[PHARM-09] Autacoids, Analgesics, NSAIDs, Opioids, Gout & Disease-Modifying Antirheumatic Drugs (DMARDs)
PHARM-09 • 2. PharmacologyLearning Objectives
Contrast non-selective COX-1/COX-2 inhibitors ([6.4] Ibuprofen, [6.5] Diclofenac, [6.6] Naproxen), preferential COX-2 inhibitors ([6.8] Aceclofenac), selective coxibs ([6.9] Etoricoxib), and [6.1] Paracetamol.; Apply the WHO Analgesic Ladder and opioid reversal/toxicity protocols ([6.10] Morphine, [6.11] Fentanyl, [6.12] Tramadol, [12.36] Naloxone).; Differentiate acute gout therapy ([6.18] Colchicine, NSAIDs) from chronic urate-lowering therapy ([6.16] Allopurinol, [6.17] Febuxostat) and rheumatoid arthritis DMARDs ([6.20] Methotrexate, [6.21] Hydroxychloroquine, [6.22] Sulfasalazine).
Chapter Overview & Core Explanation
Pain and inflammation medicines work either peripherally by blocking cyclooxygenase (COX) enzymes that make inflammatory prostaglandins, centrally in the spinal cord and brain by activating opioid receptors, or immunologically by slowing autoimmune joint destruction.
Key Exam & Clinical Takeaways
- Never initiate [6.16] Allopurinol or [6.17] Febuxostat during an acute gout flare without anti-inflammatory cover, as rapid serum urate shifts mobilize synovial tophi and worsen the flare.
- [6.20] Methotrexate for rheumatoid arthritis or psoriasis is dosed ONCE WEEKLY (never daily), with [10.7] Folic Acid given on non-methotrexate days.