Pharmacology OBJECTIVES List the major effects of prostaglandin and leucotriene List important sites of synthesis and the effects of thromboxane and prostacyclin in the vascular system List the currently available antagonists of leucotrienes and prostaglandins and their targets Explain the different effects of aspirin on prostaglandin synthesis and on leucotriene synthesis OBJECTIVES
Contrast the functions of COX-1 & COX-2
Describe the effects of Aspirin on prostaglandin synthesis Contrast the action and toxicity of Aspirin, the older non selective NSAIDs & COX-2 selective drugs List the toxic effect of Aspirin Describe the effects and the major toxicity of Acetaminophen TERMINOLOGY AINS Anti Inflamasi Non Steroid NSAID Non Steroidal Anti Inflammation Drug SAARD Slow Acting Anti Rheumatic Drug DMARD Disease Modifying Anti Rheumatic Drug Analgesik Obat utk mengurangi nyeri sedang-ringan Antipiretik Obat utk menurunkan demam Anti inflamasi Obat utk menghambat keradangan Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Eicosanoid Klasifikasi : Prostaglandin, Prostasiklin, Tromboksan, Leukotrien Mekanisme Kerja : Aktifasi reseptor : protein G Adenylyl Cyclase (c AMP) / Phosphatidylinositol cascade ( IP3 & DAG) Penggunaan Klinis Obgyn : PGE2 (Dinoprostone), PGF2, mematangkan Cervix, PGE1 (Misoprostol) Kontraksi uterus Pediatry : PGE1 Patent Duktus Arteriosus Dialysis : PGI2 (Epoprostenol) Hipertensi Pulmoner Ulkus Peptikum AINS : Misoprostol Urology : PGE1 (Alprostadil) Impotensi Ophthalmology : PGE2 (Latanoprost) Glaucoma, Unoprostone Meningkatkan out flow Humor Aqueous Antagonis Eicosanoid Kortiko steroid AINS Antagonis Leukotrien : Zileuton Lypoxygenase inhibitor, Leukotrien receptor antagonist Zafirlukast, Montelukast Steps in Pain Control 1. NSAID or acetaminophen (Ibuprofen, Naprosyn, Tylenol) 2. Add adjuvant analgesic (TCA, Anticonvulsant, Tramadol) 3. Add opioid analgesic to above (codeine, hydrocodone, oxycodone) 4. Increase potency of opioid (morphine, Fentanyl, hydromorphone) Medications used for chronic pain management Acetaminophen NSAIDs Adjunct medications Tricyclic antidepressants Anitconvulsants Serotonin reuptake inhibitors Muscle relaxants Psychotropic Drugs Tricyclic Antidepressants Amitryptiline, Nortryptiline Serotonin Reuptake Inhibitors Prozac, Zoloft Anticonvulsant Tegretol, Dilantin, Gabapentin
Effective for chronic nerve-related pain
Ibuprofen - Advil Naproxen - Anaprox, Naprosyn Diclofenac - Voltaren Indomethacin Indocin Piroxicam - Feldene Metamizole - Novalgin Mefenamic Acid - Ponstan Ketorolac Tromethamine Toradol Ketoprofen - Profenid AINS Selective COX-2 Celecoxib Rofecoxib Nimesulide Meloxicam TOKSISITAS Gastritis Tinnitus Prolonged Bleeding Time Allergy Reyes syndrome Aspirin Analgesik Lainnya : Acetaminophen Sejak 1893 Paracetamol Dipakai sebagai analgesik & antipiretik Tidak mempunyai efek anti inflamasi Menghambat PG di sentral Tidak mengiritasi lambung Dosis besar hepatotoksik DRUGS USED IN GOUT Anti Inflammatory Uricosuric Agent Allopurinol DRUGS USED IN GOUT Subclass Prototype Other Significant Agents