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Pharm Spring 2023 > OA > Flashcards

OA Flashcards

1
Q

what are the treatment goals for OA?

A
  • relieve pain
  • maintain/restore mobility
  • manage functional impairment
  • improve QOL
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2
Q

what is the 1st line of treatment of OA?

A

topical NSAIDs
1. oral NSAIDs
2. Tylenol

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3
Q

when is tylenol recommended for OA?

A

hand, knee, and hip OA
- if patient is not a candidate for NSAIDs

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4
Q

what is the dose of tylenol for OA?

A

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

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5
Q

what are important things to keep in mind when giving tylenol?

A
  • hepatotoxicity
  • watch for hidden acetaminophen (cold meds)
  • warfarin interacts with chronic doses over 2g/day a day (can increase INR –> more likely to bleed)
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6
Q

when are oral NSAIDs indicated for OA?

A

hand, knee, hip OA
- if no contraindications (1st line over all other orals)
- risk assessment is necessary

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7
Q

what are the oral NSAIDs?

A
  1. Celecoxib* (Celebrex)
  2. ibuprofen (Advil, Motrin)
  3. indomethacin (Indocin)
  4. meloxicam* (Mobic)
  5. nabumetone*
  6. naproxen (OTC: Aleve, Rx: Naprosyn)
    •NSAIDs with ↑ COX-2 selectivity: ↓ GI risk (though still present); ↑ CV risk; same renal risk
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8
Q

what dose should be used for oral NSAIDs?

A

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)

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9
Q

what is important to consider when giving oral NSAIDs?

A
  • routine monitoring advised
  • adverse GI< CV, and renal effects
  • watch for drug interactions
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10
Q

What are the non selective and Cox-2 selective NSAIDS and when are they indicated?

A

(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

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11
Q

What are the semi selective NSAIDs and when are they indicated?

A
  1. Ibuprofen, naproxen (non selective)
    *decreased risk for CV events
    *Increased risk for GI SE
  2. Indomethacin, Nabumetone
    *use with caution in patients at increased CV risks
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12
Q

what are risks of oral NSAIDs for GI events?

A
  1. increased risk of potentially fatal GI bleeding
  2. ulcers
  3. perforations
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13
Q

what are cardio event risks of oral NSAIDs?

A
  1. increased the risk of potentially fatal MI or stroke
    *avoid in patients with or at risk of CVD
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14
Q

what are BP risks of oral NSAIDs?

A
  • if controlled: okay (use caution)
  • avoid in uncontrolled HTN
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15
Q

what are renal events risks of oral NSAIDs?

A
  • decreased renal clearance
  • risk factors: dehydration, nephrotic agents
  • avoid or use with caution in proteins with renal failure
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16
Q

if there is a low GI risk and low CV risk, what NSAIDs to use?

A

any - Celecoxib, or other low GI risk NSAIDs

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17
Q

if there is a high GI risk and high CV risk, what NSAIDs to use?

A

none - use tylenol

18
Q

how to monitor NSAIDs for GI risks?

A
  • hemoglobin/hematocrit
  • blood in stool
  • abdominal pain
  • dyspepsia
19
Q

how to monitor NSAIDs for CV risks?

A
  • blood pressure
  • edema
  • weight gain
20
Q

how to monitor NSAIDs for renal risks?

A
  • Scr and BUN
  • urine output
21
Q

when are topical NSAIDs indicated?

A
  1. knee OA (prior to oral NSAID = lower systemic absorption), 2. conditionally recommended for hand OA
    *NOT for hip OA
22
Q

what is the drug for topical NSAIDs?

A

Diclofenac (OTC)

23
Q

what is the dose of topical NSAIDs?

A
  • 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

24
Q

what is important to consider when giving topical NSAIDs?

A
  • same warnings as oral NSAIDs, but less systemically absorbed
25
Q

when is intra-articular corticosteroid injections indicated for OA?

A
  • strongly recommended for knee and hip OA
  • conditionally recommended for hand OA
26
Q

what drugs are used for an intra-articular corticosteroid for OA?

A

Triamcinolone (Kenalog), methylprednisolone acetate (Depo-Medrol)

27
Q

what are the side effects of intra-articular corticosteroid for OA?

A
  • pain, swelling, and arthralgia
  • increase in blood pressure and blood glucose possible
28
Q

what is important to consider when giving a intra-articular corticosteroid for OA?

A
  • 3-4 injections per year
  • usually lasts 4-8 weeks
29
Q

when is duloxetine (cymbalta) indicated for OA? (SNRI)

A

conditionally recommended for hand, knee, and hip OA

30
Q

What is the maximum dose for duloxetine (cymbalta)

A

60mg

31
Q

when is tramadol used for OA?

A

conditionally recommended for hand, knee, and hip OA

32
Q

what is the MOA of tramadol?

A

mu opioid receptor –> blocks pain pathways

33
Q

if someone has a CrCl less than 30, can a person use tramadol?

A

yes, but lower the dose

34
Q

What are the SE of tramadol

A
  1. N/V
  2. Constipation
  3. Seizures
  4. Somnolence
  5. Potention for misuse and death (C-IV BW)
35
Q

when is capsaicin indicated for OA?

A
  • conditionally recommended for knee OA
  • do not use for hand or hip OA
36
Q

what is the MOA of capsaicin?

A

decreases substance P

37
Q

what is important to consider when giving capsaicin?

A
  • isolated from hot peppers
  • immediately wash hands
  • used regularly
  • takes 2-4 weeks of continuous application to get an analgesic effect
38
Q

what is the treatment guidelines for knee and hip OA?

A
  1. acetaminophen
    - if C/I –> NSAIDs (topical knee only) or steroids or oral NSAIDs
  2. Used acetaminophen or alternative first line doesn’t work –> opioids, surgery, duloxetine (knee only)
39
Q

what is the treatment guideline for hand OA?

A

patient over than 75?
1. topical NSAIDs/tramadol
2. if 1 doesn’t work –> try 2 agents

patient less than 75?
1. oral NSAIDs/topical NSAIDs/capsaicin/tramadol
2. if 1 doesn’t work –> try 2 agents

40
Q

when is chondroitin recommended for OA?

A
  • for hand OA
  • against knee and hip
    *look for USP verified mark
41
Q

do not use what for OA? (Supplements)

A

glucosamine or intraarticular hyaluronic acid
*risk adverse effects with administration

Pharm Spring 2023 (27 decks)

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