Osteoarthritis Flashcards
What are the first-line options for pain relief in osteoarthritis? (2)
Paracetamol Topical NSAIDs (particularly for hand or knee involvement)
If treatment with simple analgesia (paracetamol or topical NSAID) is ineffective for the pain of osteoarthritis, what are the next options for pain relief? (3)
Oral NSAID (discontinue topical NSAID)
Weak opioid analgesic (e.g. codeine)
Topical capsaicin 0.025% (particularly for knee or hand involvement)
If simple analgesia (paracetamol or topical NSAID) is ineffective pain relief for osteoarthritis and you start a patient on an oral NSAID, which of the simple analgesia would they discontinue?
Topical NSAID use should be discontinued if starting an oral NSAID
If a patient taking low-dose aspirin develops osteoarthritis, which pain relief treatment should be avoided if possible?
NSAID
What injections are considered as an adjunctive treatment for relief of moderate to severe pain associated with osteoarthritis?
Intra-articular corticosteroid
What non-drug measures should be encouraged in patients with osteoarthritis? (3)
Weight reduction (in overweight or obese patients)
Local muscle strengthening exercise
Aerobic exercise
Is glucosamine recommended for the treatment of osteoarthritis?
NO
Is chondroitin recommended for the treatment of osteoarthritis?
NO
Are topical rubefacients recommended for the treatment of osteoarthritis?
NO
Topical rubefacients may contain nicotinate compounds, salicylate compounds, essential oils, and camphor
Are intra-articular preparation of hyaluronic acid and its derivatives recommended for osteoarthritis of the knee?
NO but are available
Can intra-articular corticosteroid injections be considered for osteoarthritis?
YES
Intra-articular corticosteroid injections can be considered as an adjunctive treatment for relief of moderate to severe pain associated with osteoarthritis.
What are the indications for the use of capsaicin? (2)
- Localised neuropathic pain
2. Symptomatic relief in osteoarthritis
What are the indications for the use of codeine phosphate? (4)
Acute diarrhoea
Mild to moderate pain
Short-term treatment of acute moderate pain
Dry or painful cough
What effects can be produced when you combine opioids with benzodiazepines?
Additive CNS depressant effects
- sedation
- respiratory depression
- coma
- death
Healthcare professionals are advised to discuss with patients that prolonged use of opioids, even at therapeutic doses, may lead to (?) and (?)
dependence
addiction
Should you taper or abruptly withdraw an opioid at the end of treatment?
Taper dosage slowly
Taper dosage slowly at the end of treatment to reduce the risk of withdrawal effects associated with abrupt discontinuation (tapering high doses may take weeks or months)
What should you consider in a patient on long-term opioid treatment who present with increased pain sensitivity?
Hyperalgesia
What is the maximum daily dose of codeine in children aged 12-18 years?
240 mg
Doses may be taken up to 4 times a day at intervals of no less than 6 hours
What should the duration of treatment with codeine be limited to in children aged 12-18 years?
3 days
Can breastfeeding mothers use codeine?
NO
What are the signs and symptoms of morphine toxicity? (8)
Reduced consciousness Lack of appetite Somnolence Constipation Respiratory depression 'pin-point' pupils Nausea Vomiting
Codeine is contraindicated in patients of any age known to be (?) ultra-rapid metabolisers
CYP2D6
What are the contraindications for all opioids? (5)
Acute respiratory depression Comatose patients Head injury Raised intracranial pressure Risk of paralytic ileus
In addition to the contraindications for all opioids, what are the additional contraindications for codeine phosphate? (6)
- Acute ulcerative colitis
- Antibiotic-associated colitis
- Children < 18 years undergoing removal of tonsils or adenoids for the treatment of obstructive sleep apnoea
- Conditions where abdominal distension develops
- Conditions where inhibition of peristalsis should be avoided
- Known CYP2D6 ultra-rapid metabolisers
What are the common side effects of opioids?
- Arrhythmias
- Confusion
- Constipation
- Dizziness
- Drowsiness
- Dry mouth
- Euphoric mood
- Hallucination
- Hyperhidrosis
- Miosis
- Nausea + vomiting (more common on initiation)
- Palpitations
- Respiratory depression
- Skin reactions
- Urinary retention
- Vertigo
- Withdrawal syndrome
Respiratory depression is a major concern with opioid analgesics and it may be treated by (?) or be reversed by naloxone.
artificial ventilation
Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by (?).
naloxone
Glucosamine is a natural substance found in (1?), (2?), and (3?).
- mucopolysaccharides
- mucoproteins
- chitin
What are the common side effects of glucosamine? (6)
Constipation Diarrhoea Fatigue GI discomfort Headache Nausea
What is the contraindication for the use of glucosamine?
Shellfish allergy
What needs to be monitored in patients taking glucosamine? (2)
Blood-glucose concentration (if impaired glucose tolerance)
Cholesterol (if predisposition to cardiovascular disease)
