Block 10 AntiiNFLammatory Drugs MCQ's

Aspirin is the most likely drug that the patient was taking. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that is commonly used as an analgesic and anti-inflammatory agent. However, it can increase the risk of bleeding due to its antiplatelet effects. Since the patient is scheduled to have a tooth extraction surgery, which can cause bleeding, the dentist reschedules the surgery and advises the patient to stop taking aspirin to minimize the risk of excessive bleeding during the procedure.

The patient’s marked hyperthermia and respiratory depression suggest severe poisoning by salicylates. This is supported by the lab results indicating mixed respiratory and metabolic acidosis (low pH, increased Pco2 and decreased plasma bicarbonate content). This acid-base disturbance is typical of high salicylate content in the blood. In salicylate poisoning, the initial event (when salicylate concentration in blood is not yet high) is respiratory alkalosis caused by salicylate-induced stimulation of the respiratory center. Partial compensation is achieved, as usual, by increased renal excretion of bicarbonate. Therefore the initial phase of poisoning (or when the poisoning is mild) is characterized by high pH, and decreased plasma levels of CO2 and bicarbonate. In a later phase, when salicylate blood levels become quite high, the respiratory center becomes depressed and respiratory acidosis supervenes. This acidosis is uncompensated since a significant amount of bicarbonate has been already eliminated. Moreover, salicylates cause uncoupling of mitochondrial oxidative phosphorylation (which leads to hyperthermia) and inhibits the enzymes of Krebs cycle, resulting in increased pyruvic and lactic acids. Lipolysis, gluconeogenesis, and glycolysis are also stimulated, leading to hyperglycemia and the production of keto acids. Therefore the final picture is the one of mixed respiratory and metabolic acidosis. Acute alcohol poisoning can cause combative behavior, but hypothermia and hypoglycemia are typical signs of alcohol poisoning and tinnitus is usually absent. Poisoning by NSAIDs other than salicylates does not usually cause profound impairment of acid-base balance.

Acetaminophen would be an appropriate antipyretic drug for this patient because it is a non-steroidal anti-inflammatory drug (NSAID) that does not inhibit cyclooxygenase-1 (COX-1) or cyclooxygenase-2 (COX-2). This is important for this patient because he has a history of angioedema due to a hypersensitivity reaction to aspirin, which is an NSAID that inhibits both COX-1 and COX-2. Acetaminophen does not have the same inhibitory effects on COX enzymes and is therefore a safer choice for this patient.

Celecoxib is the ideal anti-inflammatory drug to treat the symptoms of the 44-year-old woman. This is because she is also suffering from gastric ulcer, and celecoxib is a selective COX-2 inhibitor that is less likely to cause gastrointestinal side effects compared to other nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and ketorolac. Colchicine is primarily used to treat gout and does not specifically target inflammation in the joints.

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The analgesic effect of Ketorolac in this patient can be explained by the decreased concentration of prostaglandins in the surgical area. Prostaglandins are known to be involved in the inflammatory response and sensitization of pain receptors. By decreasing the concentration of prostaglandins, Ketorolac reduces inflammation and pain at the surgical site, providing relief for the patient.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID), which when used concomitantly with aspirin, may reduce the latter's cardioprotective effect. Ibuprofen has been shown to inhibit the irreversible platelet inhibition brought about by aspirin. A clinically and statistically significant increase in the risk of mortality in persons using ibuprofen and aspirin compared to those using ibuprofen alone has been noted.
It is recommended that ibuprofen not be prescribed for the long term in patients on aspirin. Another strategy is to ingest aspirin 2 hours before ibuprofen.

Ibuprofen has not been shown to cause hyperglycemia or interact with atorvastatin.
The greater risk of gastrointestinal complications should be borne in mind Mille prescribing NSAIDS in persons aged 65 years or more.
Ibuprofen is one of the NSAIDs effective in osteoarthritis.

Prednisone is a corticosteroid that acts by altering gene expression. It enters the cells and binds to glucocorticoid receptors, leading to the activation or repression of specific genes. This modulation of gene expression results in various anti-inflammatory and immunosuppressive effects, which are beneficial in the treatment of asthma. Prednisone does not directly inhibit COX enzymes or phospholipase A2, nor does it block LT release.

Crohn’s disease is a chronic inflammatory bowel disease of unknown origin. The anti-inflammatory effect of glucocorticoids, which may dramatically reduce fever, diarrhea, and abdominal pain in the acute stage of the disease, is due to many actions, including inhibition of lymphocyte-mediated production of interleukin-2. This cytokine induces proliferation of B- and T-cells (including cytotoxic T-cells) and activation of natural killer cells and lymphokine-activated killer cells, and therefore it plays a main role in inflammatory processes. A is incorrect because glucocorticoids have no effect on the metabolism of prostaglandins. B, C, and D are incorrect because glucocorticoids have the opposite effect to those listed.

The patient is experiencing symptoms of salicylism, which is an adverse effect of salicylates. Salicylates are found in over-the-counter analgesics, such as aspirin, which the patient has been heavily self-medicating with. The symptoms of salicylism include mental confusion, respiratory rate changes, sweating, vomiting, dizziness, and tinnitus (ringing ears). Salicylism occurs due to the accumulation of salicylates in the body, leading to toxic levels. This is the most likely explanation for the patient's symptoms in this case.

Allopurinol is the most likely drug prescribed in this case. Allopurinol is a medication used to treat high levels of uric acid in the blood, which can lead to gout or kidney stones. It works by inhibiting the production of uric acid in the body. The decrease in plasma urate levels and urinary uric acid levels after three weeks of treatment suggests that the medication is effectively reducing uric acid levels in the patient.

The symptoms and signs of the patient indicate that he is suffering from many adverse effects due to chronic treatment with a glucocorticoid, like prednisone. Polyarteritis nodosa is a connective tissue disorder of unknown cause which is usually treated with high doses of glucocorticoids. Chronic treatment with these drugs can cause epigastric distress (because of increased peptic acid secretions and inhibition of prostaglandin synthesis), muscle weakness (because of potassium wasting), hypertension (mechanisms still uncertain), and candidiasis (because of the anti-inflammatory effect that increase the probability of opportunistic infections). These drugs can cause hyperglycemia (due to increased gluconeogenesis, decreased glucose utilization, and increased glucagon secretion), and increased blood urea nitrogen (due to protein wasting). These other drugs do not cause the syndrome presented by the patient and are not currently used in the therapy of polyarteritis nodosa.

The symptoms described, including drowsiness, stomach ache, and pronounced hyperpnea, suggest that the boy may be experiencing respiratory alkalosis. This is characterized by increased pH, decreased PCO2 (partial pressure of carbon dioxide), and decreased bicarbonate levels in the blood. Aspirin overdose can lead to metabolic acidosis, which is characterized by decreased pH, increased PCO2, and increased bicarbonate levels. Therefore, the most likely result of the laboratory exams would be increased pH, decreased PCO2, and decreased bicarbonate levels.

The signs and symptoms described, such as petechia, hemorrhage, and anemia, suggest that the patient is experiencing gastrointestinal bleeding. This is a known side effect of prolonged inhibition of COX-1, which is the enzyme responsible for the production of prostaglandins that protect the stomach lining. Aspirin, at a low dose of 81 mg, acts as an irreversible inhibitor of COX-1, leading to a decreased production of prostaglandins and an increased risk of gastric bleeding.

Ibuprofen has been approved for use as an antipyretic in children and is currently available over the counter. All NSAIDs have antipyretic activity and therefore the initial choice is often based on specific patient related contraindications. Aspirin is contraindicated because of the risk of Reye’s syndrome. Indomethacin is not indicated for general use as an antipyretic because of its toxicity. Normally, acetaminophen would be an appropriate choice, but it is contraindicated in this patient because of his congenital deficiency of RBC glutathione synthase. Acetaminophen is partially metabolized to NAPQI which is rapidly conjugated with glutathione. If glutathione stores are deficient, the metabolite reacts with hepatic bio-macromolecules, resulting in hepatotoxicity. Patients with a congenital deficiency of glutathione synthase are therefore at increased risk of acetaminophen toxicity. Prednisone is not used as an antipyretic.

Ketorolac would likely be the most effective in the relief of her pain because it is a nonsteroidal anti-inflammatory drug (NSAID) that is known for its strong analgesic properties. It is often used for short-term management of moderate to severe pain, such as postoperative pain or pain due to musculoskeletal conditions. Ketorolac works by inhibiting the production of prostaglandins, which are substances in the body that cause pain and inflammation. By reducing the levels of prostaglandins, ketorolac can effectively alleviate pain in conditions such as severe arthritic pain in the knees.

The symptoms and the history of the patient suggest that the pain is caused by bone metastases that are the most frequent metastases in cases of prostatic carcinoma. Osseous metastases induce an inflammatory reaction with the production of prostaglandins that may cause osteolysis and sensitize free nerve endings, thereby augmenting pain perception. The NSAIDs effectively decrease prostaglandin and endoperoxide production and therefore can be useful for an initial treatment of metastatic bone pain. Piroxicam is a long-acting, nonselective competitive inhibitor of COX enzymes that also inhibits polymorphonuclear cell migration and decreases oxygen radical production. Likely all NSAIDs would be useful, and the superiority of any particular drug for a particular patient cannot be predicted. Therefore the initial choice is often based on specific patient related contraindications. Aspirin is contraindicated because of his congenital G6PD deficiency (salicylates can cause hemolytic anemia in patients with this deficiency). Acetaminophen is a very weak inhibitor of COX enzymes in the periphery and in the presence of a high concentration of peroxide which is often found in inflammatory lesions. All propionic acid derivatives (including ibuprofen and oxaprozin) are contraindicated because of the serious allergic reaction to naproxen.