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PY6020 > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

What is osteoarthritis?

A

It is a non-inflammatory abnormality due to wear/tear of the synovial joints as you grow older. Cartilage is then progressively lost.

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2
Q

Where does osteoarthritis usually occur?

A

Hands, knees, spine & hips

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3
Q

Which gender is more prone to osteoarthritis?

A

Women

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4
Q

Which 2 pro-inflammatory mediators can speed up the process of cartilage degradation?

A

TNF-a, and IL-1

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5
Q

What are some risk factors for osteoarthritis?

A
  1. Obesity
  2. Females
  3. Increasing age
  4. Inflammatory diseases
  5. Chronic strain - e.g. due to job
  6. Gout
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6
Q

What are the symptoms of osteoarthritis?

A
  1. Pain in joints - worse when moving
  2. Stiffness when sitting down
  3. Creaking/cracking of joints when moving
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7
Q

What one thing should patients with osteoarthritis avoid, to prevent osteoporosis?

A

They should avoid weight bearing exercise, as this can lead to osteoporosis.

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8
Q

What non-drug treatments are available for osteoarthritis?

A
  1. Weight reduction in obese patients
  2. Local heat to affected joint
  3. Physiotherapy
  4. Psychological support
  5. Surgery
  6. Non-weight bearing exercise
  7. TENS: nerve stimulation to distract pain receptors of the site
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9
Q

Why should oral NSAIDs be avoided in elderly patients?

A

Because they are more likely to have renal complications, which can be worsened by NSAIDs

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10
Q

Which class of drug should be given if a patient has a history of GI complications/ulcers?

A

COX-2 inhibitors, e.g. celecoxib

- This is because COX-2 is more selective & prevents GI side effects

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11
Q

What is the maximum safest dose of ibuprofen which can be given? Why is it this number?

A

Less than 1.2g

This is because anything higher than 1.2g is associated with increased risk of thrombotic events

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12
Q

Which NSAID has the best CV safety profile? Give the dose too

A

Naproxen 1g

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13
Q

Why are topical NSAIDs preferred for osteoarthritis?

A

Because it acts locally & has less side effects than oral NSAIDs

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14
Q

Why can’t oral & topical NSAIDs be given together?

A

Because side effects can increase due to the higher dose.

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15
Q

What is the max. dose of paracetamol which a patient with osteoarthritis can take?

A

Max 1g QDS

Must take regularly, not PRN to avoid future pains

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16
Q

What should you do if a patient <50kg is taking paracetamol for osteoarthritis?

A

Adjust the dose

17
Q

Which opioid can be used in osteoarthritis?

A

Codeine (Co-codamol)

18
Q

Can paracetamol + topical NSAID + codeine be given for osteoarthritis?

A

Yes.

19
Q

What does topical capsaicin do?

A

It generates heat to distract you from the pain.

20
Q

Why should NSAIDs not be given with antiplatelets?

A

Because they can increase the risk of bleeding

21
Q

What risk factors should you consider before giving an oral NSAID to an osteoarthritic patient?

A
  1. Smoking
  2. GI problems
  3. > 65 years old
  4. CV risks
  5. Renal function
22
Q

Why should laxatives be considered if you are giving a patient an opioid?

A

Because opioids can cause constipation.

Laxatives can include: lactulose, fybogel, porridge oats

23
Q

What is always co-prescribed with an NSAID or COX-2 inhibitor (which are the 1st line treatments for osteoarthritis)?

A

Co-prescribe with a PPI.

24
Q

What is the dose of diclofenac for osteoarthritis?

A

150mg daily

25
Q

Why should alcohol be avoided when taking NSAIDs?

A

Because alcohol increases the risk of gastro intestinal haemorrhage with NSAIDs.

26
Q

If a patient has had a previous ulcer history with no CV risk, which drug choice is their 1st option?

A

COX-2 inhibitor

27
Q

Do you start with low-dose ibuprofen, or naproxen as treatment for osteoarthritis?

A

Start with low dose ibuprofen <1.2g (can also be taken with paracetamol)
The next choice would be naproxen.

28
Q

Why would intra-articular corticosteroids be given in osteoarthritis?

A

Could produce temporary benefit especially if there is soft-tissue inflammation.

29
Q

What other agents could the patient try which can aid in their osteoarthritis pain?

A
  1. Cod liver oil
  2. Vitamin E
  3. Glucosamine
30
Q

Which type of acid can be injected in the joint to reduce osteoarthritic pain?
Why is this injected?

A

Hyaluronic acid.
This can be injected because the fluid in the knee is hyaluronic acid, so this can reduce the friction of the joints & relieve pain.

31
Q

What is the max. number of corticosteroid injections a person can take per year?

A

4.

PY6020 (22 decks)

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