IA Medications

Question 1

What two layers make up the synovial membrane?

Answer 1

Subintimal

Intimal

Question 2

What does the subintimal layer of the synovial membrane consist of?

Answer 2

Blood supply and innervation

Question 3

What does the intimal layer of the synovial membrane consist of?

Answer 3

Synoviocytes

Macrophages Type A and Fibroblast Type B

Question 4

What does articular cartilage create?

Answer 4

Joint surface

Question 5

What is articular cartilage composed of?

Answer 5

80% water, PG, HA and collagens

Question 6

What substance protects collagens from damage?

Answer 6

Aggrecan

Question 7

What is the backbone of the cartilaginous matrix?

Answer 7

Hyaluronic acid

Question 8

What provides a sponge-like shock absorbing effect?

Answer 8

Glycosaminoglycans bound to HA

Question 9

What is known as the shock absorber?

Answer 9

Subchondral bone

Question 10

What is the cause of OA?

Answer 10

Single injury, use trauma

Release of IL-1 from trauma helps the cyclical effect of damage of osteoarthritis

Question 11

What are some clinical parameters of OA?

Answer 11

Effusion, decreased viscosity of synovial fluid, increased TP

Question 12

What are some gross cartilage changes from OA?

Answer 12

Yellow, fibrillated, dull, ulcerated

Question 13

What is it called when there are ST attachments with mineralization?

Answer 13

Enthesiophyte formation

Question 14

What are some CS of OA?

Answer 14

Lameness, joint pain, decreased ROM, +/- radiographic changes

Question 15

What are some goals of OA treatment?

Answer 15

Reduce/minimize inflammation
Slow progression of degeneration
Reduce/eliminate pain
Restore synovial fluid to normal

Question 16

WHat are some chondroprotective agents?

Answer 16

Hyaluronic acid
Polysulfated glycosaminoglycans
Polyglycan
Pentosan gold plus Halo

Question 17

Where is sodium hyaluronate from?

Answer 17

Type B synoviocytes, chrondrocytes

Question 18

What is sodium hyaluronate?

Answer 18

Long, unbranched non-sulfated GAG

Question 19

What does sodium hyaluronate do?

Answer 19

provides viscoelasticity, boundary lubrication, scavenges free radicals, decreases degradation of aggrecan

Question 20

T/F: Sodium hyaluronate is chondroprotective when administered IA, provides analgesia and reduces cartilage fibrillation IA

Answer 20

TRUE

Question 21

How much sodium hyaluronate is needed once weekly for 3 weeks for lameness improvement

Answer 21

20 mg

Question 22

What is the benefit of using HA and Triamcinolone together?

Answer 22

You will get the chondroprotective effects from both and the anti-inflammatory effects from TA

Question 23

What route is most likely to be efficacious?

Answer 23

IA

Question 24

What is the thought behind the mechanism of polysulfated glycosaminoglycans (adequan)?

Answer 24

Inhibits degradative enzymes
Counteracts deleterious effects of IL-1
Reduction of synovial effusion

Question 25

T/F: Brand name adequan is significantly more effective in recovery of induced deficits than the 2 “generic” versions

Answer 25

TRUE

Question 26

What is a major drawback of adequan?

Answer 26

Significant potentiation of sub-infective dose of bacteria to produce infection
can use 125 mg of Amikacin to eliminate this effect

Question 27

T/F: there was an increase in disease progression that was observed when IV polyglycan was administered

Answer 27

TRUE

IA is better route

Question 28

T/F: Triamcinolone acetonide has condroprotective effects

Answer 28

TRUE

Question 29

T/F: Methylprednisolone acetate has been consistently shown to have deleterious effects on articular cartilage when used at therapeutic levels

Answer 29

TRUE

Question 30

T/F: Some studies show that laminitis can occur secondary to joint injections

Answer 30

TRUE