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III. Clinical Pharmacy > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

It is a common, progressive disorder affecting primarily weightbearing diarthrodial joints

A

Osteoarthritis

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2
Q

Osteoarthritis is characterized by:

A
  • progressive deterioration and loss of articular cartilage
  • osteophyte formation
  • pain
  • limitation of motion
  • deformity
  • disability
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3
Q

Idiopathic Osteorarthritis is also known as:

A

Primary OA

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4
Q

T/F:

Trauma, metabolic or endocrine disorders, and congenital disorders are the known cause of Secondary OA?

A
  • True
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5
Q

Risk factors for OA:

A
  • increasing age
  • obesity
  • repetitive use through work or leisure
    activities
  • joint trauma
  • genetic predisposition
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6
Q

ESR for the diagnosis of Hip OA?

A
  • less than 20 mm/h
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7
Q

Age more than 50 years, morning stiffness
lasting 30 minutes or less, crepitus on motion, bony enlargement, bony
tenderness, and/or, palpable joint warmth are the symptoms needed for the diagnosis of what kind of OA?

A
  • Knee OA
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8
Q

T/F:
ESR may be slightly elevated if inflammation is present. Rheumatoid factor is negative.
Analysis of synovial fluid reveals high viscosity and mild leukocytosis (<2000 white
blood cells/mm3 [<2 × 109
/L]) with predominantly mononuclear cells are the signs associated with OA?

A
  • True
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9
Q

T/F:
The goals of treatment for OA are: (1) educate patient, family members, and caregivers; (2) relieve
pain and stiffness; (3) maintain or improve joint mobility; (4) limit functional impairment; and (5) maintain or improve quality of life.

A
  • True
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10
Q

T/F:

Drug therapy for OA is targeted at relief of pain?

A
  • True
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11
Q

Preferred first-line treatment for Knee and Hip OA?

A
  • Acetaminophen
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12
Q

Acetaminophen is much effective than NSAIDs. Also, has less risk of serious gastrointestinal (GI) and cardiovascular events.

A
  • Acetaminophen is less effective than NSAIDs
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13
Q

Advantage of COX-2 inhibitors than non-selective NSAIDs in the treatment of OA?

A
  • less

risk for adverse GI events than nonselective NSAIDs

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14
Q

Drug that reduces adverse GI events in patients
taking NSAIDs?
CLUE: PGE1

A
  • Misoprostol
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15
Q

Drug that reduces adverse GI events in patients

taking NSAIDs?

A
  • Proton pump inhibitors
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16
Q

COX-2 inhibitors may not be sustained beyong?

A
  • 6 months
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17
Q

For knee OA, it is the recommended medication if acetaminophen fails?

A
  • Topical NSAIDs
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18
Q

Topical NSAIDs are preferred than Oral NSAIDs in what patient age?

A
  • older than 75 years old
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19
Q

Advantage of Topical NSAIDs compared to Oral NSAIDs in Knee OA?

A
  • fewer adverse GI events
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20
Q

A drug that is recommended for both hip and
knee OA when analgesia with acetaminophen or NSAIDs is suboptimal?
CLUE: corticosteroid injection, but what route?

A
  • Intra-articular corticosteroid injection
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21
Q

T/F:
IA corticosteroid injections should not be administered more frequently than once every 3 months to minimize adverse effects?

A
  • True
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22
Q

Criteria for using Tramadol as a treatment for Hip and knee OA?

A
  • patients who have failed scheduled full-dose acetaminophen and topical NSAIDs
  • who are not appropriate candidates for oral NSAIDs
  • who are not able to receive IA corticosteroids.
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23
Q

Criteria for using Opioids as a treatment OA?

A
  • patients not responding adequately to nonpharmacologic and first-line pharmacologic therapies
  • Patients who are at high surgical risk
    and cannot undergo joint arthroplasty are also candidates for opioid therapy.
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24
Q

T/F:
Adverse
events limit routine use of opioids for treatment of OA pain.

A
  • True
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25
Q

Adjunctive treatment in patients with partial response to

first-line analgesics (acetaminophen, oral NSAIDs).

A
  • Duloxetine
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26
Q

preferred second-line

medication in patients with both neuropathic and musculoskeletal OA pain

A
  • Duloxetine
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27
Q

Not routinely recommended for knee OA pain.

A

IA hyaluronic acid

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28
Q

T/F:
Injections do
not provide clinically meaningful improvement and may be associated with serious
adverse events (eg, increased pain, joint swelling, and stiffness).

A
  • True
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29
Q

T/F:
lucosamine and/or chondroitin and topical rubefacients (eg, methyl salicylate, trolamine salicylate) lack uniform efficacy for hip and knee pain and are not
preferred treatment options.

A
  • True
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30
Q

first-line option for hand OA

A
  • Topical NSAIDs
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31
Q

alternative first-line treatment for patients who cannot tolerate
the local skin reactions or who received inadequate relief from topical NSAIDs.

A
  • Oral NSAIDs
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32
Q

alternative first-line treatment and demonstrates modest
improvement in pain scores. It is a reasonable option for patients unable to take oral
NSAIDs. Adverse effects are primarily skin irritation and burning.

A
  • Capsaicin creams
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33
Q

T/F:
Use of nonprescription
combination products containing acetaminophen and NSAIDs is discouraged
because of increased risk of renal failure.

A
  • True
34
Q

T/F:
NSAIDs may cause gastric
and duodenal ulcers and bleeding through direct (topical) or indirect (systemic)
mechanisms.

A
  • True
35
Q

Risk factors for NSAID-associated ulcers and ulcer complications (perforation, gastric outlet obstruction, and GI bleeding)

A 
- history of complicated
ulcer
- concomitant use of multiple NSAIDs (including aspirin) or anticoagulants
- use of high-dose NSAIDs
- age more than 70 years.
36
Q

Options for reducing the GI risk of nonselective NSAIDs:

A
  • the lowest dose possible and only
    when needed
  • misoprostol four times daily with the NSAID
  • a PPI or full dose H2 -receptor antagonist daily with the NSAID
37
Q

T/F:

All nonselective NSAIDs inhibit COX-1–dependent thromboxane production in platelets, thereby reducing bleeding risk.

A
  • False (Increasing bleeding risk)
38
Q

T/F:

NSAIDs should not be given in late pregnancy due to risk of premature closure of ductus arteriousus?

A
  • True
39
Q

The most potentially serious drug interactions include use of NSAIDs:

A
  • Lithium
  • Warfarin
  • Oral hypoglycemics
  • Methotrexate
  • Antihypertensives
  • ACE-inhibitors
  • B-blockers
  • Diuretics
40
Q

The most serious adverse event associated with Tramadol?

A
  • Seizures
41
Q

T/F:
There is increased risk
of serotonin syndrome when tramadol is used with other serotonergic medications,
including duloxetine.

A
  • True
42
Q

Brand name:

Sodium hyaluronate 20 mg/2 mL: once weekly for five injections

A
  • (Hyalgan)
43
Q

Brand name:

Sodium hyaluronate 20 mg/2 mL: once weekly for three injections

A
  • (Euflexxa)
44
Q

Brand name:

Sodium hyaluronate 25 mg/2.5 mL: once weekly for five injections

A
  • (Supartz)
45
Q

Brand name:

Hylan polymers 16 mg/2 mL: once weekly for three injections

A
  • (Synvisc)
46
Q

Brand name:
Hylan polymers 48 mg/6 mL: single injection (with efficacy for
up to 26 weeks)

A
  • (Synvisc-One)
47
Q

Hyaluronan 30 mg/2 mL: once weekly for three injections

A
  • (Orthovisc)
48
Q

T/F:
Depending on the joint(s) affected, measurement of grip strength and 50-ft walking
time can help assess hand and hip/knee OA, respectively

A
  • True
49
Q

T/F:
Obtain baseline serum creatinine, hematology profile, and serum transaminases with
repeat levels at 6- to 12-month intervals to identify specific toxicities to the kidney,
liver, GI tract, or bone marrow.

A
  • True
50
Q

Starting dose of Acetaminophen?
(UR: 325–650 mg every 4–6 h or 1 g 3–4 times/
day)

A

325–500 mg 3 times

a day

51
Q

Starting dose of Tramadol?
(UR: Titrate dose in 25-mg increments to reach a
maintenance dose of 50–100 mg 3 times
a day)

A

25 mg in the morning

52
Q

Starting dose of Tramadol ER? (UR: Titrate to 200–300 mg daily)

A

100 mg daily

53
Q

Starting dose of Hydrocodone/
acetaminophen?
(UR: 2.5–10 mg/325–650 mg 3–5 times daily)

A

5 mg/325 mg 3 times

daily

54
Q

Starting dose of Oxycodone/
acetaminophen?
(UR: 2.5–10 mg/325–650 mg 3–5 times daily)

A

5 mg/325 mg 3 times

daily

55
Q

Usual range for Capsaicin 0.025% or

0.075%

A

Apply to affected joint 3–4 times per day.

56
Q

Usual range for Diclofenac 1% gel

A

Apply 2 or 4 g per site as prescribed, 4

times daily.

57
Q

Usual range for Diclofenac 1.3%

patch

A

Apply one patch twice daily to the site to

be treated, as directed.

58
Q

Usual range for Diclofenac 1.5%

solution

A

Apply 40 drops to the affected knee, applying and rubbing in 10 drops at a time.
Repeat for a total of 4 times daily

59
Q

Starting dose for Triamcinolone? (UR: 10–40 mg per large joint (knee, hip, shoulder))

A

5–15 mg per joint

60
Q

Starting dose for Methylprednisolone

acetate? (UR: 20–80 mg per large joint (knee, hip, shoulder))

A

10–20 mg per joint

61
Q

Starting dose for Aspirin (plain, buffered, or enteric coated)?
(UR: 325–650 mg 4 times a day)

A

325 mg 3 times a day

62
Q

Starting dose for Celecoxib? (UR: 100 mg twice daily or 200 mg daily)

A

100 mg daily

63
Q

Starting dose for Diclofenac IR? (UR: 50–75 mg twice a day)

A

50 mg twice a day

64
Q

Starting dose for Diclofenac XR? (UR: 100–200 mg daily)

A

100 mg daily

65
Q

Starting dose for Diflunisal? (UR: 500–750 mg twice a day)

A

250 mg twice a day

66
Q

Starting dose for Etodolac? (UR: 400 to 500 mg twice a day)

A

300 mg twice a day

67
Q

Starting dose for Fenoprofen? (UR:400–600 mg 3–4 times a day)

A

400 mg 3 times a day

68
Q

Staring dose for Flurbiprofen? (UR: 200–300 mg/day in 2–4 divided doses)

A

100 mg twice a day

69
Q

Staring dose for Ibuprofen? (UR: 1200–3200 mg/day in 3–4 divided doses)

A

200 mg 3 times a day

70
Q

Starting dose for Indomethacin? (Titrate dose by 25–50 mg/day until pain
controlled or maximum dose of 50 mg
3 times a day)

A

25 mg twice a day

71
Q

Starting dose for Indomethacin SR? (UR: Can titrate to 75 mg SR twice daily if
needed)

A

75 mg SR once daily

72
Q

Starting dose for Ketoprofen?(UR: 50–75 mg 3–4 times a day)

A

50 mg 3 times a day

73
Q

Starting dose for Meclofenamate? (UR: 50–100 mg 3–4 times a day)

A

50 mg 3 times a day

74
Q

Staring dose for Mefenamic acid? (UR:250 mg 4 times a day)

A

250 mg 3 times a day

75
Q

Starting dose for Meloxicam? (UR: 15 mg daily)

A

7.5 mg daily

76
Q

Starting dose for Nabumetone? (UR: 500–1000 mg 1–2 times a day)

A

500 mg daily

77
Q

Starting dose for Naproxen? (UR: 500 mg twice a day)

A

250 mg twice a day

78
Q

Starting dose for Naproxen sodium? (UR: 220–550 mg twice a day)

A

220 mg twice a day

79
Q

Starting dose for Naproxen sodium CR? (UR: 500–1500 mg once daily)

A

750–1000 mg once

daily

80
Q

Staring dose for Oxaprozin?(UR: 600–1200 mg daily)

A

600 mg daily

81
Q

Starting dose for Piroxicam? (UR: 20 mg daily)

A

10 mg daily

82
Q

Starting dose for Salsalate? (UR: 500–1000 mg 2–3 times a day)

A

500 mg twice a day

III. Clinical Pharmacy (3 decks)

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