IA Medications Flashcards
What two layers make up the synovial membrane?
Subintimal
Intimal
What does the subintimal layer of the synovial membrane consist of?
Blood supply and innervation
What does the intimal layer of the synovial membrane consist of?
Synoviocytes
Macrophages Type A and Fibroblast Type B
What does articular cartilage create?
Joint surface
What is articular cartilage composed of?
80% water, PG, HA and collagens
What substance protects collagens from damage?
Aggrecan
What is the backbone of the cartilaginous matrix?
Hyaluronic acid
What provides a sponge-like shock absorbing effect?
Glycosaminoglycans bound to HA
What is known as the shock absorber?
Subchondral bone
What is the cause of OA?
Single injury, use trauma
Release of IL-1 from trauma helps the cyclical effect of damage of osteoarthritis
What are some clinical parameters of OA?
Effusion, decreased viscosity of synovial fluid, increased TP
What are some gross cartilage changes from OA?
Yellow, fibrillated, dull, ulcerated
What is it called when there are ST attachments with mineralization?
Enthesiophyte formation
What are some CS of OA?
Lameness, joint pain, decreased ROM, +/- radiographic changes
What are some goals of OA treatment?
Reduce/minimize inflammation
Slow progression of degeneration
Reduce/eliminate pain
Restore synovial fluid to normal
WHat are some chondroprotective agents?
Hyaluronic acid
Polysulfated glycosaminoglycans
Polyglycan
Pentosan gold plus Halo
Where is sodium hyaluronate from?
Type B synoviocytes, chrondrocytes
What is sodium hyaluronate?
Long, unbranched non-sulfated GAG
What does sodium hyaluronate do?
provides viscoelasticity, boundary lubrication, scavenges free radicals, decreases degradation of aggrecan
T/F: Sodium hyaluronate is chondroprotective when administered IA, provides analgesia and reduces cartilage fibrillation IA
TRUE
How much sodium hyaluronate is needed once weekly for 3 weeks for lameness improvement
20 mg
What is the benefit of using HA and Triamcinolone together?
You will get the chondroprotective effects from both and the anti-inflammatory effects from TA
What route is most likely to be efficacious?
IA
What is the thought behind the mechanism of polysulfated glycosaminoglycans (adequan)?
Inhibits degradative enzymes
Counteracts deleterious effects of IL-1
Reduction of synovial effusion
T/F: Brand name adequan is significantly more effective in recovery of induced deficits than the 2 “generic” versions
TRUE
What is a major drawback of adequan?
Significant potentiation of sub-infective dose of bacteria to produce infection
can use 125 mg of Amikacin to eliminate this effect
T/F: there was an increase in disease progression that was observed when IV polyglycan was administered
TRUE
IA is better route
T/F: Triamcinolone acetonide has condroprotective effects
TRUE
T/F: Methylprednisolone acetate has been consistently shown to have deleterious effects on articular cartilage when used at therapeutic levels
TRUE
T/F: Some studies show that laminitis can occur secondary to joint injections
TRUE
