Chapter 3.1 Flashcards
- Describe the joint changes characteristic of osteoarthritis
progressive wear and tear of large joints. Hypertrophy and spurring of bone and erosion of cartilage
- List the categories of drugs used in the management of osteoarthritis.
analgesics and joint protection and restoration
- Indicate the stage of osteoarthritis that is best managed by acetaminophen and NSAIDs.
Early to mod stages for acetaminophen
NSAID’s: any stage of OA
- List the advantages and disadvantages of the categories of drugs used in the management of osteoarthritis.
Acetaminophen is easier on stomach and anti-inflammatory effects not needed
NSAID’s are more helpful in later stages if synovitis develops
- Define viscosupplementation.
try to supplement the viscous property of joint fluids. Helps restore the viscosity of synovial fluid and keeps joint better lubricated. Done by injecting hyaluronan into joint
- State the mechanism of action of glucosamine and chondroitin sulfate in the management of osteoarthritis.
Provide substrates to help regenerate and maintain strength of cartilage and synovial fluid
- Describe the joint changes characteristic of rheumatoid arthritis
pain, stiffness, inflammation and damage in various joints
- State the role of autoimmunity in the development of rheumatoid arthritis using the terms systemic and synovial inflammation, tumor necrosis factor-alpha, and interleukins.
Immune system goes haywire and does this via chemical and cellular factors like tumor necrosis, factor alpha or interleukin 1 or 6.
- Indicate the role of the following agents in the management of rheumatoid arthritis: acetaminophen, NSAIDs
NSAID’s are the cornerstone of treatment in RA and are good at treating mild inflammation and pain.
glucocorticoids
are powerful inflammatory supressents. These drugs are great after a flare up. Huge side effects doe
and disease-modifying anti-rheumatic drugs (DMARDS)
modifying the course of RA and try to slow it down.
- State the mechanism of action of the traditional DMARDs.
inhibit the autoimmune response underlying RA. Inhibit cytokine synthesis or inhibit cellular activation of monocytes, T and B lymphocytes
- State the mechanism of action of tumor necrosis factor inhibitors
Suppresses a specific messenger that promotes the immune response called TNF-alpha.
- State the mechanism of action of anakinra.
blocks effects of interleukin 1 on joint tissues. It spars immune functions
- Indicate the therapeutic categories of the following agents: ibuprofen
NSAID
prednisone
glucocorticoid
methotrexate, hydroxychloroquine, auranofin, penicillamin
DMARD
adalimumab, etanercept
Tumor necrosis factor inhibitor
anakinra
Other DMARD
- State the role of DMARD combination therapy for rheumatoid arthritis.
Provides better effects at lower doses of each drug and they don’t necessarily increase risk of toxicity over monotherapy.
- State the adverse effects of the DMARDs.
GI problems, lung toxicity, hematological disorders, fever
- List the special considerations when using methotrexate, hydroxychloroquine
Periodic ophthalmic exams recommended to check for retinal toxicity
adalimumab
Risk of infection
etanercept
Risk of infection
- State the special considerations of a physical therapist caring for a patient being treated for rheumatoid arthritis
may cause headache and nausea, which may be bothersome during the therapy session. Joint pain and swelling may also occur with drugs such as methotrexate and penicillamine
