1. ANTI INFLAMMATORY DRUGS

2. NSAIDS Salicyclates Aspirin Mesalamine Sodium-salicyclate Propionic Acid Derivatives Ibuprofen Ketoprofen Naproxen Acetic Acid Derivatives Diclofenac Ketorolac Oxicams Piroxicam Meloxicam Indole Derivatives Indomethacin Selective COX-2 Inhibitors Celecoxib

3. Analgesic-Antipyretic Drugs Anti-Inflammatory Steroids Acetaminophen Beclomethasone Betamethasone Budesonide Cortisone Dexamethasone Hydrocortisone Prednisone Triamcinolone

4. NSAIDS MoA: reversible, competitive inhibition of COX Irreversible inactivation by Aspirin Most block COX-1 and -2 Celecoxib is COX-2 inhibitor Inhibit synthesis of PGs but NOT leukotrienes Indomethacin is extremely potent Reduce elevated temperature due to PGE1 & PGE2 Analgesic and antipyretic effects do not undergo tolerance Toxicity: Acute renal failure & Nephrotic syndrome

5. Agents Effect NSAID Block Effect PGE2, PGI2, PGD2 Enhance early stages of inflammation Anti-inflammatory PGE2, PGI2 Pain receptors in peripherals Peripheral analgesic effect PGE1, PGE2 Increase body temp set Antipyretic point

6. SALICYCLATES RS: moderate/high doses stimulate; toxic dose depresses US: high doses cause inhibition of uric acid reabsorption, decrease GFR hypovolemia acute renal failure; chronic doses can cause renal lesions Hematopoietic: low/moderate = decreased platelet aggregation (decrease TXA2, increase PGI2); high dose = sideropenia (iron deficiency) Uses: general analgesic, Ulcerative colitis and Crohns disease (mesalamine & olsalazine), Thromboemolic disease prophylaxis Toxicity: 1% hypersensitivity, 15% adverse effects (heartburn, nausea, fecal blood loss, gastric bleeding, tinnitus, deafness, vertigo), toxicity in pregnancy, Reyes syndrome in children, Analgesic nephropathy

7. Non-Salicyclate NSAIDS All effects similar to salicyclates Greatest analgesic agent efficacy: Ketorolac Greatest anti-inflammatory: Indomethacin, Piroxicam, Diclofenac MoA: COX-1 inhibition: indomethacin, piroxicam COX-2 inhibition: celecoxib, meloxicam COX-1 and 2 inhibitors: ibuprofen, naproxen, diclofenac

8. Non-Salicyclate NSAIDS Propionic Acid Derivatives MoA: reversible competitive inhibition of COX Acetic Acid Derivates MoA: reversible competitive inhibition of COX and decrease in oxygen radicals Diclofenac: ankylosing spondylitis, eye inflammation, chronic tx of Rheumatoid Arthritis Ketorolac: analgesic agent, 60% excreted by kidneys renal damage Oxicams MoA: piroxicam is potent reversible COX-1 inhibition; meloxicam for COX-2 Piroxicam has 100% oral bio and ~50 hr half life

9. Indomethacin Powerful COX-1 inhibitor Also inhibits: PLA2 PMN cell migration T-Cell and B-Cell proliferation Everything else is same as other NSAIDS Cant be used as antipyretic or analgesic agent due to toxicity Uses: Barters syndrome, PDA, nephrogenic diabetes insipidus

10. Analgesic-Antipyretic Drugs Acetaminophen 95% biotransformed in liver Small amount toxic metabolite formed NAPQI hepatotoxicity Potent COX inhibitor in CNS; weak in inflamed tissues

11. Anti-Inflammatory Steroids Glucocorticoids MoA: Alters #, distribution, function of peripheral macrophages; decreases leukocytes, macros, cyto, etc Inhibition of PG and LT synthesis Decrease postcapillary permeability Inhibits effects of complement system Strong inhibitors of cellular immunity Weak inhibitors of humoral immunity Diagnostic use: Dexamethasone suppression test used for differential diagnosis of Cushings Syndrome

12. RELATED PRODUCTS If you enjoyed this presentation, please take a look at the rest of our products. Our website has many more FREE excellent presentations and tons of other FREE information. HIGHSCORE: Must Know Pharmacology Description: This is a book of 400+ flashcards covering 20 highly tested, and high-yield topics in pharmacology. It is designed so that you can use it anywhere on any device or print it out and use as flashcards. Get the eBook: HERE! Our site: Exam Masters Tutoring Service

13. RELATED PRODUCTS HIGHSCORE: Comparisons of High Yield Topics for the Medical Boards Description: This book contains over 100 comparisons of some of the most highly tested diseases and topics on the USMLE Step 2 CK. The questions on the exam are much more vague than what you see in the practice question banks and it is very difficult to differentiate between two diseases with similar symptoms. So this book is designed to help students improve their score by targeting these types of difficult questions. Get the Free Sample: HERE! Get the whole eBook: HERE!

14. RELATED PRODUCTS USMLE STEP 2 CK TIDBITS & TIPS MONTHLY SUBSCRIPTION Join hundreds of other students preparing for the USMLE Step 2 CK on our USMLE Step 2 CK Tidbits & Tips newsletter! It is an amazing newsletter with tons of great info. The monthly subscription entails a weekly newsletter with info such as high yield disease comparisons, most commonly tested facts, treatments & management, and much more! View a sample Newsletter: HERE! Subscribe to this awesome Newsletter: HERE!