ESSAY: NSAIDS CASE STUDY ASSIGNMENT
Using information gleaned from your readings on Eicosanoids, give a clear biochemical response
to these questions (Your answers should not be more than 2 pages):
a. A 65 year old retired construction worker is referred to the dialysis clinic following a
recent diagnosis of chronic kidney disease due to a prolonged use of of the NSAID
Ibuprofen. Explain the biochemical basis of NSAID nephropathy?
b. What is the biochemical rationale for the use of low dose aspirin in patients with
coronary artery disease? Why is Ibuprofen not a good substitute for aspirin in this
case?
Materials for this assignment
Glew & Rosenthal: Chapters 14 — 16 (I don’t have access to this book but please try to get a
reference from here.
Below is the transcript to Eicosanoids
Today we’ll be looking at the clinical applications of eicosanoids. And I’ll take a little bit of a
different approach today because I will be looking at some questions that help us to appreciate
the clinical applications of DES eicosanoids. The first question I’ll look at is about a drug called
Sally break’s, Sally Bragg’s easy. Cyclooxygenase two inhibit Tor. My question is, explain the
biochemical basis for the therapeutic benefits of disk drunk under dangerous adverse effects.
This drug now suddenly breaks was designed as a specific inhibitor of COX two into i carcinoid
generation pathway. The Eliott drugs or the end seeds like aspirin are nonspecific, inhibit those
of the cyclooxygenase enzyme system. So the inhibit COX one, an COX two. Now, if you’ve
ever taken any of those NSAIDS, you will realize that the biggest challenge that patients have
with the use of NSAIDS is the GI upset that they experienced. The patients tend to complain
about it, gastritis, heartburn, like an all saw Pepsi calls our pain that they experience when they
take NSAIDS. And so in a bead to be, to design drugs that will give you a similar effect. Bought
loc dot advice of GI effect. The Cox to inhibit those were identified again, the goal of the COX
two inhibitor to reduce the gastric toxicity that was very prevalent with the ease of NSAIDS, the
effect of Cox to inhibit those was still quite similar to the effects of the NSAIDS with respect to
the unknown analgesia and anti-inflammatory effects. Unfortunately, the inhibition of Cox to
actually reduces the production of Prosper cyclin, which is PG i2, which is a vasodilator. And it
also leaves the trombone scenes on touched. So you How, whereas you have a reduction in the,
in the synthesis of cyclin, you have an increase in the synthesis of the throne Bach saints,
especially from boxing, a2, what’s, what’s with that? Whereas prostate cyclin is a vasodilator,
Trump boxing IS promotes platelet aggregation. In other words, it promotes blood clot
formation, especially in the arterial system. So whereas these Cox to inhibit those were
successful in reducing pain and reducing inflammation, they run into a big problem and that was
they lost some of the vasodilate tree effects of plus the cyclin. And then unfortunately, they had
an increased incidence of blood clot formation because of the excessive amounts of from box
and a2 that was being generated due to the selective inhibition of COX two. Okay, and so far
celebrates has been pulled from the market because patients that had having a lot of issues with
blood clotting, hotbox strokes. Pulmonary embolism and those thromboembolic conditions on so
he was pulled from the market because of that. Okay. The next question we’ll look at is a little bit
of a case study. Read through the question and then I’ll kind of walk you through the the correct
responses to the questions. This is a case of a 25-year old man who presents to the EN knows and
truth claim ache would complains of a difficulty breathing. He was eventually diagnosed with
tons of light is and the doctor prescribed a cause of pregnant, pretty nice alone, which is a
corticosteroid to reduce the fever and the swelling. And so the questions include describe the
biochemical rationale for the use of prednisolone as an anti-inflammatory agent. And then what
are the possible activate those inducers of phosphor lipids a2. And what will be the biochemical
physiologic effect of its activation? Fessler fall glucocorticoids are known to inhibit
phospholipase A2. Phospholipase A2 is the enzyme initially mobilizes arachidonic acid from the
phosphor lipids in the cell membrane. And so if you are able to inhibit mobilization, you inhibit
the formation of arachidonic acid. You will subsequently inhibit the formation of eicosanoids.
And so because eicosanoids are involved in mediating inflammation, media Tim Payne, a
immediate fever, soiling under behaviors are blood vessels. It then means that if we inhibit
phospholipids a2, we will inhibit production of these eicosanoids, which would subsequently
lead to the anti-inflammatory effects that you get from glucocorticoids. The other thing is that
these glucocorticoids also inhibit the transcription of cooks too. And so by doing that, they also
will affect the ability to generate eicosanoids and therefore they have these anti-inflammatory
effect. What are possible activators of phospholipids? A2, outside thrombin, thrombin is eyes and
activate phospholipids a2 bacterial toxins, like the lipopolysaccharides bacteria release also
known to activate phospholipase A2. And the consequent consequence of this is that once you
activate phospholipase A2, you generate a lot of eicosanoids and you will tend to have a massive
inflammatory response to that, including blood clotting. Okay. The next question is full cost on
the therapeutic uses of the eicosanoids. And so I’m going to walk you through a number of
disease conditions on Dan, I’ll identify the eicosanoids are the prostaglandins in this case that I
used induce clinical conditions. The first one is erectile dysfunction. Erectile dysfunction
benefits from the use of prostaglandin E2, which is a vasodilator of cause vasodilation promotes
erect erection of these erect our tissues, especially in the *****. And so it does make sense that
using a vasodilate thought in prostaglandin E2 analog will give you that same visit I literally
effect on the help to attain or maintain erection in patients with erectile dysfunction,
prostaglandin i2, which is also prostate cyclin. Ease of vasodilate though any benefits patients
with pulmonary hypertension so reduces the pulmonary vasoconstriction, reduces the afterload
on helps to reduce pulmonary blood pressure in the patients. Also, somewhat dark conditions that
benefit from plus the cyclin prostaglandin I2 would be re nodes disease, renal disease causes on
pay for our visit, constriction, especially in the hands and feet. And so using like cycling can help
a knockoff that visit constriction on and helped to sustain blood supply to peripheral tissues.
Ischemic limb disease is another one that would benefit from a vasodilator like process cycling
of prostaglandin i to prostaglandin E2 has also been used in induction of label on the ripening of
the cervix. So you can actually inserted into the cervix to induce labor, ought to ripen the cervix
to quicken label a little bit. Prostaglandin I1 helps to promote a gastric blood flow and therefore
increases mu close production on the gastric mucosa. So it is protective of the gastric mucosa.
Patients with peptic ulcer disease in patients who have congenital heart disease disorders, like
transposition of the Great Arteries, some cyanotic condition of the heart. In the babies, usually
they will benefit from maintaining the patency of the doctors Arteriosclerosis. And in order to do
that, prostaglandin E2 serves to maintain that patency of the doctors arterial suits to allow time to
for circulation to be maintained in the baby before surgery is done. Glaucoma is another
condition that has recently been found to benefit from prostaglandins, especially prostaglandin F
two alpha has visit constrictive effects and helps to reduce the amount of fluid that accumulate,
that accumulates in the eyes of patients with glaucoma. Glaucoma usually results from increased
intraocular pressure and so DES prostaglandin F two alpha helps to reduce the production of
fluids in the eyes and helps to reduce intraocular pressure. And the last one I’d like to mention is
asthma. Asthma benefits from the use of five lipo oxygenase inhibit taus and also this system
eight that legal trying receptor antagonists are also used in asthmatic patients on these two
classes of drugs are helpful in asthma because the Likud trials that are produced by the lightbox
cDNAs pathway from arachidonic acid tend to promote bronchoconstriction. And so these drugs
are used to reduce the production of those legal trials or lightbox sense, reduce
bronchoconstriction.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
