Pharm Class Indications, Actions, Effects, Contraindications (WEEK 11)

Salicylates

-Anti-inflammatory, antipyretic, and analgesic agents

-Extracted from willow bark, poplar trees, and other

plants

-Inhibit synthesis of prostaglandin by blocking

cyclooxygenase enzyme (key enzyme in

prostaglandin synthesis)

-Used for mild to moderate pain, fevers and

inflammatory conditions

-OTC and prescription

-Relatively non-toxic when used as directed

Selective Cox 2 Inhibitor

-Anti-inflammatory, antipyretic, and analgesic agents

-Extracted from willow bark, poplar trees, and other

plants

-Inhibit synthesis of prostaglandin by blocking

cyclooxygenase enzyme (key enzyme in

prostaglandin synthesis)

-Used for mild to moderate pain, fevers and

inflammatory conditions

-OTC and prescription

-Relatively non-toxic when used as directed

Centrally Acting COX Inhibitor

- Not NSAIDs

• Used as an antipyretic and analgesic

• Works directly on cells in the hypothalamus causing

sweating and vasodilation to occur- this lowers

fever by releasing body heat

• MOA analgesic effect is unclear

• No anti-inflammatory properties

• Most frequently used in children for managing pain

and fever

• OTC drug

• Extremely toxic at high dosages: severe liver

toxicity leading to death

• Maximum daily dose for most: 4g/day

Interferons

Indications: treatment of leukemias, warts, hepatitis B, malignant melanoma, multiple sclerosis, granulomatous, malignant osteopetrosis, hepatitis C

Action:

-prevent virus particles from replicating inside cells

-Stimulate interferon receptor sites on noninvaded cells to produce antiviral proteins, which prevent viruses from entering the cell

-Inhibit tumor growth and replication, stimulate cytotoxic T cell activity and enhance inflammatory response

Contraindications: Pregnancy

CAUTION: Lactation; cardiac disease; myelosuppression; CNS dysfunction

Interleukins (IL)

-Cytokines (chemicals) secreted by active leukocytes to influence other leukocytes

-IL-1 stimulates T and B cells to initiate and immune response

-IL-2 is released from active T cells to stimulate the production of more T cells and to

increase activity of B cells

-Cause fever, arthralgia, and myalgia and induce slow-wave sleep (all to help conserve

energy)

Colony Stimulating Factors

Indications: severely neutropenic patients r/t antineoplastic chemotherapy; increase survival after myelosuppressive doses of radiation

Action: increasing production of cells

Contraindications: allergy to any component of the drug or E. coli produced product to prevent hypersensitivity reactions; pregnancy

CAUTION: hepatic/renal failure; bone marrow cancer or sickle cell disease due to stimulation effect on bone marrow; pregnancy/lactation

Immunosuppressants

-Inhibit patient’s immune system

-Used to treat severe autoimmune diseases

• -lupus, rheumatoid arthritis, myasthenia gravis, Hashimoto’s thyroiditis, multiple sclerosis

-Used to treat severe inflammatory processes

-Prevent tissue rejection following organ transplantation

• -Organ transplantations would be impossible without immunosuppressants

-Toxic to bone marrow → myelosuppression

-Suppress a specific antibody

-Increased risk of infections and lymphoma

-Include:

• -T and B-Cell Suppressors

• -Interleukin Receptor Antagonists (not a PD)

• -Monoclonal Antibodies

• -Immune Modulators

Monoclonal Antibodies

-Proteins designed to be attracted to a specific target

• May be designed to attach to a specific cell, virus, bacteria, antibody

• Specific functions to treat cancers, arthritis, MS, and other diseases

-Contraindications: Presence of known allergies to drug or murine products; presence of fluid overload; fever; previous admin of monoclonal antibody (repeat admin can result in hypersensitivity); pregnancy; lactation

-Adverse Effects: acute pulmonary edema (dyspnea, chest pain, wheezing); fluid retention; cytokine release syndrome (flulike syndrome can lead to shock); fever, chills, malaise, myalgia, nausea, diarrhea, vomiting, increased susceptibility to infection and cancer development

Immune Modulator

• Immune Stimulants:

–Interferons: interferon alfa-2b

–Interleukins: aldesleukin –Colony Stimulating Factor: filgrastim

• Immunosuppressants:

–T and B Cell Suppressor: cyclosporine

–Monoclonal Antibodies: bevacizumab

–Immune Modulator: omalizumab