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NON‐STEROID ANTI‐INFLAMMATORY DRUGS (NSAID)
‐may act by inhibits synthesis of prostaglandins(Pg I₂).
(1) role of Pg as local mediators
‐ Generally act locally on Gssue in which the are synthesized rapidly metabolized to inacGvate
products at sites of acGon.
~ don’t circulate in blood in significant concentraGon
(2) synthesis of Pg
‐ primary precursor of Pg : arachidonic acid
‐ arachidonic acid as component of phospholipids of cell membrane ( 1⁰ phosphaGdyl inositol & other
complex lipid.)
‐ free arachidonic acid release from Gssue phospholipids by acGon of phospholipase A₂.
‐ 2 major pathways synthesis of eicosanoids from amino acids :‐
I) cyclooxgenase pathway
. products : Pg, Tx, Pg I₂
. COX‐1 / COX‐2 (in response to inflammaGon sGmuli)
II) lipoxygenase pathway
. products : LT / lipoxins depending on Gssue
(3) NSAID
‐ Act as 1⁰ by inhibits COX enzymes ( different COX emzymes), but not the lipoxygenase enzyme.
‐ Aspirin is protoptype of group
Aspirin & other NSAID
‐ AnG‐inflammaGon, anG‐ pyreGc analgesic
‐ AcGon :
. block PGs synthesis at thermoregulatory centers in hypothalamus & at peripheral target sites.
. prevent sensiGzaGon of pain receptors to both mechanism & chemical sGmuli.
. ↓ pain sGmuli at subcorGcal sites (thalamus & hypothalamus).
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‐ Uses :
I ) anG‐pyreGc & analgesic in treatment of rheumaGc fever / rheumaGc arthriGs/ gout
II) ↓ dose : prophylacGcally ↓ incidence of ischemic a]ack
( ↓ platelet aggregaGon, reversible block of COX in platelet.)
‐ Adverse effect :
I ) GIT
. Nausea, vomiGng, exfoliaGon of gastric mucosal cells, ↓ gastric mucous secreGon.
. ulcer (NSAIDs block synthesis of Pg E –gastroprotector )
II) petechial hemorrhage (aspirin)
III) acid‐base balance disturbance (aspirin)
IV) Kussmaul respiraGon (aspirin toxic dose)
AnL‐inflammatory drugs
(1) NSAID
. aspirin
. diclofenac
.ibuprofen
.indomethacin
. sulindac (pro‐drug)
~ block COX, inhibit synthesis of Pg E, F₂a
~ reduce inflammaGon & fever &pain
(2) COX₂ inhinbitors →response to inflammatory sLmuli
o Celecoxib
(3) Non‐narcoLc analgesics
o Paracetamol
~block COX, inhibits synthesis of Pg E, F₂a.
~analgesics & anG‐pyreGc
~doesn’t have anG‐inflammaGon acGvity
(4) Drugs for arthriLs
.chloroquine
.gold salts
. aren’t inhibit COX
. have no li]le analgesics & anG‐inflammaGon
. stablilize lysosomal membrane & treat inflammaGon disorders.
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(5) Drug for gout
. colchicines ‐ ↓ movement of granulocytes into affects area
. allopurinol (purine analogue) ‐ ↓ producGon of waste by inhibits xanthine oxidase
. probenecid ‐ ↓ ureate eliminaGon in urine
Drug for gout
‐ Acute gout a]acks can result from :
. ↑ alcohol consumpGon
. diet rich in purines
. kidney disease
I ) acute aVacks ** is :
‐a) colchicines ‐ ↓ movement of granulocytes into affected area.
‐b) NSAID ‐ ↓ pain & inflammaGon
* aspirin is contraindicated because it ↓ ureate (uric acid) secreGon in proximal tubules of kidney.
II) chronic gout
‐a) allopurinol (purine analogue)
. ↓ ureate producGon by inhibiting biosynthesis (inhibit xanthine oxidase )
‐b) probenecid
. ↑ uric acid eliminaGon in urine (long term treatment).
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