Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTH 565 - Rheumatology > Arthritis Medications > Flashcards

Arthritis Medications Flashcards

1
Q 
↓ pain
↓ damage
↑/maintain function
↑/maintain QOL
↑/maintain work productivity
A

OA Patient Priorities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q 
↓ pain
↓ damage
↑/maintain function
↑/maintain QOL
↑/maintain work productivity

Stop joint swelling, stiffness, fatigue, damage ( = remission)

A

Inflammatory Arthritis Patient Priorities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q 
↓ pain
↓ damage
↑/maintain function
↑/maintain QOL
↑/maintain work productivity

Prevent comorbidities
Prevent complications
Delay need for surgery

A

OA Physician Priorities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
↓ pain
↓ damage
↑/maintain function
↑/maintain QOL
↑/maintain work productivity

Prevent comorbidities
Prevent complications
Delay need for surgery

*Induce remission where possible

A

Inflammatory Arthritis Physician Priorities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Good disease control = better participation in PT, ↑ physical activity, ADLs, work productivity, life roles

Poor medication adherence = major cause of disease progression + disability, morbidity, health care cost

Only 1 in 5 RA pt’s take medications as prescribed at > 80% adherence

Often stigma & fear around medication

Educate pt’s: Importance of pain & disease control for their QoL & function, redirect to pharmacist/MD for more detailed information or followup

Reassurance and education

A

PT Role in Medication Adherence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

1) Patient related factors
- socio-demographics, psycho-social profile, comorbidities, cognitive ability, health literacy, & *health beliefs)

2) Drug-related factors
- # of drugs taken, adverse effects, & administration regimes -> med review by pharmacy

3) Other factors
- patient-prescriber relationship, access to medications, social support

A

3 Categories of Barriers to Medication Adherence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Analgesia

Disease Modifiers

A

Arthritis Medication Categories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Control pain (& some inflammation)

  • Acetaminophen/paracetamol
  • NSAIDs
  • Steroids (short-course)
  • Drugs for off-label use (central/neuropathic pain)
  • Opioids
A

Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Control disease by modifying or suppressing immune inflammatory response

  • NSAIDs (only in spondylitis)
  • Corticosteroids
  • Disease Modifying Anti-rheumatic Drugs (DMARDs)
  • Biologic Disease Modifying Anti-rhuematic Drugs (Biologic DMARDs or “Biologics”)

Used for control of abnormal inflammatory pathways in INFLAMMATORY arthritis

  • 1st Line Tx: DMARDs
  • 2nd line Tx: Biologic DMARDs
  • Adjuncts: Corticosteroids; analgesics, NSAIDs

*Exception: NSAIDs can be used as 1st line tx. in Axial Spondylitis

A

Disease Modifiers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Analgesic

Ex: Tylenol

Function: ↓ pain (also fever reducing)

Use: 1st line of OA; control of mild to moderate joint pain; 1-2 hours to take effect

Precautions for PT:

  • None; generally fewer side effects & tolerated better than NSAIDs & safer in elderly w/ comorbidities
  • Safe to take in combination w/ NSAIDs or other arthritis meds
  • Hepatotoxic past 4g (4,000mg)/day or w/ alcohol can result in liver failure
A

Acetominophen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Analgesic

Ex:

  • OTC oral tablet = Aspirin, ibuprofen, naproxen
  • Topical cream/gel
  • Prescription NSAIDs

Function: ↓ pain, swelling, stiffness & fever

Use:

  • Primarily in OA; spondylitis for joint pain & inflammation
  • *High intake slows new bone formation in individuals w/ ↑ C-reactive protein (CRP) only
  • Analgesia 30-60mins, steady state after 2 days (few days to 1 week for optimal anti-inflammatory effects)

Precautions for PT:

  • Raises BP
  • ↑ CV event risk (non-aspirin), but the risk is lower than smoking/hypertension
  • Make sure to not combine 2 types together
  • Topical’s have similar effects & safer
A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Analgesic

Name: Serotonin-Norepinephrine Reuptake Inhibitor (SNRI): e.g. Duloxetine (prescription oral capsule)

Function: Second-line analgesic agent where no/partial response to acetaminophen/NSAIDs; takes effect within 1 week

Use: Neuropathic pain in OA (also fibromyalgia, anxiety, depression)

Precautions for PT:

  • Side effects: dizziness/light-headedness
  • May raise BP
A

Other Analgesics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ex: Codeine, Hydromorphone, Oxycodone, Fentanyl, Morphine

Function: ↓ pain

Use:

  • Second-line Rx for mod-to-severe OA pain; not commonly used as often risk>benefit
  • No data on benefit for inflammatory arthritis past 6 weeks
  • Works within 1 hr

Precautions for PT:

  • Side effects: drowsiness, dizziness, constipation
  • Opioid tolerance with prolonged use can sensitize to pain
  • Risk of dependence w/ chronic use
A

Opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prescribed for:

  • Acute/chronic pain resulting from disease, surgery, or injury
  • Moderate to severe coughs & diarrhea
  • Treat addiction to other opioids such as heroin or oxycodone (e.g. methadone, suboxone)
  • Controlling pain in terminal illness

Can produce both analgesia & euphoria = potential for abuse

Easy to become addicted

Long term use can lead to:

  • ↑ tolerance to the drug, so that more is needed to produce same pain relieving effect
  • Dependence
  • Withdrawal symptoms

Recommended optimization of non-opioid pharmacotherapy & non-pharmacologic therapy rather than a trial of opioids for pt’s with chronic non-cancer pain (in which most have back pain or OA)

A

Opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Disease Modifier

Ex: Methotrexate (MTX) - oral tablets or subcutaneous injection

Function: Prevent joint damage by suppressing inflammatory pathways; can take up to 3 MONTHS for full effect

Use: IA = RA, JIA, Psoriatic arthritis, Lupus

Precautions for PT:
- Side effects: nausea & fatigue the day after (taking folic acid/folinic acid - aka leukovorin improves this)

A

DMARDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Disease Modifier

Large, complex proteins made from living cells through highly complex manufacturing processes
- Tend to be more VARIABLE & structurally COMPLEX than chemically synthesized drugs

Ex: Etanercept, Adalimumab, Infliximab (subcutaneous injection or IV infusion)

Function: Prevent joint damage by suppressing inflammatory pathways; reserved for people who have NOT responded adequately to conventional DMARDs & for those who cannot tolerate DMARDs in doses large enough to control inflammation

Use: RA, Axial Spondylitis, etc.

Precautions for PT:

  • ↑ risk of serious infections (e.g. pneumonia, cellulitis)
  • Sterile technique if dry needling, keep environment hygienic (clean plinths, pillow covers)
A

Biologics

17
Q

Biologic drugs are large, complex proteins made from living cells through highly complex manufacturing processes

A Biosimilar is a copy of biologic medicine that is similar, but not identical to the original medicine

To be called a biosimilar, these compounds need to demonstrate structural & functional similarities with comparable pharmacokinetic and pharmacodynamic properties to the references product

A

Biologics vs Biosimilars

18
Q

Drugs that enter the market subsequent to a previously authorized version (i.e. biologics) whose patent has expired

Approved only after showing that it is “highly similar” to an approved biological product (reference product), in therms of:

  • Safety
  • Purity
  • Potency
  • Efficacy w/ allowable minor differences
A

Biosimilars

19
Q

Present & clarify benefits & harms of tx options based on available research

Help pt’s communicate questions, concerns, & preferred choice to rheumatologists

Promote SHARED DECISION-MAKING
- The process by which a healthcare choice is made jointly by the health professional & the pt

Ex:

  • Methotrexate Patient Decision Aid
  • Biologic Patient Decision Aid
A

Patient Decision Aids

20
Q

Disease Modifier

Ex:

  • Prescription oral tablet = Prednisone
  • Injection = methylprednisolone, triamcinolone

Function:

  • Most efficacious anti-inflammatory drug available
  • Oral takes effect within 1-4 days
  • Injections 24-48h (rest joint)

Use: OA (joint injection), Inflammatory Arthritis (oral or injection)

Precautions for PT: (with >2months oral use)

  • ↓ bone density & risk of # w/ long term use
  • ↑ blood sugars
  • ↑ muscle wasting
  • ↑ infection risk
  • Small risk of avascular necrosis
  • Do NOT combine w/ alcohol or large amounts of NSAIDs
  • Risk of GI ulceration
A

Corticosteroids

21
Q

Corticosteroids in vitro can ↓ cell proliferation & collagen synthesis, collagen disorganization, & necrosis

Underlying tendinopathy, mechanical failure, & cartilage erosion often already present in inflammatory arthritis & OA

If joint/tendon inflammation is NOT controlled, risk of joint damage/tendon rupture -> risk of corticosteroid injection in IA

A

Corticosteroid Cartilage & Tendon Effects

22
Q

Corticosteroid injections provide powerful, localized anti-inflammatory effects so patient can resume function/participate in rehab

Some situations very beneficial to have anti-proliferative effects (e.g. trigger finger, tenosynovitis)

Often standard interventions adjunctive with or following failure of conservative tx. prior to surgical intervention

No longer inject directly into tendons

A

Injection Controversy

23
Q

1st line: NSAIDs
2nd line: Anti-TNF inhibitors (Biologics) for people who do not respond to NSAIDs

Conditionally recommend continuous tx. w/ NSAIDs over on-demand tx.

A

Axial Spondylitis Tx

24
Q
  • Acetaminophen & other
  • NSAIDs
  • Corticosteroid intra-articular injections
A

OA Meds

25
Q
  • Can use Acetaminophen & other NSAIDs
  • Can use NSAIDs
  • Corticosteroids (oral)
  • Conventional DMARDs
  • Biologic/Biosimilar DMARDs
  • Corticosteroid intra-articular injections
A

RA Meds

26
Q
  • NSAIDs
  • Biologic/Biosimilar DMARDs
  • Corticosteroid intra-articular injections
A

AxSpA Meds

PHTH 565 - Rheumatology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions