1. ANTI – INFLAMMATORY DRUGS

2. NSAIDS
 Salicyclates
 Aspirin
 Mesalamine
 Sodium-salicyclate
 Propionic Acid Derivatives
 Ibuprofen
 Ketoprofen
 Naproxen
 Acetic Acid Derivatives
 Diclofenac
 Ketorolac
 Oxicams
 Piroxicam
 Meloxicam
 Indole Derivatives
 Indomethacin
 Selective COX-2
Inhibitors
 Celecoxib

3. Analgesic-Antipyretic
Drugs
Anti-Inflammatory
Steroids
 Acetaminophen
 Beclomethasone
 Betamethasone
 Budesonide
 Cortisone
 Dexamethasone
 Hydrocortisone
 Prednisone
 Triamcinolone

4. NSAIDS
 MoA: reversible, competitive inhibition of COX
 Irreversible inactivation by Aspirin
 Most block COX-1 and -2
 Celecoxib is COX-2 inhibitor
 Inhibit synthesis of PGs but NOT leukotrienes
 Indomethacin is extremely potent
 Reduce elevated temperature due to PGE1 & PGE2
 Analgesic and antipyretic effects do not undergo
tolerance
 Toxicity: Acute renal failure & Nephrotic syndrome

5. Agents
Effect
NSAID Block Effect
PGE2, PGI2, PGD2
Enhance early stages
of inflammation
Anti-inflammatory
PGE2, PGI2
Pain receptors in
peripherals
Peripheral analgesic
effect
PGE1, PGE2
Increase body temp set Antipyretic
point

6. SALICYCLATES
 RS: moderate/high doses stimulate; toxic dose




depresses
US: high doses cause inhibition of uric acid reabsorption,
decrease GFR  hypovolemia  acute renal failure;
chronic doses can cause renal lesions
Hematopoietic: low/moderate = decreased platelet
aggregation (decrease TXA2, increase PGI2); high dose
= sideropenia (iron deficiency)
Uses: general analgesic, Ulcerative colitis and Crohns’
disease (mesalamine & olsalazine), Thromboemolic
disease prophylaxis
Toxicity: 1% hypersensitivity, 15% adverse effects
(heartburn, nausea, fecal blood loss, gastric bleeding,
tinnitus, deafness, vertigo), toxicity in pregnancy, Reye’s
syndrome in children, Analgesic nephropathy

7. Non-Salicyclate NSAIDS
 All effects similar to salicyclates
 Greatest analgesic agent efficacy: Ketorolac
 Greatest anti-inflammatory: Indomethacin,
Piroxicam, Diclofenac
 MoA: COX-1 inhibition: indomethacin, piroxicam
 COX-2 inhibition: celecoxib, meloxicam
 COX-1 and 2 inhibitors: ibuprofen, naproxen,
diclofenac

8. Non-Salicyclate NSAIDS
 Propionic Acid Derivatives
 MoA: reversible competitive inhibition of COX
 Acetic Acid Derivates
 MoA: reversible competitive inhibition of COX and
decrease in oxygen radicals
 Diclofenac: ankylosing spondylitis, eye inflammation,
chronic tx of Rheumatoid Arthritis
 Ketorolac: analgesic agent, 60% excreted by kidneys
 renal damage
 Oxicams
 MoA: piroxicam is potent reversible COX-1 inhibition;
meloxicam for COX-2
 Piroxicam has 100% oral bio and ~50 hr half life

9. Indomethacin
 Powerful COX-1 inhibitor
 Also inhibits:
 PLA2
 PMN cell migration
 T-Cell and B-Cell proliferation
 Everything else is same as other NSAIDS
 Can’t be used as antipyretic or analgesic agent
due to toxicity
 Uses: Barter’s syndrome, PDA, nephrogenic
diabetes insipidus

10. Analgesic-Antipyretic Drugs
 Acetaminophen
 95% biotransformed in liver
 Small amount toxic metabolite formed  NAPQI 
hepatotoxicity
 Potent COX inhibitor in CNS; weak in inflamed
tissues

11. Anti-Inflammatory Steroids
 Glucocorticoids
 MoA:
 Alters #, distribution, function of peripheral





macrophages; decreases leukocytes, macros, cyto, etc
Inhibition of PG and LT synthesis
Decrease postcapillary permeability
Inhibits effects of complement system
Strong inhibitors of cellular immunity
Weak inhibitors of humoral immunity
 Diagnostic use:
 Dexamethasone suppression test used for differential
diagnosis of Cushing’s Syndrome

12. RELATED PRODUCTS
If you enjoyed this presentation, please take a look at the rest of our
products. Our website has many more FREE excellent presentations and
tons of other FREE information.
HIGHSCORE: Must Know
Pharmacology
Description: This is a book of
400+ flashcards covering 20
highly tested, and high-yield
topics in pharmacology. It is
designed so that you can use it
anywhere on any device or print it
out and use as flashcards.
Get the eBook: HERE!
Our site: Exam Masters Tutoring Service

13. RELATED PRODUCTS
HIGHSCORE: Comparisons of High Yield Topics for
the Medical Boards
Description: This book contains over 100
comparisons of some of the most highly tested
diseases and topics on the USMLE Step 2 CK. The
questions on the exam are much more vague than
what you see in the practice question banks and it
is very difficult to differentiate between two
diseases with similar symptoms. So this book is
designed to help students improve their score by
targeting these types of difficult questions.
Get the Free Sample: HERE!
Get the whole eBook: HERE!

14. RELATED PRODUCTS
USMLE STEP 2 CK TIDBITS & TIPS
MONTHLY SUBSCRIPTION
Join hundreds of other students
preparing for the USMLE Step 2 CK
on our USMLE Step 2 CK Tidbits &
Tips newsletter! It is an amazing
newsletter with tons of great info.
The monthly subscription entails a
weekly newsletter with info such as
high yield disease comparisons,
most commonly tested facts,
treatments & management, and
much more!
View a sample Newsletter: HERE!
Subscribe to this awesome Newsletter:
HERE!