Question

Discuss the clinical uses and potential effects associated with anti-inflammatory,costicosteroids, and anti-gout drugs.

Answer 1

1.Clincal Uses of Anti inflamotory drugs:

Cardio vascular effect-

Potenital side effects:

Gastrointestinal effects

Dyspepsia heart burn,epigastric distress, nausea

GI bleeding

Mucosal lesions (erosins or ulcerations) - misprostal can be used to reduce this dangerous effects

dose dependent heapatis

Reyes syndrome

Renal:

Reduction in creatinine clearance

Acute tubular necrosis with renal failure

Cardiovascular:

Non cardiovascular pulmonary edema

• NSAIDs are usually used for the treatment of acute or chronic conditions where pain and inflammation are present

• decrease the incidence of transient ischemic attacks
• unstable angina
• coronary artery thrombosis with myocardial infraction
• thrombosis after coronary by pass grafring
• long term use low dosage is associated with a lower incidence of colon cancer-possibly realted to its COX Inhibitng effects
• previously not recommended for during preganancy, but recently it has proved valuble in treating preeclampsia and eclampsia

• NSAIDs are useful in the management of post-operative dental pain following invasive dental procedures such as dental extraction. When not contra-indicated they are favoured over the use of paracetamol alone due to the anti-inflammatory effect they provide

2.costicosteroids clincal uses:

the Adrenal gland is the source of diverse group of hormones essential for metabolic control, regulation of water and electrolyte balance,regulation bodu response to stress,using cholestrol as a substrate,the adrenal cortex produce a large number of substances collectivly known as corticosteriods

In Medicine Replacement therapy Acute adrenal insufficiency

• Hydrocortisone or dexamethasone are given i.v, first as a bolus injection and then as infusion along with istonic saline and glucose solutions. Chronic adrenal insufficiency

• Hydrocortisone given orally is the most commonly used drug with adequate salt and water allowance Congenital adrenal hypoplasia • 0.6 mg/kg daily in divided doses round the clock

Pharmacotherapy:

• Single dose (even excessive) is not harmful can be used to tide over mortal crisis even when benefit is not certain. • Short courses (even high doses) are not likely to be harmful in the absence of contraindications. Starting doses can be high in severe illness

Long term use is potentially hazardous: keep the dose to minimum which is found by trial and error, even partial relief may have to be tolerated.

1. • No abrupt withdrawal after a corticoid has been given for > 2 to 3 weeks: may precipitate adrenal insufficiency
2. . • Arthritis • Collagen diseases • Severe allergic reactions • Autoimmune disorders • Bronchial asthma • Infective diseases • Eye diseases • Skin diseases • Intestinal diseases

Side effects of Corticosteriods:

1. osteoporosis (fragile bones),
2. hypertension (high blood pressure),
3. diabetes,
4. weight gain,
5. increased vulnerability to infection,
6. cataracts and glaucoma (eye disorders),
7. thinning of the skin,bruising easily

anti-gout drugs clincal Uses:

Gout is usually characterized by recurrent attacks of inflammatory arthritis—a red, tender, hot, and swollen joint. Pain typically comes on rapidly in less than twelve hours.

• Uricosuric Drugs Uricosurics are often used in the treatment of gout, a disease in which uric acid crystals form deposits in the joints.

• By decreasing plasma uric acid levels, uricosurics help dissolve these crystals, while limiting the formation of new ones.
• However, the increased uric acid levels in urine can contribute to kidney stones. Thus, use of these drugs is contraindicated in persons already with a high urine concentration of uric acid (hyperuricosuria).

• In borderline cases, enough water to produce 2 liters of urine per day may be sufficient to permit use of an uricosuric drug. By their mechanism of action, some uricosurics (such as probenecid) increase the blood plasma concentration of certain other drugs and their metabolic products. Assessment of drug interactions is very important when using uricosuric drugs in the presence of other medications.
• MOA of uricosuric Drugs Uricosuric drugs Increase the loss of Uric acid in Urine Inhibit competitively renal tubular re- absorption of Uric acid Uricosuric drugs are substances that increase the excretion of uric acid in the urine, thus reducing the concentration of uric acid in blood plasma. In general, this this effect is achieved by action on the proximal tubule of the kidney.

side effects of gout medicine:

• Probenecid
• Headache
• joint pain, redness, or swelling
• loss of appetite
• nausea or vomiting (mild)
• Sulfinpyrazone