"Xiao Li, my leg seems to be inflamed again. Please prescribe me some more of that anti-inflammatory drug , which is the cephalosporin I used last time."
"Uncle Zhang, I just took a look. Your legs do have some inflammation. But there is no need to use cephalosporins. Cephalosporins are antibacterial drugs and are not the same as anti-inflammatory drugs. "
" Isn't inflammation caused by bacterial infection? Same. The uncomfortable symptoms caused by pathogenic microorganisms such as bacteria are called infection . Antibacterial drugs are very effective. However, inflammation is not the same as infection. inflammatory response mainly refers to the body's response to various harmful factors. "
" This harmful factor covers many categories, such as high temperature, low temperature, mechanical trauma and other physical factors; strong acid , strong alkali, strong oxidant, etc. chemical factors; biological factors such as viruses, bacteria, protozoa ; and tissue necrosis, allergic reactions, foreign bodies, etc. . All factors that can cause tissue and cell damage can cause inflammation. "
believes. After reading the conversation between these two people, everyone has a better understanding of inflammation, but there is one more thing I hope everyone knows: there are only two types of anti-inflammatory drugs that are actually used clinically, and one is ibuprofen. Non-steroidal anti-inflammatory drugs represented by fen and so on, and two kinds of steroidal anti-inflammatory drugs such as glucocorticoids and .
One of the anti-inflammatory drugs - non-steroidal anti-inflammatory drugs
There are many types of non-steroidal anti-inflammatory drugs in clinical practice, which can generally be divided into selective cyclooxygenase 2 inhibitors (COX-2) and non- selective COX -2 inhibitor , selective cyclooxygenase 2 inhibitor like meloxicam, nimesulide , etc., ibuprofen, diclofenac sodium , etc. are non-selective COX-2 inhibitors .
Non-steroidal anti-inflammatory drugs mainly inhibit cyclooxygenase through and then inhibit the synthesis of prostaglandin . After non-steroidal anti-inflammatory drugs combine with cyclooxygenase, they cover up the active center of the enzyme. , thus blocking the conversion of arachidonic acid to prostaglandins catalyzed by cyclooxygenase, thereby exerting the anti-inflammatory effect of .
However, the clinical use of nonsteroidal anti-inflammatory drugs is limited due to the high incidence of adverse reactions. Non-steroidal anti-inflammatory drugs, while exerting their medicinal effects, can cause damage to the digestive system and damage to the kidneys, etc., thus triggering a series of adverse reactions.
Gastrointestinal adverse reactions often occur, including indigestion, peptic tract ulcers, gastrointestinal bleeding, etc. , which are mainly caused by non-steroidal anti-inflammatory drugs inhibiting prostaglandin synthesis and destroying the gastrointestinal mucosal barrier.
Therefore, gastric mucosal protective agents misoprostol , H2 receptor antagonists, proton pump inhibitors, etc. can be used together with nonsteroidal anti-inflammatory drugs, or selective COX-2 inhibitors It is also feasible and causes less damage to the gastrointestinal mucosa.
However, the use of selective COX-2 inhibitors requires attention to the risk of cardiovascular and cerebrovascular diseases , which may be related to the mismatch in the ratio and activity of COX-1 and COX-2 in the body, resulting in changes in heart and kidney function.
damage to kidneys is mainly reflected in renal perfusion and glomerular filtration function. Under normal circumstances, although prostaglandins do not participate in the maintenance of basic renal function, when blood volume decreases , prostaglandins can maintain renal perfusion and glomerular filtration function through vasodilation . This compensatory effect is impaired due to decreased prostaglandin synthesis following the use of NSAIDs.
In addition, the use of nonsteroidal anti-inflammatory drugs will increase the risk of stroke , and it is related to the fact that it can induce platelet aggregation to varying degrees, leading to an increased risk of venous thrombosis .
It is precisely because of the possibility of these adverse reactions, especially for the elderly, that you need to pay attention to the following two aspects when taking this anti-inflammatory drug .
On the one hand, we need to pay attention to the adjustment of drug dosage . Due to the loss of body water and the decline of various functions in the elderly, and they often have chronic diseases, they have multiple medications, and the absorption and protein binding capacity of non-steroidal anti-inflammatory drugs are higher than normal values. If there are any changes, you should pay attention to the patient's complaints of discomfort during actual medication and adjust the drug dosage in a timely manner.
It is recommended that the dosage of medication for the elderly should start with a small dose of . When increasing the dose, attention should be paid to observe whether there are any adverse reactions such as epigastric discomfort and so on. And try to choose enteric-coated tablets and sustained-release agent type pharmaceutical preparations to reduce gastrointestinal reactions, and try to take them before meals.
On the other hand, pay attention to the combined use of drugs and beware of unreasonable combined use of drugs. It is not recommended to use selective serotonin reuptake inhibitors, glucocorticoids, aspirin and other drugs at the same time , which will increase the risk of gastrointestinal ulcers or gastrointestinal bleeding; it should also be avoided combined with methotrexate , nonsteroidal antibiotics may decrease the renal clearance of methotrexate.
Steroidal anti-inflammatory drugs - glucocorticoids and their derivatives
Another anti-inflammatory drug is the glucocorticoid and its derivatives secreted by adrenal cortex that we will mention next.
Glucocorticoids can prevent lymphocytes , granulocytes , macrophages and other inflammatory cells from moving to the site of inflammation, and prevent inflammation such as kinins, histamine and slow-reacting substances. Media reacts. At the same time, the congestion degree of and the permeability of capillaries are reduced , resulting in a decrease in the functionality of phagocytes and ensuring the stability of the lysosomal membrane.
and interfere with the complement to participate in the inflammatory response and prevent the repair of post-inflammatory tissue damage. Therefore, in the later stages of inflammation, glucocorticoids can also alleviate tissue adhesion and scar formation.
Take budesonide as an example. After being absorbed in the body, it can improve the stability of smooth muscle cells and lysosomal membranes and endothelial cells , and reduce the release of allergic active mediators and cytokines . , thereby reducing smooth muscle contraction. At the same time, it can reduce the impact of cytokines on inflammatory cells, thereby producing a powerful anti-inflammatory effect.
However, the use of hormones needs to be cautious. If is used for too long or improperly used, will be complicated by a series of adverse reactions .
First of all, long-term use of glucocorticoids will reduce one's own immunity ;
Secondly, it is easy to cause water and electrolyte disorders , which not only causes water and sodium retention, edema and hypokalemia, but also Accelerate protein dissimilation and excretion of calcium and phosphorus, leading to muscle atrophy, osteoporosis and other .
Furthermore, glucocorticoid drugs promote the decomposition of protein, inhibit protein synthesis, and delay the formation of granulation tissue , resulting in slow wound healing .
In addition, after taking glucocorticoids, the drug cannot be stopped suddenly. Drug withdrawal reactions will occur, manifesting as loss of appetite, depression, low fever, hypotension , hypoglycemia and other uncomfortable symptoms.
How much do you know about antibacterial drugs that are easily confused with anti-inflammatory drugs?
After reading this, you must have a certain understanding of the only two anti-inflammatory drugs. Next, let’s take a look at antibacterial drugs that are easily confused with anti-inflammatory drugs.
Antibacterial drugs mainly refer to chemical substances produced by microorganisms or higher animals and plants in the course of their lives, and have anti-pathogenic microorganism effects. Although antibacterial drugs do not directly target inflammatory reactions, can destroy the pathogenic microorganisms that cause inflammatory reactions. This is why the two drugs are easily confused.
Antibacterial drugs commonly used in clinical practice include β-lactams, macrolides, quinolones , etc.
penicillins and cephalosporins antibacterial drugs are all representative drugs of β-lactam drugs.Since penicillin not only requires a skin test, a small number of patients may even suffer from severe anaphylactic shock during the skin test, and its use is subject to certain restrictions.
but Cephalosporins not only have strong antibacterial effects, but are also widely used. Different levels of cephalosporins have different levels of coverage for different bacterial infections.
azithromycin, erythromycin , etc. belong to the category of macrolide antibacterial drugs and have time-dependent . Although erythromycin has a longer half-life , its effect after administration is short, so it needs to be administered in a timely manner according to its half-life in the body. Erythromycin is usually effective 13 to 4 times a day. antibacterial effect.
The difference is that azithromycin will superimpose the antibacterial effect when the drug concentration changes, so azithromycin can usually achieve effective antibacterial effects ~2 times a day.
Quinolone drug is an antibacterial drug whose ends with "floxacin". It is widely used in clinical practice and its popularity is second only to β-lactam antibacterial drugs. It is a representative type of concentration-dependent drug . The higher the drug concentration in the patient's body, the better the antimicrobial drug is in clearing pathogens. However, should avoid administering in large doses, because the higher the drug concentration, the higher the risk of adverse reactions.
In addition, streptomycin , gentamicin and kanamycin and other aminoglycoside antibacterial drugs are very effective against Pseudomonas aeruginosa infection ; polyenes, flucytosine, and It is an antifungal antibiotic; it treats severe infections caused by drug-resistant Gram-positive bacteria vancomycin , etc., which also have certain clinical uses.
The doctor said
The reason why antibacterial drugs are easily confused with anti-inflammatory drugs is because antibacterial drugs can destroy pathogenic microorganisms that cause inflammatory reactions. As everyone knows, there are many factors that cause inflammatory reactions, such as physical, chemical and biological factors. Just one of them.
After reading this article, I hope everyone will remember: there are only two types of anti-inflammatory drugs in the clinical sense - non-steroidal anti-inflammatory drugs and steroidal anti-inflammatory drugs!
References:
【1】Liu Mingyu, Wang Linlin, Dong Tianqi, Ma Xuemei. Mechanism of action of antibacterial drugs and research progress [J]. 2021,48(15):125-126.
【2】Xu Yuhong, Pan Xiaotang. Non-steroidal Related analysis of adverse reactions of clinical application of anti-inflammatory drugs in the body [J]. Journal of Rational Clinical Drug Use , 2019, 12(02): 93-94.
[3] Xu Rongzhen, Wang Liuqing, Lu Jianxin, Zhang Shoucheng, Wang Hong. Safety and precautions for the use of non-steroidal anti-inflammatory drugs in the elderly [J]. Chinese General Medicine, 2019, 22(5):506-510
[4] Xia Zhengkun. Clinical application of glucocorticoids Re-understanding[J]. Journal of Medical Postgraduates,2018,31(02):113-117.
[5]He Mengjing, Zhou Wei. Clinical application of glucocorticoids[J]. Chinese Clinical Research, 2018,31( 05):679-681.
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