Osteo Flashcards
What joints are involved in osteoarthritis?
Distal interphalangeal joint, hips and knees
What is the difference between a Herberden and Bouchard node?
Herberden- upper joint in hand
Bouchard- lower joint in hand
What is the presentation of inflammation in osteoarthritis?
Absent or mild
T/F: Osteoarthritis therapy can repair the integrity of the joint affected
False: therapy is for pain and discomfort relief
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What are three topical therapy options of Osteoarthritis?
Menthol, Camphor, Oil of Wintergreen
What topical therapy depletes substance P? What is its wait time for results? Side effects?
Capsaicin Cream (Zostrix)
Wait 2-4 weeks for results
SE: Burning, stinging, and redness
What OTC topical therapy for osteoarthritis uses local inhibition of COX-2 enzymes? Its recommendation? Side effects?
Diclofenac Gel 1%- Voltaren Gel
Not recommended in combo with systemic NSAID
SE: pruritus, burning, pain and rash
What prescribed topical therapy for osteoarthritis is used for the knee only? Side effect?
Diclofenac Topical Solution- Pennsaid
SE: Local reaction
What is acetaminophens (Tylenol) method of action within the body? Its max dose and trial time?
Inhibits synthesis of prostaglandins
Max dose 2-4g per day
2-4 week trial on scheduled dose
Where is acetaminophen contraindicated?
Patients at risk for hepatotoxicity (liver disease, heavy alcohol intake)
What is some of the greatest contraindications for NSAID therapy?
Anticoagulants/Antiplatelet and glucocorticoids
How are NSAIDs monitored in patients?
Blood pressure, swelling, kidney function (SCr) every 3 mon, Hemoglobin (Hgb/Hct) every 6-12 mon, signs of dehydration
What COX-2 inhibitor can be used to lower incidence of GI bleeding?
Celebrex
What are the three combination products for protecting from stomach upset?
NSAID + PPI
NSAID + misoprostol
NSAID + H2 antagonist
How should dosing go for opioid analgesics?
Start low and go slow (using long and short acting)
Adverse effects of opioid analgesics?
Nausea, Somnolence, Constipation and Dizziness
Which analgesic has affinity for m receptor and inhibits NE and serotonin?
Tramadol (Ultram)
Which drug is adjunct and has a “neuropathical, musculoskeletal nature” Can not be taken with tramadol.
Duloxetine (Cymbalta)
What is the main side effect for opioid prescription drugs (such as Tramadol and Duloxetine)
GI upset
What OTC supplement is not recommended and has a slow onset? Why isn’t it recommended?
Glucosamine/Chondroitin
SE: Hypertension, diabetes, insulin resistance
What injection temporarily increases viscosity and is used weekly for 3-5 weeks?
Hyaluronate Injections (Synvisc)
