Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concepts in PharmacologyCHAPTER

Copyright ©2011 by Pearson Education, Inc.All rights reserved.

Core Concepts in Pharmacology, Third EditionHolland • Adams

Core Concepts in Pharmacology

CHAPTERCHAPTER

Third Edition

Drugs for Inflammation and Immune Modulation

24



Directory

Classroom Response System

Lecture Note Presentation



Question 1

A patient is getting ready to go home from the hospital and the health care provider and patient are discussing the types of over-the-counter NSAID medications that are available. The health care provider states that an OTC medication that is not classified as an NSAID is:



Question 1 Choices

1. Aspirin

2. Ibuprofen

3. Acetaminophen

4. Motrin



Question 1 Answer

1. Aspirin

2. Ibuprofen

3. Acetaminophen

4. Motrin



Question 2

The patient has been taking aspirin for several days for headache. While assessing the patient, the health care provider discovers that the patient is experiencing ringing in the ears and dizziness. The most appropriate action by the nurse is:



Question 2 Choices

1. To question the patient about history of sinus infection

2. To determine if the patient has mixed the aspirin with other medications

3. To tell the patient not to take any more aspirin

4. To tell the patient to take the aspirin with food or milk



Question 2 Answer

1. To question the patient about history of sinus infection

2. To determine if the patient has mixed the aspirin with other medications

3. To tell the patient not to take any more aspirin

4. To tell the patient to take the aspirin with food or milk



Question 3

The most common adverse effect of NSAIDs is:



Question 3 Choices

1. Edema

2. Rash

3. GI upset

4. Bleeding



Question 3 Answer

1. Edema

2. Rash

3. GI upset

4. Bleeding



Question 4

The patient taking glucocorticoids is at risk for:



Question 4 Choices

1. Bleeding

2. Respiratory distress

3. Dehydration

4. Infection



Question 4 Answer

1. Bleeding

2. Respiratory distress

3. Dehydration

4. Infection



Learning Outcomes

1. Identify common signs and symptoms of inflammation.

2. Outline the basic steps in the acute inflammatory response.

3. Describe the central role of histamine in inflammation.

4. Outline general strategies for treating inflammation.



Learning Outcomes

5. Compare and contrast the humoral and cell-mediated immune responses.

6. For each of the drug classes in the Drug Snapshot, identify representative drugs, explain the mechanisms of drug action, primary actions related to inflammation and/or the immune system, and important adverse effects.



Learning Outcomes

7. Categorize drugs used in the treatment of inflammation, allergies, and immune disorders based on their classifications and mechanisms of action.

8. For each of the major vaccines, give the recommended dosage schedule



Core Concept 24.1

Inflammation is a body defense that limits the spread of invading microorganisms

and injury.



Inflammation

• Occurs in response to many different stimuli – physical injury, exposure to toxic chemicals,

extreme heat, invading microorganisms, or death of cells.



Inflammation

• Purpose of inflammation - contain the injury or destroy the microorganism– Removing cellular debris and dead cells,

repair of the injured area can move at a faster pace

• Proceeds in the same manner regardless of cause

• Signs of inflammation - swelling, pain, warmth, and redness of the affected area.



Core Concept 24.2

The body reacts to injury by releasing chemical mediators that cause

inflammation.



Chemical Mediators

• Released by damaged tissue releases • Act as “alarms” to notify the surrounding

area of the injury• Include

– Histamine, leukotrienes, bradykinin, complement, and prostaglandins.



Figure 24.1 Steps in acute inflammation Source: Pearson Education/PH College





Table 24.2 (continued) Selected Nonsteroidal Anti-inflammatory Drugs (NSAIDs)



Core Concept 24.3

Inflammation may be treated with nonpharmacologic and pharmacologic

therapies.



Treatment of Inflammation

• Cause of the inflammation is identified and treated.

• mild symptoms, nonpharmacologic therapies such as ice packs and rest should be used whenever applicable.

• Topical drugs – fewer adverse effects



Treatment of Inflammation

• Used for - skin and mucous membranes of the mouth, nose, rectum and vagina

• Two primary drug classes – Nonsteroidal anti-inflammatory drugs

(NSAIDs)– Glucocorticoids (also called corticosteroids)



Common Diseases

• Allergic rhinitis• Anaphylaxis• Ankylosing spondylitis• Contact dermatitis• Crohn’s disease• Glomerulonephritis



Common Diseases

• Hashimoto’s thyroiditis• Peptic ulcer disease• Rheumatoid arthritis• Systemic lupus erythematosus• Ulcerative colitis.



Core Concept 24.4

NSAIDs are the primary drugs for the treatment of mild inflammation.





Core Concept 24.5

Glucocorticoids are effective in treating severe inflammation.





Core Concept 24.6

The immune response is obtained through activation of the humoral and cell-mediated

immune systems.



Figure 24.2 Steps in the humoral and cell-mediated immune responses Source: Pearson Education/PH College



Core Concept 24.7

Vaccines are biological agents used to prevent illness.



Vaccination Immunization

• Process of introducing a foreign substance into the body to trigger immune activation before the patient is exposed to the real pathogen

• Goal is to induce long-lasting immunity to a pathogen without producing an illness in an otherwise healthy person



Vaccination Immunization

• Four methods of producing safe and effective vaccines include the following:

• Attenuated (live) vaccines • Inactivated (killed) vaccines • Toxoids • Recombinant vaccines



Figure 24.3 Mechanisms of active and passive immunity





Core Concept 24.8

Biologic response modifiers are used to boost the immune response.



Biologic Response Modifiers

• Interferons (IFNs)– Cytokines secreted by lymphocytes and

macrophages – Slow the spread of viral infections– Enhance the activity of existing leukocytes.



Biologic Response Modifiers

• Interleukins – Levamisole (Ergamisole) stimulate B cells, T

cells, and macrophages in patients with colon cancer

– Bacille Calmette-Guéin (BCG) vaccine (TICE, TheraCys) is an attenuated strain of Mycobacterium tuberculosis, used for the pharmacotherapy of certain types of bladder cancer.



Core Concept 24.9

Immunosuppressants are primarily used to avoid tissue rejection following organ

transplant.





Concept Review 24.3

• Why are oral glucocorticoids usually used concurrently with the immunosuppressant drugs following a transplant operation?

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Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concepts in PharmacologyCHAPTER