Transcript Chapter 2 Law and Ethics of Pharmacy Teresa Hopper

Antiinflammatories and Antihistamines
Chapter 26
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Objectives
 List both generic and trade drug names
covered in this chapter.
 Describe the symptoms of inflammation.
 Differentiate between steroidal and
nonsteroidal antiinflammatories.
 List the major side effects of the agents
discussed.
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Objectives
(cont’d)
 List the major cells that are activated
from the immune system to repair
damaged cells.
 List the major inflammatory
conditions.
 List the drug action of pain receptors.
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Objectives
(cont’d)
 List the major medications used in the
treatment of arthritis, rheumatoid
arthritis, osteoarthritis, and other major
conditions.
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The Inflammatory
Response
 Inflammation can be caused by
infection, allergic reactions, or injury.
 Inflammation is a necessary response
for healing
 Inflammation and pain run hand in hand
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Aspirin
 England, 1800s—bark from willow tree
effective for pain, fever, inflammation.
 Aspirin is acetylsalicylic acid-ASA.
 The first company to market Aspirin was
Bayer Company in 1899.
 Still popular due to effectiveness and low
cost
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Aspirin
(cont’d)
 Used to treat pain, fever, inflammation, and
gout
 Aspirin should not be given to children.
 Aspirin causes Reye’s syndrome: vomiting,
lethargy, encephalopathy (leads to coma
and death).
 Side effect can be upset stomach.
 If taken with anticoagulants, increased
bleeding.
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Aspirin
(cont’d)
 Most common uses: prevention of strokes
or heart attacks.
 Aspirin decreases platelet aggregation
(clotting).
 Dose to decrease blood clotting is
81 to 325 mg/day.
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NSAIDs
 NSAIDs (Nonsteroidal Antiinflammatory
Drugs) have analgesic, antipyretic,
antiinflammatory properties.
 Are available in prescription and OTC
forms.
 Are used for mild or moderate pain.
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Common OTC NSAIDs
 Motrin/ibuprofen
 Aleve/naproxen
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NSAIDs
(cont’d)
 NSAIDs used to treat muscle pain,
rheumatoid arthritis, bone pain, PMS.
 Overuse can worsen stomach problems
(GERD).
 Take with food.
 Do not take with anticoagulants.
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Cyclooxygenase (COX)
 Responsible for synthesizing
prostaglandins which are responsible for
pain and inflammation
 COX-1 (protects gastric mucosa and
promotes platelet aggregation)
 COX-2 (found at sites of tissue injury and
in the brain)
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Cyclooxygenase-2 Inhibitors
 First-generation NSAIDs
 Inhibit COX-1 and COX-2—decrease in
inflammation, pain, fever
 Negative effect of inhibiting COX-1—gastric
erosion, ulceration, bleeding, renal damage
 Second-generation NSAIDs—COX-2
selective
 Reduce inflammation, pain, fever without side
effects of COX-1 inhibitors
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COX inhibitors
 COX-1 inhibitors taken off the market-too
dangerous
 Most common COX-2 inhibitorCelebrex/celecoxib
 Auxiliary labels“May Cause Dizziness or drowsiness”;
“Take with food or milk”;
“Do not crush or chew capsules”
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Steroids
 Steroids are produced naturally by the
body
 Main gland-adrenal gland
 Used to decrease inflammation in
conditions like RA, OA, asthma, cancer
 High doses can cause decreased
immune response, increased appetite,
bruising, insomnia, restlessness, anxiety,
hypotension, headache
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 Serious side effects—if taken over long
period of time, taken inappropriately, or
stopped abruptly.
 Discontinuing a steroid must be done
slowly.
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Steroids (cont’d)
 To treat asthma-steroids (corticosteroids)
available in inhalant or parenteral forms
 Cause bronchodilation
 Auxiliary label: Shake Well on Inhalers
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Common Steroids
 prednisone
 hydrocortisone
 methylprednisolone
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Controlled Analgesics
 Opiods: to treat pain
Oxycodone, Duragesic (fentanyl),
Vicodin, Percocet, Tylenol w/ Codeine
 May be combined with NSAIDs to
intensify their effects
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Antihistamines
 Histamine causes allergic responses
when antigen is found in the body
 Allergic response can become
anaphylactic shock=death
 Antihistamines block histamine receptors
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Histamine1
 H1 receptors are found in the lower resp.
tract and skin When histamine binds with H1 receptors=
coughing, sneezing, wheezing, urticaria
(rash), bronchiolar constriction
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Histamine2
 H2 receptors are located in GI tract When histamine binds with H2
receptors= nausea, vomiting, diarrhea,
cramps
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Allergic Conditions and
Their Treatment
 OTC drugs used for short-term relief.
 First-generation antihistamines:
 Nonspecific—bind both H1 and H2
 Cause sedation (affect CNS)
 Decrease nausea, vomiting, motion sickness.
EX: Benadryl/diphenhydramine
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Allergic Conditions and Their
Treatment (cont’d)
 Second-generation antihistamines
 Affect H1 only
 Cromolyn (inhaled), Allegra/fexofenadine,
Zyrtec/cetirizine taken to prevent allergic
responses.
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Antihistamine and
Combination Drugs
 Used to decrease inflammation and
irritation from allergens.
 Some antihistamines are combined with
decongestants.
 Work best when taken before an allergic
reaction.
 There are OTC nasal sprays and drops.
 Steroids used.
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Drug Interactions
 Do not consume alcohol with
antihistamines—will increase drowsiness.
 Antibiotics—macrolides (Erythromycin),
ketoconazole, itraconazole—intensify
effects of second-generation
antihistamines.
 Only non-drowsy OTC is Claritin.
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Anaphylaxis
 Most severe reactions cause swelling of
airways.
 Epinephrine given by inhalation, injection
to open airways.
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