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PT2 Pain 5-10 > OA and gout therapeutics > Flashcards

OA and gout therapeutics Flashcards

1
Q

symptoms of osteoarthritis

A
  • pain localized to affected joint
  • stiffness
  • limited joint motion
  • instability of weight-bearing joints
  • limitation in ADLs
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2
Q

risk factors for OA

A
  • age
  • obesity
  • men more <50 y/o
  • occupation
  • joint injury
  • genetics
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3
Q

treatment preference order for hand OA

A
  • topical NSAID
  • oral NSAID
  • capsaicin
  • tramadol
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4
Q

treatment preference order for knee/hip OA

A
  • APAP
  • oral NSAID
  • topical NSAID
  • intraarticular steroid
  • tramadol
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5
Q

second line options for OA

A

opiods
duloxetine
glucosamine/chondroitin

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6
Q

acetaminophen use in OA

A
  • 1st line in knee/hip due to less side effects

- should be used on a schedule, not as needed

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7
Q

NSAIDs in pts. >75

A

use topical over orals to reduce side effects

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8
Q

topical NSAID with best evidence

A

diclofenac

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9
Q

concurrent topical and oral NSAID use

A

don’t do it

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10
Q

intraarticular glucocorticoids

A

methylprednisolone

triamcinolone

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11
Q

intraarticular glucocorticoids frequency

A

once every 3 months

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12
Q

capsaicin use

A
  • recommended in hand OA

- may take 2 weeks to work

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13
Q

non-pharm for gout

A
  • ice
  • reduce alcohol consumption
  • weight loss
  • reduce meat intake
  • reduce sugary drinks
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14
Q

medications that increase urate

A
  • thiazides
  • loop diuretics
  • niacin
  • aspirin
  • cyclosporine
  • tacrolimus
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15
Q

mild-moderate acute gout drugs to use

A
  • NSAID
  • colchicine
  • systemic corticosteroid
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16
Q

severe acute gout drugs to use

A
  • Colchicine + NSAID
  • colchcine + oral steroid
  • NSAID + intraarticular steroid
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17
Q

colchicine renal and hepatic considerations

A

dose adjustments

18
Q

colchicine side effects

A
  • N/V/D

- neutropenia

19
Q

colchicine dosage

A

1.2 mg initially, 0.6 mg 1 hour later, then 0.6 mg once or twice daily for duration of attack

20
Q

FDA approved NSAIDs for gout

A
  • indomethacin
  • naproxen
  • sulindac
21
Q

NSAID dosing in gout

A

use the max dose

22
Q

steroid precautions in gout

A

avoid long term use and caution with patients with DM

23
Q

indications for preventative treatment of gout

A
  • 2 or more gout attacks per year
  • tophi
  • CKD stage 2-5
24
Q

serum uric acid goal in gout patients

A

<6 mg/dl

25
Q

tophi

A

hard crystals of urate that are mostly found in fingers, toes, and elbows

26
Q

first line drugs for preventative treatment of gout

A
  • allopurinol
  • febuxostat
  • maybe probenecid
27
Q

allopurinol side effects

A
  • rash

- rarely allopurinol hypersensitivity syndrome

28
Q

risk factors for allopurinol hypersensitivity syndrome

A
  • recent initiation of treatment
  • renal impairment
  • diuretics
  • HLA-B5801 allele
  • high starting dose
29
Q

allopurinol dosing

A
  • start low and titrate slow
  • 100 mg qd if no CKD
  • 50 mg qd if CKD 4-5
  • titrate every 2-5 weeks
30
Q

febuxostat dosing

A

40 mg qday, increase to 80 mg if needed after 2 weeks

31
Q

febuxostat side effects

A

rash

increased LFTs

32
Q

problems with probenecid

A
  • can’t use if CKD

- lots of drug interactions

33
Q

pegloticase MoA

A

converts uric acid to allantoin

34
Q

pegloticase dosing

A

IV infusion ever 2 weeks

35
Q

pegloticase adverse reactions

A
  • anaphylaxis
  • nausea
  • urticaria
  • antibody formation
36
Q

pegloticase recommended in

A
  • severe gout disease

- refractory or intolerant of conventional drugs

37
Q

first line antiinflammatory gout prophylaxis

A
  • low dose colchicine

- low dose NSAID

38
Q

how long to continue anti-inflammatory gout prophylaxis treatment

A

-until 3 months after achieving serum uric acid goal
OR
-6 months of treatment

39
Q

combination therapy in gout

A

if target is not reached with XOi then you may add:

  • probenecid
  • fenofibrate
  • losartan
40
Q

monitoring in gout

A
  • renal function
  • liver enzymes
  • serum uric acid levels every 2 weeks during titration
41
Q

second line antiinflammatory gout prophylaxis

A

low dose prednisone or prednisolone

PT2 Pain 5-10 (6 decks)

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