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Chapter 22: Prostaglandins, NSAIDs, and Pharmacotherapy of Gout

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    AMA Citation
    Prostaglandins, NSAIDs, and Pharmacotherapy of Gout. In: Rollins DE, Blumenthal DK. Rollins D.E., Blumenthal D.K. Eds. Douglas E. Rollins, and Donald K. Blumenthal.eds. Workbook and Casebook for Goodman and Gilman's The Pharmacological Basis of Therapeutics New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com/content.aspx?bookid=1697&sectionid=111005280. Accessed February 19, 2020.
    MLA Citation
    . "Prostaglandins, NSAIDs, and Pharmacotherapy of Gout." Workbook and Casebook for Goodman and Gilman's The Pharmacological Basis of Therapeutics Rollins DE, Blumenthal DK. Rollins D.E., Blumenthal D.K. Eds. Douglas E. Rollins, and Donald K. Blumenthal. New York, NY: McGraw-Hill, , http://accesspharmacy.mhmedical.com/content.aspx?bookid=1697&sectionid=111005280.

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INTRODUCTION

This chapter will be most useful after having a basic understanding of the material in Chapter 33, Lipid-Derived Autacoids: Eicosanoids and Platelet-Activating Factor, and Chapter 34, Anti-inflammatory, Antipyretic, and Analgesic Agents: Pharmacotherapy of Gout in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. In addition to the material presented here, the 12th Edition contains:

  • Table 33-1 Eicosanoid Receptors that lists the major classes of eicosanoid receptors and their signaling characteristics

  • The molecular structures of lipid-derived autacoids, nonsteroidal anti-inflammatory drugs (NSAIDs), and drugs used to treat gout

LEARNING OBJECTIVES

  • Understand the mechanisms of action of drugs used as prostaglandin agonists.

  • Understand the mechanisms of action of the NSAIDs.

  • Understand the mechanisms of action of the drugs used in the pharmacotherapy of gout.

  • Know the untoward effects of prostaglandin agonists, NSAIDs, and the drugs used in the pharmacotherapy of gout.

  • Know the therapeutic utility of prostaglandin agonists, NSAIDs, and the drugs used in the pharmacotherapy of gout.

  • Know which drugs can be used in combination, and those that should not be used concomitantly to treat inflammatory disorders, fever, pain, arthritis, and gout.

DRUGS INCLUDED IN THIS CHAPTER

  • Acetaminophen (TYLENOL, others)

  • Allopurinol (ZYLOPRIM, ALOPRIM, others)

  • Alprostadil (CAVERJECT, EDEX, MUSE, PROSTIN VR PEDIATRIC)

  • Aspirin (acetylsalicylic acid, ASA)

  • Balsalazide (COLAZOL, others)

  • Bimatoprost (LUMIGAN)

  • Bromfenac (XIBROM)

  • Carboprost tromethamine (HEMABATE)

  • Celecoxib (CELEBREX)

  • Colchicine

  • Diclofenac (CATAFLAM, ZIPSOR, FLECTOR, VOLTAREN, SOLAREZE, CAMBIA, others)

  • Diflunisal

  • Dinoprostone (CERVIDIL, PREPIDIL)

  • Etodolac (LODINE)

  • Febuxostat (ULORIC)

  • Fenoprofen (NALFON 200, others)

  • Flurbiprofen (ANSAID, OCUFEN, others)

  • Ibuprofen (ADVIL, MOTRIN, NEOPROFEN, CALDOLOR, others)

  • Iloprost (VENTAVIS)

  • Indomethacin (INDOCIN, others)

  • Ketoprofen

  • Ketorolac (ACULAR, others)

  • Latanoprost (XALATAN)

  • Meclofenamate (MECLOMEN)

  • Mefenamic acid (PONSTEL)

  • Meloxicam (MOBIC, others)

  • Mesalamine (ASACOL, LIALDA, APRISO, DIPENTUM, CANASA)

  • Misoprostol (CYTOTEC)

  • Nabumetone (RELAFEN)

  • Naproxen (ALEVE, NAPROSYN, others)

  • Nepafenac (NEVANAC)

  • Olsalazine

  • Oxaprozin (DAYPRO)

  • Piroxicam (FELDENE, others)

  • Probenecid (PROBALAN)

  • Prostacyclin (epoprostenol, FLOLAN)

  • Rasburicase (ELITEK)

  • Salicylate (DOAN’S, MOMENTUM, others)

  • Salsalate

  • Sulfasalazine (AZULFIDINE, others)

  • Sulindac (CLINORIL, others)

  • Tolmetin (TOLECTIN, others)

  • Travoprost (TRAVATAN)

  • Treprostinil (REMODULIN)

MECHANISMS OF ACTION OF PROSTAGLANDINS AND THEIR ANALOGS
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MECHANISMS OF ACTION OF PROSTAGLANDINS AND THEIR ANALOGS
DRUG CLASS DRUG MECHANISM OF ACTION
PGE1 Alprostadil

Activates EP prostaglandin receptors in vascular smooth muscle causing vasodilation

The ductus arteriosus in neonates is highly sensitive to relaxation by PGE1
PGE1 Analog Misoprostol Activates EP prostaglandin receptors in the stomach, increasing mucous secretion and reducing acid secretion and pepsin content
PGE2 Dinoprostone Activates EP prostaglandin receptors in the uterus and cervix, promoting uterine contractions, cervical ripening, and cervical dilation
PGF2α Analog

Carboprost tromethamine

Latanoprost

Bimatoprost

Travoprost

Activates FP prostaglandin receptors in the uterus and cervix, promoting uterine contractions, cervical ripening, and cervical dilation

Activates FP prostaglandin receptors in the eye, causing a decrease in intraocular pressure by increasing aqueous humor outflow via the uveoscleral and trabecular meshwork pathway
PGI2 Prostacyclin Activates IP prostaglandin receptors in pulmonary artery smooth ...

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