Clinical Osteoarthritis - 23 WIP Flashcards
PATHOPHYSIOLOGY
Degenerative changes that occur in ___ and the associated ___. Characterized by increased destruction and subsequent ___ of cartilage and bone
- cartilage
- bone
- proliferation
INCIDENCE
most common joint releated disease
* 85% of patients over ___ years old
* severity increases with age
* more common in ___
- 75
- females
JOINT INVOLVEMENT
what are the common joints involved
- hips
- knees
- distal interphalangeal joint
RISK FACTORS
- increased age
- obesity
- congenital defects
- muscle weakness
- female
- repetitive stress
- major joiny trauma
- heredity
CLINICAL MANIFESTATIONS
- Joint pain
- __ stiffness
- Crepitus (___ sound)
- Inflammation
- Muscle ___
- ___ involvement
- morning
- popping
- atrophy
- asymmetric (left knee, right hip, etc)
CLINICAL MANIFESTATIONS
- No systemic symptoms
- Instability of weight bearing joints
- ___ and ___ nodes
- Herberden’s and Bouchard’s nodes
GOALS OF THERAPY
- Relief of pain and discomfort
- Maintain function of joint and strength
- try to minimize risk factors
cannot reverse damage that has already been done (no cure)
TREATMENT OF OA
non-drug therapy (focus on ___).
Psychological support
* education
* rest
Physical acitivity/exercise
* heat/ice
* physical and ___ therapy
* ___ loss
- strength
- occupational
- weight
TREATMENT OF OA
drug therapy - based on hand, knee, hip
- topical
- oral
- supplements
- injectables
topical therapy - Icy-Hot, Bengay, Salonpas
active ingredients: ___, camphor, ___ (methyl salicylate)
* counterirritant
* dose: apply ___ times per day
- methol, wintergreen
- multiple
Topical Therapy - Capsaicin Cream
- MOA: depletes substance ___
- Dose: apply sparingly to affected area ___ times daily
- wait ___ to evaluate results
- adverse effects: ___, ___, and ___
- substance P
- 2-4 times daily
- 2-4 week
- burning, stinging, and redness
Topical Therapy - Diclofenac (Voltaren) Gel 1%
- MOA: local inhibition of ___
- Dose: Applied to joint ___
- Max ___ to any one joint daily
- Not recommended in combination with ___
Adverse Effects: ___, ___, pain, and ___
- COX-2 enzymes
- QID
- 16g
- systemic NSAID
- pruritus, burning, rash
Topical Therapy - Diclofenac (Pennsaid) Topical Solution %
For ___ only
Dose:
* 40 ___ (___mg) to each knee ___
* Apply ___ drops at a time
* 2 ___ (40mg) ___
* Local reaction most common adverse effect
Acetaminophen (Tylenol™)
- MOA: inhibits synthesis of
prostaglandins
Dose: Max: 3g – 4g per day
Two – four week trial
ACETAMINOPHEN
Patients at risk for hepatotoxicity
* heavy ___ intake
* pre-existing ___ disease
* Monitor ALT/AST annually if on
routine doses
NSAIDs
No two patients respond the same
If patient does not respond → switch to alternative NSAID
Dosing: Analgesic v. anti-inflammatory
with osteoarthitis there is not a lot of ___.
* ___ doses are for anagesic puposes
* ___ doses are for anti-inflammatry purposes
* 1-2 week trial for pain and 2-4 week trial if inflammation exists
NSAID Adverse Effects
- GI upset
- ulcers
- bleeding
- renal dysfunction
- Increase BP
- Increased risk of stroke, MI, and death
Education tip: always take with food
NSAID Therapy
Greatest Risk for Adverse Effects
- dose dependent
- age > 75
- h/o GI bleed
- h/o of PUD
- anticoagulants
- antiplatelet
- glucocorticoids
Education tip: sign of stomach bleed = bright red/black stools
NSAID Therapy
Patients at greatest risk for nephrotoxicity
– CHF
– HTN
– renal dysfunction
– dehydration
Patients at greatest risk for cardiovascular adverse effects
– CHF
– CVD
MONITORING NSAIDs
- blood pressure
- signs of edema or weight gain
- SCr (kidney function) - every 3 months
- Hgb / Hct (bleeding) - every 6 - 12 months
- signs of dehydration
COX-2 INHIBITORS
Celecoxib (Celebrex)
* Dose: 100 - 200 mg orally daily or bid
* Lower incidence of GI bleeding
Potential risks associated with COX-2 Inhibitors:
* increased risk of cardiovascular disease
* same effects on renal function
* increase cost of therapy
