Case Questions Exam One Flashcards
Physical Exam for FM
Hyperanalgesia
Allodynia
2016 Update to ACR Criteria 2010/2011
- Generalized pain > 4 body regions
- Symptoms >3 months
- WPI and SSS
- No other disorder explains pain
What is the non-pharmacologic treatment most recommended?
Aerobic Exercise
FDA Approved FM Drugs
- Lyrica
- Cymbalta
- Savella
Inexpensive drugs to recommend to patient?
Recommend Pregablin to help with sleep
What anti depressive drugs are recommended to patient for sleep?
Amitriptyline
If the patient cannot tolerate amitriptyline, what else should be recommended that has a similar structure?
Cyclobenzaprine
What drug has an enhanced benefit when added to amitriptyline or cyclobenzaprine?
Fluoxetine
What are the risk factors of OA?
- Prior injury
- Female
- Age 65 and older
- Overweight/Obese
What are the S/S of OA?
- Gelling
- Pain
- Herbdens Notes
- Limit to daily activities
- Bilateral Deformity
- Osteophyte
- Joint Space Narrowing
- Crepitus
What are considerations to selecting OA therapy?
- Diabetes
- CrCl
- Uncontrolled HTN
- Age
- GI ULCER, CV, Renal RISKS
Does she have primary or secondary OA?
Secondary, because injury to her knee
Primary in other areas maybe
How should she be treated for OA?
- Topical NSAIDs Voltaren
- APAP
Do not use NSAIDs due to the risk factors
What is the education provided for OA patients?
- Diet
- Exercise/Weight Loss
- Stop NSAIDs
What do you monitor in the follow up of OA patients?
- Pain
- Weight Loss
Does treatment with NSAIDs alter the course of osteoarthritis?
NO
4 Categories that fall under the ACR for RA?
- Small/Large Joints involved
- Duration of symptoms
- Serology
- Acute Phase Reactant
What oral disease-modifying anti-rheumatic drug would you recommend?
Methotrexate
What is the dosing frequency of Methotrexate?
Q WEEK
What are the 3 lab tests monitored with on Methotrexate?
- LFTs- ALT/AST/Albumin
- CBC
- Chest X-Ray
- CrCl Creatinine
What can be done to decrease the risk of A/E with methotrexate?
Folic Acid
If the patient does not respond to Methotrexate, what is recommended to have increased efficacy when added with Methotrexate?
- Biologics
- JAK
- SAS
- Leflunomide
- HCQ
- Enbrel
What should be done prior to starting JAK inhibitors/biologics?
TB Screening
Hep B/C
What is the agent’s main MOA?
Biologics/Jak Inhibitors