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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

25
tophi
hard crystals of urate that are mostly found in fingers, toes, and elbows
26
first line drugs for preventative treatment of gout
- allopurinol - febuxostat - maybe probenecid
27
allopurinol side effects
- rash | - rarely allopurinol hypersensitivity syndrome
28
risk factors for allopurinol hypersensitivity syndrome
- recent initiation of treatment - renal impairment - diuretics - HLA-B5801 allele - high starting dose
29
allopurinol dosing
- start low and titrate slow - 100 mg qd if no CKD - 50 mg qd if CKD 4-5 - titrate every 2-5 weeks
30
febuxostat dosing
40 mg qday, increase to 80 mg if needed after 2 weeks
31
febuxostat side effects
rash | increased LFTs
32
problems with probenecid
- can't use if CKD | - lots of drug interactions
33
pegloticase MoA
converts uric acid to allantoin
34
pegloticase dosing
IV infusion ever 2 weeks
35
pegloticase adverse reactions
- anaphylaxis - nausea - urticaria - antibody formation
36
pegloticase recommended in
- severe gout disease | - refractory or intolerant of conventional drugs
37
first line antiinflammatory gout prophylaxis
- low dose colchicine | - low dose NSAID
38
how long to continue anti-inflammatory gout prophylaxis treatment
-until 3 months after achieving serum uric acid goal OR -6 months of treatment
39
combination therapy in gout
if target is not reached with XOi then you may add: - probenecid - fenofibrate - losartan
40
monitoring in gout
- renal function - liver enzymes - serum uric acid levels every 2 weeks during titration
41
second line antiinflammatory gout prophylaxis
low dose prednisone or prednisolone

PT2 Pain 5-10 (6 decks)

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