====== Inflammation — Episode 1: The Big Map ======

This episode builds the **master framework** used throughout pharmacology.

Everything that treats inflammation fits somewhere on this pathway:
NSAIDs, steroids, antihistamines, leukotriene drugs, biologics, and immunosuppressants.

<WRAP center round important 90%>
If you memorize drugs → you forget them  
If you understand the pathway → you predict them
</WRAP>

----

===== Watch the Lecture =====

<WRAP lecturevideo>
{{youtube>VIDEO_ID_HERE}}
</WRAP>

<WRAP center round important 60%>
📄 **Download Slides (PDF)** \\ 
{{:office_hours:inflammation:episode_1_inflammation_map.pdf|Download Slides}}
</WRAP>

----

===== The Purpose of Inflammation =====

Inflammation is not damage — it is **controlled vascular signaling**.

Its job:

  * Deliver immune cells
  * Deliver proteins
  * Isolate injury
  * Begin repair

Symptoms are simply the side-effects of the delivery system.

^ Symptom ^ What Actually Happened ^
| Redness | Vasodilation |
| Warmth | Increased blood flow |
| Swelling | Vascular permeability |
| Pain | Chemical mediators activate nociceptors |
| Loss of function | Protective reflex |

----

===== The Four Levels of the Pathway =====

Every anti-inflammatory drug works at one of these levels:

<WRAP center 95%>
^ Level ^ What Happens ^ Example Drug Classes ^
| 1 — Trigger | Cell injury / immune activation | (no drugs here clinically) |
| 2 — Mediators | Histamine, prostaglandins, leukotrienes | Antihistamines, NSAIDs, leukotriene blockers |
| 3 — Gene Response | Cytokines & transcription | Corticosteroids |
| 4 — Immune Signaling | Targeted cytokines | Biologics & JAK inhibitors |
</WRAP>

**Key principle:**
The higher upstream you treat → the stronger and broader the effect.

----

===== Why Drugs Feel Different Clinically =====

Patients often notice:

  * Antihistamines help itch but not arthritis
  * NSAIDs help pain but not autoimmune disease
  * Steroids help almost everything
  * Biologics fix diseases steroids only suppress

This is not potency — it is **position on the pathway**.

<WRAP center round box 90%>
Mechanism determines clinical behavior
</WRAP>

----

===== Acute vs Chronic Inflammation =====

==== Acute (Fast, Vascular, Chemical) ====
  * Histamine
  * Prostaglandins
  * Leukotrienes

Treat with:
  * Antihistamines
  * NSAIDs
  * Leukotriene modifiers

----

==== Chronic (Immune-Driven, Cellular) ====
  * Cytokines
  * T-cells
  * Macrophages

Treat with:
  * Steroids
  * Immunosuppressants
  * Biologics

----

===== Clinical Translation =====

If disease is:

^ Disease Type ^ Best Drug Category ^
| Allergy | Histamine blockers |
| Pain/Fever | Prostaglandin blockers (NSAIDs) |
| Asthma | Leukotriene + cytokine pathway |
| Autoimmune | Cytokine inhibitors |
| Transplant rejection | Broad immune suppression |

----

===== Key Takeaway =====

<WRAP center round important 90%>
You are not choosing a drug.

You are choosing how far upstream you want to intervene.
</WRAP>

----

===== Next Episode =====

→ [[office_hours:inflammation:episode_2|Episode 2 — Arachidonic Acid Pathway]]

----

===== Related =====

  * [[office_hours:inflammation:start|Inflammation Series Home]]
  * [[eicosanoids:start|NSAIDs & Leukotrienes]]
  * [[allergy:start|Hypersensitivity & Histamine]]
  * [[rheum:start|Rheumatology Drugs]]
  * [[lectures:start|Full Lecture Series]]