OA Flashcards
what are the treatment goals for OA?
- relieve pain
- maintain/restore mobility
- manage functional impairment
- improve QOL
what is the 1st line of treatment of OA?
topical NSAIDs
1. oral NSAIDs
2. Tylenol
when is tylenol recommended for OA?
hand, knee, and hip OA
- if patient is not a candidate for NSAIDs
what is the dose of tylenol for OA?
325-650 mg every 4-6 hours scheduled or 1 g 3-4 times daily
- max 4,000 mg daily
- dose adjust in patients with liver disease or chronic alcoholic intake
what are important things to keep in mind when giving tylenol?
- hepatotoxicity
- watch for hidden acetaminophen (cold meds)
- warfarin interacts with chronic doses over 2g/day a day (can increase INR –> more likely to bleed)
when are oral NSAIDs indicated for OA?
hand, knee, hip OA
- if no contraindications (1st line over all other orals)
- risk assessment is necessary
what are the oral NSAIDs?
- Celecoxib* (Celebrex)
- ibuprofen (Advil, Motrin)
- indomethacin (Indocin)
- meloxicam* (Mobic)
- nabumetone*
- naproxen (OTC: Aleve, Rx: Naprosyn)
•NSAIDs with ↑ COX-2 selectivity: ↓ GI risk (though still present); ↑ CV risk; same renal risk
what dose should be used for oral NSAIDs?
lowest effective dose in shortest duration
- Celecoxib: 100 mg BID or 200 mg daily
- Ibuprofen: 400-800 mg Q6-8H (Rx) | 200-400 mg Q4-6H (OTC)
- Meloxicam: 15 mg daily
- Naproxen: 500 mg BID (Naprosyn; Rx) | 200 mg (220 mg naproxen sodium; OTC) Q8-12 H; 1st dose can take 2 tabs (max 3 tabs/24 hours)
what is important to consider when giving oral NSAIDs?
- routine monitoring advised
- adverse GI< CV, and renal effects
- watch for drug interactions
What are the non selective and Cox-2 selective NSAIDS and when are they indicated?
(Irreversible) NON: ASA
*cardioprotective at low doses
*increased risk for GI SE
COX-2 : Celecoxib
*increased risk for CV events
*decreased risk for GI SE
What are the semi selective NSAIDs and when are they indicated?
- Ibuprofen, naproxen (non selective)
*decreased risk for CV events
*Increased risk for GI SE - Indomethacin, Nabumetone
*use with caution in patients at increased CV risks
what are risks of oral NSAIDs for GI events?
- increased risk of potentially fatal GI bleeding
- ulcers
- perforations
what are cardio event risks of oral NSAIDs?
- increased the risk of potentially fatal MI or stroke
*avoid in patients with or at risk of CVD
what are BP risks of oral NSAIDs?
- if controlled: okay (use caution)
- avoid in uncontrolled HTN
what are renal events risks of oral NSAIDs?
- decreased renal clearance
- risk factors: dehydration, nephrotic agents
- avoid or use with caution in proteins with renal failure
if there is a low GI risk and low CV risk, what NSAIDs to use?
any - Celecoxib, or other low GI risk NSAIDs
if there is a high GI risk and high CV risk, what NSAIDs to use?
none - use tylenol
how to monitor NSAIDs for GI risks?
- hemoglobin/hematocrit
- blood in stool
- abdominal pain
- dyspepsia
how to monitor NSAIDs for CV risks?
- blood pressure
- edema
- weight gain
how to monitor NSAIDs for renal risks?
- Scr and BUN
- urine output
when are topical NSAIDs indicated?
- knee OA (prior to oral NSAID = lower systemic absorption), 2. conditionally recommended for hand OA
*NOT for hip OA
what is the drug for topical NSAIDs?
Diclofenac (OTC)
what is the dose of topical NSAIDs?
- Knees: apply 4 g to affected area 4 times daily
- Hands: apply 2 g to affected area 4 times daily
- Maximum dose: 32 grams/day
use the dosing card
what is important to consider when giving topical NSAIDs?
- same warnings as oral NSAIDs, but less systemically absorbed
