Okay guys timmy coming at you again and today what i want to do is i want to explain to you the mechanism of action of nsaids and cortical steroids now look one of the things you have to remember and they get their names court cortic right that should sound familiar that should sound like cortisol right and we learned in the last unit that cortisol suppresses
The immune system right and one of the functions of the immune system is to produce inflammation so if you suppress the immune system you won’t get inflammation that’s how cortical steroids work as an anti-inflammatory now it’s very basic and i’ll get into a little more detail about this all right nsaids as the name implies non-steroidal anti-inflammatory drugs
All right so what i’m going to do is i’m going to talk to you about those first and then i’m going to explain to you the mechanism for action of the cortical steroids all right so here we go first of all these are the common nsaids right you should know that now one of the drugs that you won’t see on the list is acetaminophen right or tylenol because tylenol is
Not an anti-inflammatory tylenol works centrally in the brain it doesn’t affect what happens in the body in terms of the inflammatory process more on that later but these are the common ones right you got your your motrin your naproxen right your cell breaks your endomethyl sin into sin all that stuff and high dose aspirin can function as an anti-inflammatory
Two all right so watch if you recall from watching the video on inflammation prostaglandins these chemicals are intimately involved in producing inflammation they’re also intimately involved in producing fever and they also stimulate pain receptors in the area of tissue damage or infection so prostaglandins when they’re produced by white blood cells or other
Cells of the immune system or they’re released from your own cells let’s say you twist your ankle and you damage your ankle cells those damaged cells will release those prostaglandins and that will cause inflammation now how do you get inflammation number one the capillaries start getting leaky so make sure you watch that video and if they become leaky then what
Happens watch it hang out right if they become leaky i’m gonna get this all right so here’s a little capillary i’m going to put some holes in it and then you got a cell boom who cares what cell it is what’s going to happen is because there’s now holes in the capillary fluid from the capillary is going to go into the interstitial space right so and that fluid
Is going to collect in the interstitial space and produce edema so one of the signs of inflammation is of course swelling edema now the other thing is is that it’s going to cause arterial vasodilation right so you’re going to get the arterial vasodilation you remember that arteries carry blood that’s oxygenated and because arteries tend to stay closer to the core
Of the body right you don’t have a lot of arteries that come to the surface of the skin that blood is warmer so that area will become red and warm and again they stimulate pain receptors here’s the other thing too prostaglandins are involved in the blood clotting mechanism so prostagland nsaids are also can be used as a anticoagulant that’s why if you’re having
Surgery like elective surgery then you’re informed that you should stop taking aspirin or nsaids about seven days before you have surgery because they don’t want you taking a bunch of ibuprofen or aspirin and then bleeding out during surgery and they can’t control it all right so remember that nsaids they work at the site of the tissue damage or infection right
So they’re anti-inflammatory drugs and because prostaglandins are also involved in the formation of fever they can be used as antipyretic drugs and prostaglandins also stimulate pain receptors so they can be used as analgesics right so they reduce inflammation they reduce pain they reduce fever and they’re an anticoagulant and then real quick my two cents worth
On what about tylenol tylenol you produce prostaglandins in your brain and where do you feel pain in your brain you should write that down look again you’ve got a smiley face there so tylenol inhibits the synthesis of prostaglandin centrally in the brain so they can be used tylenol can be used as an analgesic to reduce pain and it can be used as an antipyretic
Right it can reduce fever because the hypothalamus controls temperature and if you can prevent the synthesis of prostaglandins in your brain bam you won’t get a fever but because they act centrally and inflammation damage to parts of the body occur in the body and not in the brain then tylenol cannot be used as an anti-inflammatory it’s very important because
The mechanism of action is different if you got a kid and they got a fever right you call the doctor doctor doctor my baby’s got a fever what do i do and they’ll say oh no that’s what i’d say too i don’t know look it up no they’re gonna tell you to alternate ibuprofen and tylenol that way you reduce the risk of overdosing a kid on that one particular medication
Because the mess mechanism of action is different and by altering it you can control that fever and you don’t give them tylenol and ibuprofen all the time right you want that fever to go up the body does stuff that makes sense you just don’t want that fever to stay up or get real high that’s why if you’ve got a kid’s got a fever of 101 or 102 okay that’s good
The body does stuff that makes sense and from that video i explained to you that the cells of the immune system that control that control infection work better at higher temperatures so you don’t want to constantly suppress that fever that’s why it’s every four to six hours see there’s reasons why they do stuff all right okay now again quick and dirty hope hopefully
That helps let’s look at steroids for a minute right now watch arachidonic acid which is a essential fatty acid is required in order to make these chemicals of inflammation and just so you know prostaglandins are not the only chemicals that are involved in inflammation or producing fever so if you look nsaids just inhibit the synthesis of prostaglandins where
Cortical steroids basically inhibit the whole process of inflammation that is why steroids cortical steroids that mimic cortisol are much more powerful anti-inflammatory drugs the problem with that is that and this is very important anytime you see a cascade of chemical reactions like here the higher the farther up you inhibit that process here you’re inhibiting
It right here prostaglandins here with cortical steroids you’re inhibiting this that means that you’re inhibiting this process and this process and as a result you’re going to get this profound anti-inflammatory effect but you’re also going to get the other side effects associated with the use of cortical steroids because you’re basically suppressing the entire
Inflammatory process that’s why cortical steroids are not used forever it’s bad for you and they’re usually given in a step down dose right and i explain that too right so they step you down on cortical steroids to allow your own adrenal cortex to start naturally producing that cortisol again tell me you got that so that’s the primary difference between nsaids
And cortical steroids and also a little tidbit on the effects of tylenol and i hoped that helped just a little bit
Transcribed from video
MECHANISM OF ACTION OF NSAIDS, ACETAMINOPHEN AND CORTICOSTEROIDS By Timothy Sorensen
