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.
If you memorize drugs → you forget them If you understand the pathway → you predict them
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Inflammation is not damage — it is controlled vascular signaling.
Its job:
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 |
Every anti-inflammatory drug works at one of these levels:
| 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 |
Key principle: The higher upstream you treat → the stronger and broader the effect.
Patients often notice:
This is not potency — it is position on the pathway.
Mechanism determines clinical behavior
Treat with:
Treat with:
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 |
You are not choosing a drug.
You are choosing how far upstream you want to intervene.