Anti-Inflammatory Drugs & Glucocorticoids

Front 1

Salicylates

Back 1

Aspirin
Sulfasalazine

Front 2

Propionic Acid Derivatives

Back 2

Flurbiprofen
Ibuprofen
Naproxen
Oxaprozin

Front 3

Acetic Acid Derivatives

Back 3

Diclofenac
Ketorolac
Sulindac

Front 4

Indole Derivatives

Back 4

Indomethacin

Front 5

Oxicams

Back 5

Meloxicam
Piroxicam

Front 6

Coxib

Back 6

Celecoxib

Front 7

Non-NSAID Analgesic-Antipyretic

Back 7

Acetaminophen

Front 8

Clinical Uses of Salicylates

Back 8

Local derm use as keratolytics, antifungal agents, counterirritants;
Antipyresis;
Analgesia - nonspecific relief of pain caused by headache, toothache, arthralgia, myalgia, dysmenorrhea, tendinitis, bursitis, low back pain, bone metastases, postop pain, etc;
Inflammatory diseases - acute rheumatic fever, RA, ankylosing spondylitis;
Thromboembolic disease prophylaxis

Front 9

Aspirin

Back 9

Irreversible inhibition of COX1 & COX2; increase formation of LTs from LOX pathway;
CIed in pregnant women; Hypersensitivity to aspirin is a CI to therapy with any other NSAID!!!

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Sulfasalazine

Back 10

ONLY NSAID used for ulcerative colitis and Crohn's disease; safe for pregnant women

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Reye's Syndrome

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Do NOT use aspirin to treat children with fevers from viral infections; develops in 2 phases: respiratory infection, then after 4 days, nausea and vomiting, sudden change in mental status, lab signs of liver damage; may be mild or may progress to toxic encephalopathy which is rapidly fatal (20% lethality)

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CIs and Precautions of Salicylates

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Gastritis, peptic ulcer, and other ulcerative GI diseases (except for Sulfasalazine); alcohol consumption; coagulation disorders; G6PD deficiency; renal disease; gout; advanced heart failure; sever hypertension; asthma; NSAID hypersensitivity; viral febrile illnesses in children (Reye's Syndrome);
Concomitant use of the following drugs: Methotrexate, Anticoagulants, Bilirubin, Corticosteroids, Phenytoin, Probenecid

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Flurbiprofen

Back 13

RoA: oral, ophthalmic, IV;
particularly effective for inhibition of intraoperative miosis (ophthalmic); peroperative analgesia in minor ear, neck, and nose surgery (IV); sore throat (oral)

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Ibuprofen

Back 14

RoA: oral, topical, IV;
much higher doses are required for anti-inflammatory effects;
particularly effective for closing PDA (oral & IV); primary knee osteoarthritis (topical); postsurgical dental pain;
Safe to use in children!!

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AEs of Ibuprofen

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Aseptic meningitis (especially SLE patients), fluid retention, agranulocytosis, aplastic anemia

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Naproxen

Back 16

RoA: oral, topical, and ophthalmic;
Half dose will achieve same effects because it is a single enantiomer;
Safe to use in children!!!

Front 17

Oxaprozin

Back 17

RoA: oral;
particularly effective for gout because it is mildly uricosuric therefore increasing the excretion of uric acid

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Diclofenac

Back 18

Inhibits COX nonselectively and also inhibits LOX (low level), also decreases ROS production;
RoA: oral, ophthalmic, topical, and rectal;
particularly effective for postop ophthalmic inflammation; solar ketoses (topical); preemptive analgesia and postop nausea (rectal)

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Ketorolac

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RoA: Oral, IV, IM, and ophthalmic;
Primarily used for analgesic action, not anti-inflammatory - used in conjunction with opioids to reduce opioid requirement by 25-50%

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Sulindac

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RoA: oral; administered as a PROdrug to prolong duration of action to 12-16 hours;
particularly effective for familial intestinal polyposis; may inhibit colon, breast, and prostate cancer development

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AE of Sulindac

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Stevens-Johnson syndrome, thrombocytopenia, agranulocytosis, nephrotic syndrome, cholestatic liver damage

Front 22

Indomethacin

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RoA: oral, rectal, ophthalmic, epidural, topical (oral rinse);
MoA: potent nonselective COX inhibitor, inhibits phospholipase A & C, decreases neutrophil migration and B&T cell proliferation

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Uses of Indomethacin

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Gout, ankylosing spondylitis, closure of PDA, conjunctivitis (ophthalmic), gingivitis (oral rinse), analgesia in postlaminectomy syndrome (epidrual)

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Meloxicam

Back 24

RoA: oral;
MoA: highly selective inhibitor of COX2, also inhibits TXA2 synthesis;
particularly effective for osteoarthritis

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Piroxicam

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RoA: oral;
MoA: nonselective COX inhibitor, inhibits PM leukocyte migration and lymphocyte function, decreases ROS production;
displays an increased incidence (9.5x higher) of peptic ulcer and bleeding

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Celecoxib

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RoA: oral;
MoA: Highly selective COX2 inhibitor, does not affect platelet aggregation at usual doses;
BLACK BOX Warning: Cardiovascular Risk;
CIed in use with warfarin and pregnant women

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Acetaminophen

Back 27

MoA: potent inhibitor of COX1 and COX2 in the CNS!! Weak COX inhibitor in the periphery;
PREFERRED to aspirin in children with viral infections!!!

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Short to Medium Acting Glucocorticoids

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Cortisone
Hydrocortisone
Methylprednisolone
Prednisolone
Prednisone (PROdrug)

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Intermediate Acting Glucocorticoids

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Triamcinolone

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Long Acting Glucocorticoids

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Betamethasone
Dexamethasone