Osteoarthritis Flashcards

1
Q

What are the first-line options for pain relief in osteoarthritis? (2)

A
Paracetamol
Topical NSAIDs (particularly for hand or knee involvement)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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)

A

Oral NSAID (discontinue topical NSAID)
Weak opioid analgesic (e.g. codeine)
Topical capsaicin 0.025% (particularly for knee or hand involvement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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?

A

Topical NSAID use should be discontinued if starting an oral NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If a patient taking low-dose aspirin develops osteoarthritis, which pain relief treatment should be avoided if possible?

A

NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What injections are considered as an adjunctive treatment for relief of moderate to severe pain associated with osteoarthritis?

A

Intra-articular corticosteroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What non-drug measures should be encouraged in patients with osteoarthritis? (3)

A

Weight reduction (in overweight or obese patients)
Local muscle strengthening exercise
Aerobic exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is glucosamine recommended for the treatment of osteoarthritis?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is chondroitin recommended for the treatment of osteoarthritis?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Are topical rubefacients recommended for the treatment of osteoarthritis?

A

NO

Topical rubefacients may contain nicotinate compounds, salicylate compounds, essential oils, and camphor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Are intra-articular preparation of hyaluronic acid and its derivatives recommended for osteoarthritis of the knee?

A

NO but are available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Can intra-articular corticosteroid injections be considered for osteoarthritis?

A

YES

Intra-articular corticosteroid injections can be considered as an adjunctive treatment for relief of moderate to severe pain associated with osteoarthritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the indications for the use of capsaicin? (2)

A
  1. Localised neuropathic pain

2. Symptomatic relief in osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the indications for the use of codeine phosphate? (4)

A

Acute diarrhoea
Mild to moderate pain
Short-term treatment of acute moderate pain
Dry or painful cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What effects can be produced when you combine opioids with benzodiazepines?

A

Additive CNS depressant effects

  • sedation
  • respiratory depression
  • coma
  • death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Healthcare professionals are advised to discuss with patients that prolonged use of opioids, even at therapeutic doses, may lead to (?) and (?)

A

dependence

addiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Should you taper or abruptly withdraw an opioid at the end of treatment?

A

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)

17
Q

What should you consider in a patient on long-term opioid treatment who present with increased pain sensitivity?

A

Hyperalgesia

18
Q

What is the maximum daily dose of codeine in children aged 12-18 years?

A

240 mg

Doses may be taken up to 4 times a day at intervals of no less than 6 hours

19
Q

What should the duration of treatment with codeine be limited to in children aged 12-18 years?

20
Q

Can breastfeeding mothers use codeine?

21
Q

What are the signs and symptoms of morphine toxicity? (8)

A
Reduced consciousness
Lack of appetite
Somnolence
Constipation
Respiratory depression 
'pin-point' pupils
Nausea
Vomiting
22
Q

Codeine is contraindicated in patients of any age known to be (?) ultra-rapid metabolisers

23
Q

What are the contraindications for all opioids? (5)

A
Acute respiratory depression 
Comatose patients
Head injury 
Raised intracranial pressure
Risk of paralytic ileus
24
Q

In addition to the contraindications for all opioids, what are the additional contraindications for codeine phosphate? (6)

A
  1. Acute ulcerative colitis
  2. Antibiotic-associated colitis
  3. Children < 18 years undergoing removal of tonsils or adenoids for the treatment of obstructive sleep apnoea
  4. Conditions where abdominal distension develops
  5. Conditions where inhibition of peristalsis should be avoided
  6. Known CYP2D6 ultra-rapid metabolisers
25
What are the common side effects of opioids?
1. Arrhythmias 2. Confusion 3. Constipation 4. Dizziness 5. Drowsiness 6. Dry mouth 7. Euphoric mood 8. Hallucination 9. Hyperhidrosis 10. Miosis 11. Nausea + vomiting (more common on initiation) 12. Palpitations 13. Respiratory depression 14. Skin reactions 15. Urinary retention 16. Vertigo 17. Withdrawal syndrome
26
Respiratory depression is a major concern with opioid analgesics and it may be treated by (?) or be reversed by naloxone.
artificial ventilation
27
Respiratory depression is a major concern with opioid analgesics and it may be treated by artificial ventilation or be reversed by (?).
naloxone
28
Glucosamine is a natural substance found in (1?), (2?), and (3?).
1. mucopolysaccharides 2. mucoproteins 3. chitin
29
What are the common side effects of glucosamine? (6)
``` Constipation Diarrhoea Fatigue GI discomfort Headache Nausea ```
30
What is the contraindication for the use of glucosamine?
Shellfish allergy
31
What needs to be monitored in patients taking glucosamine? (2)
Blood-glucose concentration (if impaired glucose tolerance) | Cholesterol (if predisposition to cardiovascular disease)