Osteoarthritis

Question 1

Goals of treatment for osteoarthritis

Answer 1

pain reduction, optimize function, modify process of joint damage (decreased inflammation, reduce weight on joint)

Question 2

How do NSAIDs work for OA

Answer 2

hit inflammation and pain

protection of gastric mucosa (cannot prevent ulcers)

Question 3

What is the topical NSAID available for OA

Answer 3

diclofenac gel (voltaren)

Question 4

Topical NSAIDs are only recommended for __ and ___

Answer 4

knees and hands

Question 5

you must use a ____ approach for treating OA

Answer 5

combination

drugs + lifestyle mod

Question 6

Topical NSAIDs are dose based on ____

Answer 6

size of joint

Question 7

Diclofenac solution (Pennsaid) is available ____

Answer 7

prescription only

Question 8

What oral NSAIDs work for OA

Answer 8

ibuprofen, naproxen, diclofenac, meloxicam, salsalate

Question 9

What is the COX-2 selective inhibitor used for OA

Answer 9

celecoxib

Question 10

Oral NSAIDs for OA are used at a ____ than for other things. They should be taken with ___ and should not be used in patients with __ and ___

Answer 10

higher dose
food
renal dysfunction, hepatic dysfunction (decreased renal perfusion, risk of hepatorenal syndrome)

Question 11

What is the problem with using ketorolac for OA

Answer 11

short term management of acute pain only continuation treatment after IV or IM ketorolac

Question 12

COX-2 inhibitors over NSAIDs reduces the incidence of ______ unless patient is taking ____

Answer 12

peptic ulcers

aspirin

Question 13

Intra-articular injections are used for ___ and ___ osteoarthritis mostly

Answer 13

knee and hip

Question 14

Intra-articular injections must be limited on frequency due to ______. no more than ____ a year

Answer 14

cartilage degeneration

4 injections a year

Question 15

Acetaminophen for OA reduces ___ but not ______. It also does not increase risk of ______

Answer 15

pain, inflammation

peptic ulcer disease

Question 16

Acetaminophen MOA is a big unknown but though to act central and inhibit ______. ineffective as a ____

Answer 16

prostaglandin

monotherapy

Question 17

Acetaminophen for OA is given at a ___ dose and for patients who cannot tolerate ___

Answer 17

high dose

NSAIDs

Question 18

Acetaminophen- regularly monitor for ____

Answer 18

hepatotoxicity

Question 19

Tramadol can be used for OA and can be used in patients who ______

Answer 19

cannto tolerate other oral therapies or NSAIDs

Question 20

If patient takes more than 400mg/day of Tramadol, they can cuase

Answer 20

seizures

Question 21

Duloxetine is a ______ (MOA)

Answer 21

SNRI and SSRI

Question 22

Duloxetine can be used in patients with ___ who have failed ____. Prescribing should be ______

Answer 22

moderate to severe OA, NSAIDs

titrate to high dose

Question 23

How does topical capsaicin work for OA?

Answer 23

capsaicin-> release substance P (chemomediator of pain impulses from PNS to CNS)-> deletes neuron of substance P and prevents reaccumulation

Question 24

What types of treatments should be avoided in OA

Answer 24

anything immune modulating (methotrexate, TNF inhibitors, stem cell injection, etc)