1. How does COX work?
   1. Starts with Arachidonic Acid (Fatty acid) which produces prostoglandins (Lipids with hormone-like properties)
      1. How does arachidonic acid convert into prostoglandins?
         1. Cyclooxgyenase (Enzyme)
            1. Proinflammatory Effects - Inflammation - Nociception - Fever - Inhibits platelet aggregation
            2. COX-2 Inhibition leads to...
            3. Benefits
            4. Suppress inflammation
            5. Pain relief
            6. Fever reduction
            7. Protection against colorectal CA
            8. Adverse effects
            9. Promotion of MI and stroke
            10. Effects in Other Systems: - Protect GI mucosa - Promote renal perfusion - Promotes platelet aggregation
            11. COX-1 Inhibition leads to...
            12. Benefits
            13. Protection against MI and Stroke
            14. Adverse effects
            15. Gastric erosion and ulceration
            16. Renal impairment
            17. Bleeding tendencies
2. Anti-inflammatory group
   1. 1st gen
      1. COX-1 & 2 Inhibitors
         1. NSAIDs
            1. aspirin*
            2. ibuprofen
            3. kertorolac
            4. diclofenac
            5. naproxen
            6. indomethacin
            7. meloxicam
         2. Suppress pain, fever, and inflammation BUT risk for AE -gastric ulceration -bleeding -renal impairment
   2. 2nd gen
      1. COX-2 Selective Inhibitor
         1. Coxib NSAIDs
            1. celexcoxib
         2. Suppress pain, fever, and inflammation with possibly fewer AE BUT less safe than 1st gen dt r/o MI and stroke
3. Non Anti-Inflammatory group
   1. Centrally-acting COX Inhibitor
      1. acetaminophen
      2. Reduces pain and fever BUT not suppresss inflammation