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Anti-inflammatory & Pain-reducing drugs. Chapter 13 -1. OBJECTIVES. Terminology used to describe anti-inflammatory drugs MOA by which inflammation occurs MOA which glucocorticoids and NSAIDs work Comparisons of glucocorticoids and NSAIDs in their effects and side effects

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  • Terminology used to describe anti-inflammatory drugs

  • MOA by which inflammation occurs

  • MOA which glucocorticoids and NSAIDs work

  • Comparisons of glucocorticoids and NSAIDs in their effects and side effects

  • Precautions that apply to glucocorticoids, nonsteroidal anti-inflammatory drugs, and cyclooxygenase-2 inhibitor drugs


  • Anti-inflammatories: Drugs that relieve pain or discomfort by blocking or reducing the inflammatory process

    • Steroidal anti-inflammatory drugs (corticosteroids)

    • Nonsteroidal anti-inflammatory drugs (NSAIDs)

    • not considered to be true analgesics

      • Opoids work on CNS and reduce perception of pain

Moa inflammation
MOA - Inflammation


Arachidonic pathway

Phospholipids: cell membrane


  • GOOD PG: PgE and PgI2. normally decrease the volume, acidity, and pepsin content of gastric secretions released during normal digestion

Anti inflammatory drugs
Anti-inflammatory Drugs

  • Two main groups of anti-inflammatory drugs

    • Steroidal anti-inflammatory drugs block the action of phospholipase (lipoxygenase)

    • Nonsteroidal anti-inflammatory drugs block the action of cyclooxygenase (thromboxane)

Steroidal anti inflammatories
Steroidal Anti-inflammatories

  • Corticosteroids /adrenocorticosteroids

    • hormones produced by the cortex (the outer layer) of the adrenal gland.

    • mineralocorticoids

      • water and electrolyte balance (sodium, potassium, and other electrolytes), aldosterone

      • Hypoadrenocorticism/ Addison’s:

        • hyperkalemia, hyponatremia because of a lack of aldosterone production

        • TX: desoxycorticosterone pivalate (Percorten-V

    • glucocorticoids

Glucocorticoids antiinflammatories

  • Inhibit phospholipase, and to a lesser degree cyclooxygenase

    • Decreasing the production of prostaglandins and leukotrienes

  • Every corticosteroid drug has both mineralocorticoid (sodium retention) and glucocorticoid (anti-inflammatory effects to some degree

  • Are regulated by negative feedback

Glucocorticoid pros
Glucocorticoid - Pros

  • decrease inflammation

    • relieve pruritus

  • help maintain the integrity of the capillaries - decreases swelling

  • inhibit fibroblasts: reduce scarring by delaying wound healing

normal therapeutic doses of glucocorticoid does not affect humoral immunity so ok to vaccinate animals on these drugs

Glucocorticoid cons
Glucocorticoid - Cons

  • Dec. fibroblast activity delay wound healing

  • Suppress T-lymphocytes (normal therapy dose):

    • Protects fungal agents (e.g., histoplasmosis…)

    • Horses: fungal eye infections

  • Inc. gastric acid secretion and decrease mucus production: hyperacidity and GI ulceration

  • catabolize protein in the cornea > deepening ulcer, Desmetocele: poor prognosis

  • +/- induce abortion: cattle and mares , bitches

  • Stress leukogram: lymphopenia, monocytopenia, eosinopenia, neutrophilia: sequestered - lungs, spleen

Cushing s disease hyperadrenocorticism
Cushing’s Disease (hyperadrenocorticism)

  • Corticosteroids: catabolic – breakdown of protein > provide amino acids for gluconeogenesis

    • hyperglycemia

    • muscle wasting atrophy, alopecia, and decreased bone density.

    • “pot-bellied” appearance of dogs after long term glucocorticoid treatment

PU/PD/PP, risk to infections

iatrogenic Cushing's : DON’T GIVE TOO MUCH: EOD

Addison s disease hypoadrenocorticism
Addison’s Disease (hypoadrenocorticism)

  • extended use of glucocorticoid: lack of CRF and ACTH

  • adrenal cortex begins to atrophy > natural cortisol is diminished.

weakness, lethargy, vomiting, and/or diarrhea

Taper off slowly

Uses for glucocorticoid drugs
Uses for Glucocorticoid Drugs

  • Overreaction of the immune system: Autoimmune reactions such as lupus, Autoimmune hemolytic anemia, Hypersensitivity reactions such as allergic reactions

  • Shock

  • Systemic disease (Addison’s) OR iatrogenic cushion’s disease 

  • Cancer: Lymphosarcoma: lymphocytosis

    • glucocorticoids are part of the treatment protocol for this cancer

  • Inflammatory conditions: Ocular inflammation, MSK inflammation, IVD

  • Lameness (horses)

  • Pregnancy termination (Don’t use in pregnant animals)

  • Corticosteroids adrenocorticosteroids glucocorticoids

    Topical steroids almost always effect systematically so don’t give to immunocompromised/ pregnant animals


    • Short-acting: < 12 hrs

      • Hydrocortisone: topical

      • Cortisone

    • Intermediate-acting: 12 to 36 hrs; EOD; allergies/ inflammation

      • Prednisone

      • Prednisolone

      • Triamcinolone

      • Methylprednisolone (depomedrol)

      • Isoflupredone

    • Long-acting:12 to 36 hours

      • Dexamethasone

      • Betamethasone

      • Flumethasone

    Glucocorticoids formulations
    Glucocorticoids - Formulations don’t give to immunocompromised/ pregnant animals

    • Aqueous solutions

      • combined with a salt: Na-phosphate or Na-succinate to make them soluble (dissolvable) in water.

        • E.g. dexamethasone sodium phosphate and prednisolone sodium succinate (Solu-Delta-Cortef)

        • Adv: can be given in large doses intravenously with less risk of an adverse reaction; shock or CNS trauma

        • DA: pain, irritation, or inflammation at the site of injection

          in hot/cold climate

    • Alcohol solutions

    • Suspensions: acetate-glucocorticoid lipid soluble: topical

      ophthalmic medications

      • acetate, diacetate, pivalate, acetonide, or valerate appended to the glucocorticoid drug name

      • Opaque

    Safe use of glucocorticioid
    Safe Use of Glucocorticioid don’t give to immunocompromised/ pregnant animals

    • •Use NSAID rather than a glucocorticoid (as long as no contraindications exist for NSAID use).

    • •Avoid continuous use of glucocorticoids: it is preferable to use an intermediate-acting glucocorticoid such as prednisolone rather LA-glucocorticoids: systemic administration (versus topical administration

    • •Use the smallest dose of glucocorticoids that provides a clinical response. EOD

    • Tapering: to avoid Addison’s

    • Cat’s not really affected

    NSAID don’t give to immunocompromised/ pregnant animals

    • COX-2 inhibitors: Carprofen (Rimadyl), Etodolac (EtoGesic), Deracoxib (Deramaxx), Meloxicam (Metacam), Firocoxib (Previcox)

    • Tepoxalin (Zubrin)

    • Phenylbutazone

    • Aspirin (salicylates)

    • Propionic acid derivatives: Ibuprofen (Advil, Motrin), Ketoprofen (Ketofen), Naproxen (Aleve)

    • Flunixin meglumine (Banamine)

    • Meclofenamic acid (Arquel)

    • Dimethyl sulfoxide (DMSO)

    • Chondroprotective agents Polysulfated glycosaminoglycans

      • Hyaluronic acid

      • Glucosamine

      • Chondroitin sulfate (Cosequin)

    • Acetaminophen

    • Orgotein (superoxide dismutase)

    • Gold salts

    • Piroxicam

    Non steroidal anti inflammatory drugs

    IDEAL DRUG: COX 2 INHIBITOR: Newer NSAID: Deramaxx, Rimadyl, etogesic

    Non-Steroidal Anti-inflammatory Drugs

    • NSAIDs work by blocking the activity of cyclooxygenase > inhibit prostaglandins.

      • Few NSAIDs such as ketoprofen, ibuprofen, and tepoxalin (Zubrin) > inhibit lipoxygenase

      • Cyclooxygenase has two forms

        • Cox-1: in stomach: secretion of stomach-protective mucus, decrease acid; kidney: vasodilation of the renal blood supply and other organs

        • Cox-2: prostaglandins – inflammation

    • They can be used for analgesia

      • Post operative analgesia

    Nsaid con
    NSAID - CON etogesic

    Cox -2 inhibitors: Flavorful hence put away from animals to avoid toxicities

    • NSAID overdose/ nonselective NSAIDs extended period : anorexia, diarrhea, ulcerations of the stomach or duodenum

      • sucralfate, histamine 2 (H2) blockers (e.g., cimetidine or ranitidine), and omeprazole are used to treat the open ulcer and reduce the acidity of the stomach, misoprostol: like PG-E

    • Protein bound hence toxic in hypoalbuminemia

    • Block good PG (PgE and PgI2):

      • Hypotension > prostaglandin E2 is released by the kidney to dilate vessels

      • renal papillary necrosis

      • Seen also in cox -2!!

    • Hepatotoxicity

    • GI SE is reported much more frequently in dogs than horses

      • E.g phenylbutazone (old NSAID) toxic in dogs: gastritis/ melena

      • Cats: poorly tolerant of NSAIDs

        • Low dose aspirin every 2 days can be tolerable

    References etogesic

    • Bill, R.L. Clinical Pharmacology and Therapeutics for the Veterinary Technician, 3rd edition. 2006.

    • Romich, J.A. Pharmacology for Veterinary Technicians, 2nd edition. 2010.