Summary Inflammatory Bowel Disease treatment summarised

Anti-inflammatory drugs

Steroidal: Non-steroidal:
 Cortisone  Acetaminophen
 Hydrocortisone  Aspirin
 NSAIDS
 COX-2 inhibitors


INFLAMMATION:
Inflammatory mediators:

 Vasoactive amines (Histamine, 5HT)  Adhesion molecules
 PAF  Substance P
 Complement system  Arachadonic acid metabolites
 Kinin system  Prostaglandins (PGE2) (PGs)
 Cytokines main inflammatory
 Nitrous oxide mediator
 Thromboxane A2 (TXA2)
 HETE (hydroxyl-eicosatetraenoic
acid)
 Leukotrienes (LTs) – mediated by
COX




1. FLUID (vascular) phase
 Acute/transient
 ↑ vasodilation  ↑ vascular bed permeability to plasma proteins
 ↑ fluid helps:
i. Dilute irritant
ii. ↑ [antibodies] from blood  inflamed area
iii. Supply nutrients  the immune cells

2. CELLULAR (exudative) phase
 Subacute
 Infiltration:
i. Leukocytes
ii. Phagocytic cells
 Tissue macrophages & polymorphonuclear leukocytes (PMNL)  migrates  inflamed area


3. FIBROUS (proliferative) phase
 Chronic proliferative
 Formation of:
i. New connective tissue (fibrous) containing fibroblast
ii. New capillaries
 Tissue degeneration &
 Fibrosis

, NSAIDS COX-2 Other analgesic Drugs for arthritis: Drugs for gout:
inhibitors
 Adalimumab  Allopurinol
 Inhibit PGs  Acetaminophen  Anakinra  Colchicine
 Celecoxib
synthesis by (Paracetamol)  Chloroquine  Probenecid
inhibiting  Etanercept  Febuxostat
COX  Gold salts
 Infliximab
 Leflunomide
 Methotrexate
 D-penicillamine
 Aspirin
 Diflunisal
 Diclofenac
 Etodolac
 Fenamates
 Fenoprofen
 Flurbiprofen
 Ibuprofen
 Indomethacin
 Ketoprofen
 Meloxicam
 Methylsalicylate
 Nabumetone
 Naproxin
 Nimesulide
 Oxaprazin
 Piroxicam
 Sulindac
 Tolmetin




COX 1 COX 2 COX 3