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.
If you memorize drugs → you forget them If you understand the pathway → you predict them
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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:
| 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.
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.
Mechanism determines clinical behavior
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
You are not choosing a drug.
You are choosing how far upstream you want to intervene.