Anti-inflammatory agents: Diclofenac, Ketorolac, Ibuprofen, Naproxen, Piroxicam, Phenacetin, Acetaminophen, Antipyrine, Phenylbutazone | Pharmaguideline
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  • Apr 17, 2020

    Anti-inflammatory agents: Diclofenac, Ketorolac, Ibuprofen, Naproxen, Piroxicam, Phenacetin, Acetaminophen, Antipyrine, Phenylbutazone


    Anti-inflammatory drugs are the drugs used to reduce inflammation and pain for the management of edema and tissue-damaging. Non-steroidal anti-inflammatory medicines (NSAIDs) and non-narcotic analgesics are other names for them.

    Diclofenac

    STRUCTURE



    Chemically, it is sodium [0-(2,6 –dichloroanilino) phenyl] acetate. It inhibits COX-2 with more efficacy than COX-1 inhibitors and has fewer GI side effects than aspirin.

    Uses
    As an anti-inflammatory, antipyretic, and analgesic agent.

    Side effects
    Nausea, vomiting, ulceration, headache.

    Ketorolac

    STRUCTURE


    Because it lacks the benzylic methyl group, it has a half-life of 4 to 6 hours and is not vulnerable to oxidation.

    Uses – in the management of post-operative pain.

    Side effects – stomach pain, GI irritations, ulcers.

    Ibuprofen

    STRUCTURE



    Pain, fever, and inflammation are treated with this non-steroidal anti-inflammatory drug (NSAID).

    Mechanism of action –
    PTGS1 and PTGS2 encode the cyclooxygenase enzymes COX-1 and COX-2 that ibuprofen inhibits in a non-selective and reversible manner.

    Uses –
    In the treatment of rheumatoid arthritis, osteoarthritis, analgesic, and antipyretic. It should not be taken during pregnancy or breastfeeding since it can enter the foetal circulation and breast milk. It is less prone to cause GI ulcers than salicylates.

    Naproxen

    STRUCTURE



    Chemically, Naproxen is naphthyl 6-methoxyisopropionic acid. It is a non-steroidal anti-inflammatory, anti-rheumatic, analgesic, anti-dysmenorrhoeal, and vascular headache suppressant.

    Naproxen is having (partly) an ability to inhibit COX-1 and COX-2. In addition to blocking the cyclooxygenase (Prostaglandin synthase) enzyme, it also lowers the formation of prostaglandins by catalyzing the conversion of arachidonic acid to endoperoxides.

    SAR
    COOH group is essential for the activity. Replacement of this group diminishes or abolishes the activity.

    The anti-inflammatory activity of COOH compounds will increase if the acidity of the group increases. Decreases in acidity will decrease anti-inflammatory activity.

    The Presence of an indole ring is necessary for the activity. Substitution at the C5 position (R2) by fluro, methyl, dimethylamino0, alkoxy, or acetyl group increases the activity. Alkyl group at C2 position increases activity as compared to aryl groups. Substitution at the acetic acid chain gives compounds of greater activity. E.g. Indomethacin, sulindac, ketorolac, etc.

    Presence of methoxy at –C5 position group on the ring, methyl at C2 position, dimethyl amino group at C5- position in indole moiety of indomethacoin exhibit activity.

    A phenyl group with a chlorinated or fluorinated group at the para position also has anti-inflammatory properties.

    Piroxicam

    STRUCTURE



    It is a non-steroidal anti-inflammatory medicine (NSAID) used to treat the pain and inflammation of osteoarthritis and rheumatoid arthritis.

    WARNING
    Piroxicam should not be used just before or after bypass heart surgery. It may be fatal. Also, the wrong use of this drug can cause intestinal bleeding that can cause the death of the person.

    USES
    Osteoarthritis (arthritis caused by a breakdown of the cartilage lining the joints) and rheumatoid arthritis are two illnesses for which this drug is prescribed (arthritis caused by swelling of the cartilage lining the joints). Piroxicam belongs to the class of drugs known as NSAIDs.

    Phenacetin

    STRUCTURE



    Chemically, it is p-ethoxyacetamilide. It was introduced in 1885 to medicine. It causes hemolytic anemia and meth-haemoglobinanemia. Due to its side effects, which include an increased risk of some malignancies and renal impairment, its usage has decreased. Paracetamol (acetaminophen) is the product of its metabolism.

    Uses
    Analgesic, and anti-pyretic activity
    Side effects – include GI irritation.

    Acetaminophen

    STRUCTURE



    It is also called paracetamol. N-acetyl-p-aminophen is its chemical name. Phenacetin is its substrate. It inhibits the cyclooxygenase enzyme centrally but has a less effect peripherally.

    Mechanism of action of paracetamol
    Paracetamol (Acetaminophen)
    Penetrates the blood-brain barrier
    Blocks cyclooxygenase (COX3) in the brain
    Prostaglandins (PGE) synthesis and release in the central nervous system are inhibited.
    Inhibits the action of endogenous pyrogens on the heat-regulating centers in the brain.
    Antipyretic effect

    Uses
    Analgesic and anti-pyretic activity

    Side effects
    Liver toxicity in chronic alcoholics.

    Antipyrine

    STRUCTURE

    Chemically, it is 2,3-dimethyl – 1-phenyl-3-pyrazoline-5-one. A synthetic compound that was used in medicine for the first time. Powdery white, colorless powder with a slight bitter taste. It has no odor or color. Hydrogen peroxide, alcohol, and chloroform are all freely soluble in it.

    Uses
    Analgesic, anti-inflammatory, and antipyretic activities.

    Side effects
    Include GI irritation, swelling, and vomiting.

    Phenylbutazone

    STRUCTURE



    They are anti-inflammatory drugs, also possess some analgesic and anti-pyretic activities. They also have a little uricosuric effect.

    Uses
    Rheumatoid arthritis and osteoarthritis are treated with phenylbutazone.

    Side effects
    Due to bone marrow depression, the duration of treatment should be limited to seven to ten days.
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