Inflammation, NSAIDs, and Gout Review

Flashcards are intended to help students recall key concepts and detailed information relevant to inflammation, acute and chronic inflammatory responses, pharmacologic interventions including NSAIDs, and management guidelines for gout.

Inflammation is a physiologic response to or .

tissue injury; infection

The four cardinal signs of acute inflammation are __, __, __, and __.

Pain; Redness; Heat; Swelling

Chronic inflammation may lead to and .

tissue destruction; loss of function

The phases of inflammation include Phase 0 (trigger) → Phase 1 () → Phase 2 () → Phase 3 () → Phase 4 () → Phase 5 (__).

Ca²+ release; histamine/protease release; phospholipase activation; reactive oxygen species; cytokine production

Acute inflammation is characterized by __, __, __, and __ as its signs.

Pain; Redness; Heat; Swelling

The main mediators of inflammation include __, __, __, and __.

Cytokines; prostaglandins; leukotrienes; reactive oxygen species

The treatment goal for acute inflammation is to use __, while for chronic inflammation the goal is __.

NSAIDs; DMARDs

The cardinal signs of inflammation use the mnemonic __: Pain, Redness, Swelling, Heat, (Loss of function).

PRSH(L)

Phase 5 of the inflammatory response involves the production of __.

cytokines

NSAIDs inhibit __ which leads to decreased production of prostaglandins and thromboxanes.

cyclooxygenase (COX) enzymes

The two main pathways of arachidonic acid metabolism are and .

Cyclooxygenase (COX); Lipoxygenase (LOX)

Corticosteroids inhibit __ and consequently prevent the release of arachidonic acid from membranes.

phospholipase A2

COX-1 is involved in __, whereas COX-2 is induced during __ and __.

housekeeping functions; pain; inflammation

The clinical significance of COX-1 inhibition primarily involves __, __, and __.

gastric mucosa; platelet aggregation; kidney function

Celecoxib is an example of a __-2 selective inhibitor.

COX

NSAIDs are commonly used to treat __, __, and __.

pain; inflammation; fever

Indomethacin, ibuprofen, and naproxen are types of __.

NSAIDs

is the only irreversible COX inhibitor, while aspirin causes in hemophilia.

Aspirin; increased bleeding

The mechanism of action for tramadol involves weak agonism at the receptor and inhibits the reuptake of and __.

mu-opioid; norepinephrine; serotonin

Acetaminophen primarily acts in the and is preferred for patients with .

CNS; peptic ulcer disease

Patients with renal impairment should avoid __ due to increased risk of nephrotoxicity.

NSAIDs

In acute gout, the first symptom typically involves in one joint, often the big toe, referred to as .

severe pain; podagra

Colchicine is used primarily for __ but does not alter uric acid metabolism.

acute gout attacks

The normal serum uric acid level limit for men is __ mg/dL.

8

The source of uric acid is the end product of metabolism via oxidase.

purine; xanthine

First-line treatment for chronic gout involves __, and they should not be started during an __.

urate-lowering agents; acute attack

The mnemonic for the adverse effects of NSAIDs is __, which refers to GI, Cardiac, Renal, Asthma, Skin, and Hepatic effects.

G-CRASH

Indomethacin is particularly effective for managing and is used in babies to close a .

acute gout attacks; patent ductus arteriosus

and are xanthine oxidase inhibitors that lower uric acid levels.

Allopurinol; Febuxostat

Probenecid increases uric acid excretion by inhibiting tubular __ of uric acid.

reabsorption

Corticosteroids can be used to manage gout in patients with or if NSAIDs are .

renal impairment; contraindicated

Common side effects of colchicine include __, __, and __ due to its gastrointestinal toxicity.

nausea; vomiting; diarrhea

Celecoxib is preferred over traditional NSAIDs due to irritation, but it carries an increased risk of .

less gastric; cardiovascular issues

The antidote for acetaminophen overdose is __, which replenishes glutathione to neutralize hepatotoxic metabolites.

N-acetylcysteine (NAC)

Inhibiting COX leads to reduced synthesis of __, __, and __.

prostaglandins; thromboxanes; prostacyclins

Drug class of choice for chronic inflammatory diseases other than NSAIDs is __.

DMARDs

Gout is characterized by recurrent acute arthritis due to deposits of in joints.

monosodium urate crystals

In the pathophysiology of gout, hyperuricemia leads to inflammation resulting in __, __, and __.

pain; redness; swelling

There is a risk of GI bleeding when long-term NSAID use is combined with __.

anticoagulants

In acute gout, NSAIDs are preferred over corticosteroids unless the latter are contraindicated due to __ issues.

renal

Patients should be counseled about NSIAD-induced __, especially in the elderly or those with pre-existing kidney conditions.

nephrotoxicity

The mnemonic for the major effects of prostaglandin synthesis inhibition is __: Analgesia, Antipyresis, Anti-inflammatory, Closure.

A³C

The enzyme that converts xanthine to uric acid is __ oxidase.

xanthine

What is the mechanism of action of acetaminophen in its analgesic effects? It inhibits __ in the CNS.

COX

Aspirin should not be given to patients with __ because it may cause significant bleeding issues.

hemophilia

The anti-inflammatory effect of corticosteroids in gout comes from their ability to decrease the release of inflammatory mediators by inhibiting __.

phospholipase A2

Use of __ agents should be avoided during acute gout attacks because they may exacerbate pain.

urate-lowering

The __ mechanism of action of probenecid involves the inhibition of uric acid reabsorption in renal tubules.

uricosuric

The __ for easing a gout attack is NSAIDs, with indomethacin being a common choice.

first-line treatment

Indomethacin is particularly effective for __ and is often used in combination with colchicine.

acute gout attacks

Repeated gout attacks may lead to chronic __ or degenerative joint disease characterized by joint damage.

arthritis

Renal excretion of uric acid accounts for to % of total uric acid clearance.

70; 80

NSAIDs can impact renal function by reducing __ which may lead to increased serum creatinine levels.

glomerular filtration rate (GFR)

The __ effect of aspirin is dose-dependent and should be monitored in patients at risk.

antiplatelet

The __ from purine metabolism is primarily eliminated via the kidneys in healthy individuals.

uric acid

When introducing xanthine oxidase inhibitors, monitor uric acid levels closely, adjusting dosages to maintain levels __ mg/dL or less.

6

Mild to moderate pain without inflammation can be treated with __, which acts primarily in the CNS without significant anti-inflammatory action.

acetaminophen

NSAID classification includes salicylates, propionic acid derivatives, acetic acid derivatives, and __ agents.

enolic acid derivatives

__ significantly interacts with aspirin by enhancing its gastrointestinal toxicity.

Alcohol

During the management of gout, time to intervention is crucial; treatment should ideally begin within to hours of the attack onset.

12; 36

__ inhibits microtubule formation thereby blocking leukocyte migration in acute gout.

Colchicine

Prostaglandins are important mediators in the inflammatory process and are produced from arachidonic acid via the __ pathway.

cyclooxygenase

The risk of and increases with long-term NSAID use, particularly in older adults and those with pre-existing conditions.

gastric ulcers; renal damage

Clinical use of colchicine must be managed carefully due to its GI adverse effects, which can be very __ in some patients.

severe

The drug class __ can provide effective pain relief in a post-operative setting, particularly when NSAIDs are contraindicated.

opioids

When considering patient education regarding NSAIDs, advise patients to limit their use to __ days to avoid excessive GI distress.

5

In managing gout attacks, caution should be taken with __ drugs as they can initially worsen symptoms.

urate-lowering

Inhibiting COX-2 specifically can provide anti-inflammatory effects while sparing __ function compared to non-selective NSAIDs.

gastrointestinal

The and pathways both contribute to eicosanoid synthesis from arachidonic acid.

cyclooxygenase; lipoxygenase

To assess the condition of gout, monitoring uric acid levels is often performed with a target goal of under __ mg/dL for patients.

6

Nonacetylated salicylates are favorable in patients with a history of __ as they exhibit less platelet inhibition.

asthma

The __ is a common clinical scenario for nephrologists when dealing with potential serological abnormalities related to gout.

hyperuricemia

Celecoxib and other COX-2 selective NSAIDs present a therapeutic option with a risk of cardiovascular side effects due to __ inhibition.

prostaglandin

Extended use of corticosteroids as a treatment for gout can result in the risk of __ and other related adverse effects.

systemic effects

__ are the preferred drugs during acute gout flares, particularly within the first 48 hours.

NSAIDs

Adjustments to pharmacologic therapies in patients with gout should account for potential drug __ and liver function.

metabolism

The mechanism of action for non-acetylated salicylates does not include __ inhibition, making them safer in certain patient populations.

cyclooxygenase

Which drug possesses both anti-inflammatory and analgesic properties and is frequently utilized in the management of acute pain? __.

Ketorolac

Owing to its weak opioid effect and multi-modality action, __ is commonly prescribed for patients with moderate pain and a risk of dependency.

Tramadol

__ is characterized by an autoimmune response leading to chronic inflammation in joints, requiring distinct treatment strategies from gout.

Rheumatoid arthritis

The unique traits of NSAIDs include a combination of __, __, and __ in the context of pain relief.

analgesic; antipyretic; anti-inflammatory

__ presents as sudden, severe pain and is often triggered by a diet high in purine-rich foods for patients with dysregulation of uric acid metabolism.

Acute gout attack

For chronic gout management, initiate __ therapy early in the course of treatment to maintain low uric acid levels effectively.

urate-lowering

__ is critical to ensure that patients receive appropriate postoperative care without the risk of GI complications when NSAIDs are used.

Monitoring

Long-term management of gout may necessitate combination therapy; however, cautious strategy should be exercised for and .

renal function; medication interactions

Recalling the major effects of prostaglandin synthesis inhibition can be simplified with the mnemonic __.

A³C

Assessing patients during acute gout should include awareness of factors that may precipitate attacks, such as and rapid loss.

dehydration; weight

A __ pain regimen may include combining long-acting and short-acting analgesics for improved effect.

multimodal

__ therapy for gout should ensure to balance efficacy with safety considerations specific to the patient’s overall health profile.

Pharmacologic

Pharmacogenomics may play a role in individual responses to treatments for gout, particularly for drugs such as and .

allopurinol; febuxostat

Continuous education on the side effects of all medications is essential for __ in chronic gout management.

patient adherence

Because allopurinol affects uric acid levels, monitor patients for signs of __ during initial therapy.

allergic reactions

Acetaminophen can be beneficial due to its safety profile in patients with potential __ allergies when alternatives are contraindicated.

NSAID

Caution is advised when prescribing medications that can impact ____ levels, commonly leading to drug interactions seen in patients with chronic conditions.

liver

As a part of comprehensive patient care, utilize __ strategies to prevent complications associated with NSAID therapy.

prophylactic

Reviewing patients' medication history is essential for avoiding interactions, particularly with medications affecting __ functions.

liver

__ in gout can be effectively managed through lifestyle modifications, dietary changes, and maintaining proper hydration status.

Exacerbations

Trigger points for inflammation may also include oxidative stress-related conditions such as __ and environmental triggers.

smoking

Rheumatoid conditions should be addressed distinctly from gout as they often require more comprehensive management involving and therapies.

DMARD; biologic

Utilizing effective counseling on uric acid management can aid in reducing __ risk factors for gout.

modifiable