1. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concepts in PharmacologyCHAPTER Third Edition Drugs for Inflammation and Immune Modulation 24

2. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Directory Classroom Response System Lecture Note Presentation

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

4. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 1 Choices 1.Aspirin 2.Ibuprofen 3.Acetaminophen 4.Motrin

5. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 1 Answer 1.Aspirin 2.Ibuprofen 3.Acetaminophen 4.Motrin

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

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

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

9. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 3 The most common adverse effect of NSAIDs is:

10. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 3 Choices 1.Edema 2.Rash 3.GI upset 4.Bleeding

11. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 3 Answer 1.Edema 2.Rash 3.GI upset 4.Bleeding

12. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 4 The patient taking glucocorticoids is at risk for:

13. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 4 Choices 1.Bleeding 2.Respiratory distress 3.Dehydration 4.Infection

14. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Question 4 Answer 1.Bleeding 2.Respiratory distress 3.Dehydration 4.Infection

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

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

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

18. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.1 Inflammation is a body defense that limits the spread of invading microorganisms and injury.

19. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Inflammation Occurs in response to many different stimuli –physical injury, exposure to toxic chemicals, extreme heat, invading microorganisms, or death of cells.

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

21. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.2 The body reacts to injury by releasing chemical mediators that cause inflammation.

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

23. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Figure 24.1 Steps in acute inflammation Source: Pearson Education/PH College

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

25. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Table 24.2 (continued) Selected Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

26. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.3 Inflammation may be treated with nonpharmacologic and pharmacologic therapies.

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

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

29. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Common Diseases Allergic rhinitis Anaphylaxis Ankylosing spondylitis Contact dermatitis Crohn’s disease Glomerulonephritis

30. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Common Diseases Hashimoto’s thyroiditis Peptic ulcer disease Rheumatoid arthritis Systemic lupus erythematosus Ulcerative colitis.

31. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.4 NSAIDs are the primary drugs for the treatment of mild inflammation.

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

33. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.5 Glucocorticoids are effective in treating severe inflammation.

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

35. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.6 The immune response is obtained through activation of the humoral and cell-mediated immune systems.

36. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Figure 24.2 Steps in the humoral and cell-mediated immune responses Source: Pearson Education/PH College

37. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.7 Vaccines are biological agents used to prevent illness.

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

39. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Vaccination Immunization Four methods of producing safe and effective vaccines include the following: Attenuated (live) vaccines Inactivated (killed) vaccines Toxoids Recombinant vaccines

40. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Figure 24.3 Mechanisms of active and passive immunity

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

42. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.8 Biologic response modifiers are used to boost the immune response.

43. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Biologic Response Modifiers Interferons (IFNs) –Cytokines secreted by lymphocytes and macrophages –Slow the spread of viral infections –Enhance the activity of existing leukocytes.

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

45. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Core Concept 24.9 Immunosuppressants are primarily used to avoid tissue rejection following organ transplant.

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

47. Copyright ©2011 by Pearson Education, Inc. All rights reserved. Core Concepts in Pharmacology, Third Edition Holland Adams Concept Review 24.3 Why are oral glucocorticoids usually used concurrently with the immunosuppressant drugs following a transplant operation?