug classes does the diagnostic agent mostly likely belong? A) Short-acting glucocorticoids B) Intermediate-acting glucocorticoids C) Long-acting glucocorticoids D) Salicylates E) Propionic acid derivatives F) Oxicams G) Coxibs
2) C is the correct answer. Dexamethasone is utilized for the deferential diagnosis of noniatrogenic Cushing syndrome in a diagnostic procedure called the dexamethasone suppression test. Dexamethasone is classified as a long-acting glucocorticoid.
20) A 34-year-old pregnant woman in danger of giving premature birth is started on intramuscular injections of a drug to help prevent neonatal respiratory distress syndrome? Which of the following drugs is most likely being administered to this patient? A) Prednisone B) Dexamethasone C) Celecoxib D) Naproxen E) Prednisolone F) Diclofenac
20) B is the correct answer. Glucocorticoids stimulate surfactant production in the fetus, but only betamethasone and dexamethasone are currently indicated for this clinical use (why A and E are wrong).
3) A 3-day-old boy born prematurely is diagnosed with a patent ductus arteriosus and is immediately administered a drug intravenously (IV). Following three days of single injection IV therapy the ductus arteriosus is found to have closed. Which of the following drugs was most likely administered to this patient? A) Hydrocortisone B) Triamcinolone C) Naproxen D) Piroxicam E) Methylprednisolone F) Ibuprofen
3) F is the correct answer. Ibuprofen is the only drug in this list indicated for the therapy of a patent ductus arteriosus, though the other NSAIDs can accomplish this clinical goal as well
Indole derivative - Indomethacin: caution?
3rd trimester admin --> preemie closure of patent ductus arteriosus
4) A 46-year-old man suffering with rheumatoid arthritis (RA) is prescribed celecoxib. Celecoxib is effective at helping to relieve many of the patient's RA-associated symptoms. What is most likely the primary mechanism of action by which celecoxib exerts most of its therapeutic effects in this patient's condition? A) Inhibition of COX-1 in inflamed peripheral tissues B) Inhibition of COX-2 in inflamed peripheral tissues C) Inhibition of COX-1 and COX-2 in inflamed peripheral tissues D) Inhibition of COX-2 expression in inflamed peripheral tissues E) Inhibition of COX-2 in the central nervous system F) Inhibition of COX-1 in the central nervous system
4) B is the correct answer. Celecoxib is highly selective for COX-2 and the primary mechanism of action behind the analgesic and anti-inflammatory effects of the NSAIDs is their peripheral action on the COX enzymes
5) A 52-year-old woman who has been taking glucocorticoids (GCs) for the past 15 years is having these agents removed from her drug regimen. Which of the following statements correctly identifies a guideline that should be followed by her physician during this undertaking? A) Upon stoppage, patient should be considered to have pituitary-adrenal suppression for only 3 months B) GCs should be removed from her drug regimen slowly C) Upon stoppage, GCs should not be administered to this patient during stressful or traumatic events D) Upon stoppage, a single large dose of a GC will most likely be harmful to this patient E) GCs can be abruptly removed from her drug regimen
5) B is the correct answer. Patients on long-term glucocorticoid therapy should never have these drugs abruptly removed from their therapeutic regimen as it can precipitate potentially fatal adrenal insufficiency. All of the other answer choices are wrong because they are the exact opposite of what should be done in terms of glucocorticoid use
6) A 7-year-old boy with influenza received an antipyretic drug for 4 days. On the fifth day he lapsed into a coma and died. The autopsy disclosed a diffuse microvesicular fatty infiltration of the liver, heart, and kidneys, and cerebral edema. Which of the following drugs was most likely administered to this child? A) Acetaminophen B) Prednisolone C) Ibuprofen D) Aspirin E) Naproxen F) Methylprednisolone
6) D is the correct answer. The results of the autopsy and the history of the patient suggest that the cause of death was Reye syndrome. The syndrome consists of an acute encephalopathy with fatty degeneration of the viscera. It is usually seen in children and lethality is estimated to be about 20%. The cause of the syndrome is unknown, but risk factors involve viral infection and use of salicylates, like in the present case. The prevalence of Reye syndrome is very low, but the use of salicylates during a viral illness increases risk for developing the syndrome by as much as 35-fold.
7) A 48-year-old man reports to his family practitioner complaining of recurring pain in the upper lumbar region of his back that has been occurring for the past month. He also reports that during that time his urine has appeared brownish in color on several occasions. The patient's previous medical history reveals that he was diagnosed with rheumatoid arthritis at the age of 46, for which he has been self-medicating with different combinations of NSAIDs. A urinalysis reveals hematuria and a urine osmolality of 285 mOsmol/kg (average = 500-800). Which of the following drug adverse effects is the man most likely suffering from? A) Duodenal ulcer B) Acetaminophen poisoning C) Iatrogenic Cushing syndrome D) Reye syndrome E) Analgesic nephropathy F) Salicylism
7) E is the correct answer.0 The patient is displaying the signs and symptoms of analgesic nephropathy (back pain, hematuria, and decreased concentrating capacity of the kidneys). He falls within the age range at which this disorder is most predominate and he has been taking combinations of analgesic drugs for several months, conditions which precipitate the emergence of this disorder.
Glucocorticoids: Should not withdraw abruptly.. why?
--> adrenal insufficiency
NSAIDS: MOA?
-reversible competitive inhibition of COX (inh. PG synthesis, not LT synthesis) -Inh IL-1, TNF-alpha, ROS and NF-kB
8) A 25-year-old woman suffering with an inflammatory disorder is started on therapy with methylprednisolone and it provides significant amelioration of her symptoms. Which of the following most likely describes a pharmacological action of methylprednisolone that contributes to its therapeutic effect in this patient's inflammatory disorder? A) Inhibits infiltration of leukocytes into affected tissues B) Stimulates prostaglandin synthesis in affected tissues C) Stimulates anabolic processes in affected tissues D) Inhibits catabolic processes in affected tissues E) Promotes fat redistribution in affected tissues F) Competitively inhibits COX-2-mediated synthesis of prostaglandins in affected tissues
8) A is the correct answer. Glucocorticoids function by regulating the gene expression of virtually every cell of the body, particularly cells of the immune system, resulting in the alteration of their physiological actions. This action of the glucocorticoids ultimately results in a decrease in prostaglandin production (why B is wrong) and an increase in catabolic processes (why C and D are wrong). Glucocorticoids interfere with the expression of COX-2, but do not function as direct inhibitors of this enzyme (why F is wrong). Glucocorticoids do cause fat redistribution, but this is one of their adverse effects and does not account for their therapeutic effectiveness (why E is wrong)
9) A 36-year-old woman complains of excessive drowsiness and recurrent nausea and vomiting. The woman is in the hospital recovering from major surgery and is being administered intravenous morphine for pain. Her physician orders a 50% reduction in the amount of morphine she is receiving and adds another analgesic agent to her regimen that successfully compensates for this reduction and manages her post-surgical pain. Which of the following drugs was most likely administered to this patient? A) Acetaminophen B) Prednisone C) Naproxen D) Piroxicam E) Triamcinolone F) Ketorolac
9) F is the correct answer. Ketorolac is primarily utilized for its analgesic properties and is so effective in this regard in certain situations that it can dramatically reduce the necessity for opioid analgesics.
Name ONE Salicylate:
ASPIRIN
Propionic Acid Derivatives - Ibuprofen: Warning?
BLACK BOX WARNING potential cardiovascular and GI risks
Propionic Acid Derivatives - Naproxen: warning?
BLACK BOX WARNING potential cardiovascular and GI risks
Coxibs: Name 1
Celecoxib
Glucocorticoids: Clinical uses?
Chronic adrenal insufficiency (Addison's) ACUTE --> only exception for chronic use of GCs Congenital adrenal hyperplasia Cushing's syndrome (post-op) Aldosteronism Neonatal resp distress-->Stimulation of fetal lung maturation allergix rxns collagen-vascular disorders heme d/o systemic inflammation thyroid disease nephrotis syndrome nurologic pulmonary organ transplants skin dz immunosuppressant
Acetic Acid Derivatives - Diclofenac: MOA?
DI --> 2 (inhibits both) COX (nonselective) LOX (low level) dec. ROS production
Acetic Acid Derivatives: Name 2?
Diclofenac Ketorolac
Glucocorticoids: AE?
Face (round, puffy, fat depot,plethora, increase hair) buffalo hump increased appetite protein catabolism weight gain visceral fat depot thinning skin hyperglycamic -->diabetes osteoporosis aseptic necrosis of hip impaired wound healing, insomnia behavioral changes psychosis peptic ulcers pancreatitis
Indole Derivative - Indomethacin: uses?
Gout gingivitis ankylosing spondylitis (IV) closure of patent ductus arteriosus 9 analgesia (post-laminectomy syndrome) diabetes insipidus
Salicylates - Sulfasalazine: clinical use
IBD - inflammatory bowel dz Crohn's ulcerative colitis
Propionic Acid Derivatives: Name 2!
Ibuprofen Naproxen
NSAIDS: analgesic function?
Inh PG-induced sensitization of peripheral pain receptors --> relief from inflammation, surg, toothache, head ache, NO visceral relief
Glucocorticoids: Pharmacological effects?
Metabolic: inc glucose in serum, inc muscle catabolism, inc lipogenesis, dec lipolysis, net fat deposition, antiinflammatory and immunosuppresive: inc circulating neutrophils, dec circulating lymphocytes eosinophils monocytes and basophils, inh macrophages, dec TNF-alpha and IL-1, reduces PG LT and PAF synthesis, dec mast cell degranulation, dec vascular permeability,
Acetaminophen: hepatic toxicity Tx?
NAC (N-acetylcysteine) precursor to glutathione, replenishes glutathione stores & conjugates directly with NAPQI. admin <8hrs prior max effect
Glucocorticoids: Betamethasone uses
Neonatal resp distress psoriasis
Oxicams: Name 1
Piroxicam
Salicylates - Aspirin: adverse effects?
Reye;s syndrome in children Hypersensitivity reactions
Propionic Acid Derivatives - Naproxen: Safe to use when?
SAFE antipyretic and analgesic agen in children with viral illness
NSAIDS: Name the categories of NSAIDS
Salicylates Acetic acid derivative Indole derivatives Oxicams Coxibs
Acetaminophen: hepatic toxicity? explain.
acetaminophen --> NAPQI (toxic) excess NAPQI reacts with sulfhydryl groups on glutathione. Depletes glutathionine. Then NAPQI reacts with hepatic proteins--> liver failure --> liver centrilobular necrosis
Acetaminophen: poisoning in adults? in children?
adults - after a single dose 10-15g children - 250mg/kg --> fatal
Acetaminophen: hepatic toxicity exasterbated by alcohol. why?
alcohol induces CYP2E1 enzyme synthesis, which converts acetaminophen --> NAPQI (toxic)
Acetaminophen: uses?
analgesic antipyretic inh platelet aggreation gastric erosion decreased Na and water clearance
Acetic Acid Derivative - Ketorolac: uses?
analgesic - mild to severe pain, used with opiods decreases opioid requirement by 25-50% post-op ocular surgery
Salicylates: kidney nephopathy?
analgesic nephropathy (40-50 y/o women)
Salicylates: clinical uses?
antipyresis analgesia inflammatory diseases thromboembolic disease prophylaxis
Salicylates: function in CNS?
antipyretic (fever reducer) depression of Hypothalamus stimulator of chemoreceptors stimulator of CNVIII (-->tinnitus)
Salicylates - Sulfasalazine: adverse effects?
arthralgias, myalgias, BM supppression, malaise IMPAIRMENT OF FOLATE ABSORPTION
Propionic Acid Derivatives - Ibuprofen: AE?
aseptic meningitis fluid retention agranulocytosis aplastic anemia
Glucocorticoids: long acting
betamethasone (tx. psoriasis) dexamethasone (test to dx Cushing's, normal --> dec. cortisol sec)
Glucocorticoids: MOA?
binds intracellular receptor forming GC-GCR homodimer, which acts on GRE (glucocorticoid response element) to regulate gene transcription. GC-mediated expression of PLA2 inhibitory proteins--> loss of PLA2 activity activity GC-mediated reduction of COX2 expression--> arachidonic acid mobilization
Salicylates: GI toxicity?
castric distress bleeding ulcers (coated tablets)
Propionic Acid Derivatives - Ibuprofen: clinical uses?
closure of Patent Ductus arteriosus (IV) antipyresis (adults) dysmenorrhea osteoarthritis, rheumatoid arthritis post-surgical dental pain
Glucocorticoids: Short-medium acting
cortisone hydrocortisone
Salicylates: Function in hematopoietic system?
decreased platelet aggregation + sideropenia hypoprothrombinemia if toxic doses
Salicylates - Aspirin: clinical use?
decreased platelet aggregation 7-8 days thromboembolitic disease prophylaxis
Salicylates: function in RESP at toxic doses?
depresses Medulla resp center
Coxibs - Celecoxib: AE?
does not affect platelet aggregation (normal dose) fewer ulcers than other NSAIDs BLACK BOX - CV & GI risk
Salicylates: AE/toxicity?
dyspepsia heartburn N/D fecal blood loss
Salicylates: Function in GI?
erosive gastritis (irritation of gastric mucosa, increased concentration of salicylate,prolonged gastric emtying time) (increased gastric secretion, decreased bicarb secretion from inhibition of PG synthesis)
Salicylates: contraindications/precautions
gastritis, ulcers, alcohol, GI bleed, coagulation disorders, G6PDH deficiency,
Acetaminophen: is preferred to aspirin in patients with Hx of?
hemophilia peptic ulcer bronchospasm CHILDREN WITH VIRAL INFECTION ANTIPYRESIS IN CHILDREN, TEENS
Salicylates: distribution?
in all body tissues
Salicylates: Toxicity in pregos?
increased abortion, mortality, prolonged gestation, prolonged labor, pre and postpartum hemorrhage, hemostatic abnormalities in the newborn
Acetic Acid Derivatives - Diclofenac: AE?
induction upper GI ulceration reduced if taken WITH MISOPROSTOL impaired renal flow and GFR
NSAIDS: anti-inflammatory function?
inhibition of PGs and TXAs, plasmin, neutrophils, MO, mast NO SIGNIFICANT EFFECT ON SPECIFIC IMMUNE RESPONSE
Salicylates: Function in kidney?
inhibitor of uric acid excretion decreased GFR (bad for CHF, hypovolemia, renal dz pts)
Salicylates - Aspirin: MOA?
irreversible COX-1 and COX-2 inhibitor increased formation of Leukotrienes from LOX pathway
Salicylates: excretion?
kidneys
Glucocorticoids: Intermediate acting?
methylprednisone prednisolone prednisone -admin as a pro-drug (converted to active prednisolone) Triamcinolone
Acetaminophen: toxicity?
mild increase in hepatic enzymes disorientation hemolytic anemia
Glucocorticoids: AE? late effects?
myopathies weight loss depression inc intraocular pressure + cataracts renal/liver dz heart failure adrenal suppression growth retardation in children skin problems (Topical administration)
Glucocorticoids: Dexamethasone uses
neonatal resp distress Dexamethasone suppresion test for diff dx non-iatrogenic Cushings Normal-->dec. cortisol secretion Cushings Syndrome --> NO change at dec. doses + dec cortisol at high doses Tumor (Cushings disease) --> no suppression of cortisol
Oxicam - Piroxicam: MAO?
nonselective COX inh. Inh. PMN leukocyte migration decreases ROS production Inh lymphocyte function (high doses)
Indole Derivative - Indomethacin: MOA?
nonselective COX, Phospholipase A and C, inh decreases neutrophil migration, B+Tcell proliferation,
Oxicam - Piroxicam: ROA?
oral
Salicylates: Route of administration?
oral rectal parenteral
Acetaminophen: ROA?
oral rectal absorption = gastric emptying
Acetic Acid Derivative - Ketorolac: ROA?
oral, IV, IM, nasal opthalmic
Propionic Acid Derivatives - Naproxen: single enantiomer. ROA?
oral, topical, opthalmic
Propionic Acid Derivatives - Ibuprofen: ROA?
oral, topical, parenteral administration extensively metabolized
Oxicam - Piroxicam: AE?
peptic ulcer GI bleed
Acetaminophen: MOA?
potent inh. COX enzymes in CNS --> analgesia weak COX inh of inflammation
Salicylates - Aspirin: absolute contraindication?
pregnancy
Salicylates - Sulfasalazine: not contraindicated in?
pregnancy (ok)
Acetic Acid Derivative - Ketorolac: AE?
qrenal toxicity liver toxicity
Salicylates: metabolism?
rapid metabolism in blood and liver
NSAIDS: antipyretic action?
reduces fever by blocking PGs on thermoreg ctr og HT DOES NOT reduce hyperthermia
Glucocorticoids: All: IM administered GCs?
results in idiopathic thrombocytopenic purpura (this route of administration is contraindicated)
Coxibs - Celecoxib: MOA?
selective COX-2 inh
Salicylates: function in RESP at moderate /high doses?
stimulates Medulla resp center
Salicylates: Function in liver?
stimulates bile secretion
Salicylates: cause for tinnitus?
stimulator of CNVIII
Acetic Acid Derivatives - Diclofenac: uses?
upper GI ulceration solar keratoses post-op opthalmic inflammation preemptive analgesia postop nausea
Salicylates: function in CVS?
vasoDILATOR increase in circulating plasma volume
