OA

Question 1

oa pathophysiology

Answer 1

cartilage degradation
chondrocyte activity to repair damage
more breakdown
bone remodelling and osteophyte formation
synovial inflammation

Question 2

goals of therapy oa

Answer 2

relieve pain and inflammation
preserve range of motion, joint function

Question 3

pharmacotherapy choices in oa

Answer 3

1. TOP NSAID
2. PO NSAID
3. PO paracetamol/tramadol
4. Intra-articular glucocorticoid injections

Question 4

risk factors for nsaid-induced GI ulceration/bleeding

Answer 4

> 65 yo
hx of gastric ulcer
use of high dose/chronic nsaid
concurrent gc/antiplatelets/anticoag

high risk: at least 3 risk factors

Question 5

how to protect against gi toxicity for nsaid

Answer 5

• use coxib
• add PPI

Question 6

se of nsaids

Answer 6

gi
inhibition of platelet functions (stop 3 days before surgery)
CVS (MI, stroke, vascular death),
renal,
NSAID - induced AKI

Question 7

ci of nsaids

Answer 7

pregnancy 3rd trimester
HF/IHD/peripheral arterial disease
egfr<15
COPD/asthmatic patients (bronchoconstriction), uncontrolled HTN, PUD/GI bleed

Question 8

ddi of nsaids

Answer 8

(Increased renal toxicity) ACEi/ARBs, diuretics, aminoglycosides, amphotericin B, radiocontrast material

Question 9

non pharmaco OA

Answer 9

exercise - strengthening, low impact aerobics (walking, swimming)
weight management
cortisone/lubrication injections

Question 10

location of OA

Answer 10

weight-bearing joints (hand, knee, hip), asymmetrical polyarthritis

Question 11

pain characteristics of OA

Answer 11

pain on movement, worse at end of day

Question 12

s/sx of OA

Answer 12

early morning stiffness <30min
crepitus (clicking of joints)
joint swelling (maybe)
erythema (maybe)

Question 13

risk factors of OA

Answer 13

age, anatomic factors, joint injury, obesity

Question 14

men or women more likely

Answer 14

<50 yo: men
>70 yo: women

Question 15

max dose of celecoxib

Answer 15

400mg/d

Question 16

ra/oa: which is worse after rest

Answer 16

RA

Question 17

RA/OA: which is worse at the end of day

Answer 17

OA

Question 18

ra/oa: which has nocturnal pain

Answer 18

RA

Question 19

RA/OA: which is relieved with exercise

Answer 19

RA

Question 20

ra/oa: which has early morning stiffness more than 30 mins

Answer 20

RA

Question 21

what is considered overdose for panadol

Answer 21

10g per 24 hours (send to ED)
20 tablets is overdose

Question 22

what risk is increased with more than 5 days of nsaids

Answer 22

peptic ulcers

Question 23

functions of prostaglandins

Answer 23

1. reduce gastric acid secretions
2. increase mucosal blood flow
3. increase secretion of mucus
4. increase secretion of bicarbonate

Question 24

what does inhibition of pge2 production result in

Answer 24

sodium retention
water retention
peripheral edema
hypertension

Question 25

what does inhibition of pgi2 production result in

Answer 25

suppression of renin aldosterone secretion
hyperkalemia
acute renal failure

Question 26

where does pge2 inhibit sodium reabsorption primarily

Answer 26

thick ascending limb

Question 27

what does nsaid inhibit

Answer 27

pge2 and pgi2

Question 28

what does aldosterone stimulate

Answer 28

reabsorption of Na+ and excretion of K+