Osteoarthritis Flashcards
What is important from the pathophysiology of osteoarthritis?
There is an increased destruction and subsequent proliferation of cartilage and bone.
“wear and tear”
What are the risk factors for osteoarthritis?
Increased age
Females (becomes more even with age)
Obesity (weight stress on joints)
Repetitive stress (athletes)
Congenital defects
Major joint trauma
Muscle weakness
Heredity
What are the outcomes of osteoarthritis?
Joint destruction
Severe pain (also at rest)
Loss of joint function
Disability
Social Isolation
Depression
Reduced quality of life
Major economic burden
Who is typically affected by osteoarthritis?
More commonly in older patients
-85% of patients older than 75 years
-severity increases with age
More commonly in females but evens outs as age increases
What joints are involved in osteoarthritis?
Distal interphalangeal joint
Hips
Knees
What are the clinical manifestations of osteoarthritis?
Joint pain (most common Sx)
Stiffness in the morning
Crepitus; cracking or popping noise
Inflammation
Muscle atrophy
Asymmetric involvement (RA is more symmetric)
No systemic Sx
Instability of weight bearing joints
Heberden’s nodes (ones near finger nail)
Bouchard’s nodes (ones in middle of finger)
What are the pharmacist goals of therapy for osteoarthritis?
Relief the pain and discomfort
Maintain function of joint and strength
NOT reversing the damage already done or slowing progression. (we do not have medications for this yet)
What are some non-pharmacological therapies for osteoarthritis patients?
Psychological support: education and rest
Physical activity exercise: heat/ice, non rigorous physical therapy, occupational therapy
Weight loss
What is important to know about pharmacological therapy of osteoarthritis?
Broken up into Knee and Hip or Hand for treatment plans.
Most topical OTC products are minimally effective and have to apply frequently (2-4 times a day).
-Diclofenac gel is best but expensive
Acetaminophen is the first life of defense for OA.
What is the maximum dose of acetaminophen per day for an osteoarthritis patient?
4 grams
It will take time to see the results so important to take as directed around the clock.
Lot of OTC products also have acetaminophen in it as well.
Who are patients at risk for hepatotoxicity with acetaminophen?
Those with a heavy alcohol intake.
Pre-existing liver disease.
These patients should avoid tylenol if major issue. Make sure to monitor ALT/AST annually if on routine dose.
What are the adverse effects of NSAID therapy?
GI upset -take with food then
Ulcers -take with food then
Bleeding
Renal dysfunction
Increase BP
Increased risk of stroke, MI, and death
Who is at risk for adverse effects of NSAID therapy?
Dose dependent
Those older than 75
h/o GI bleed
h/o of PUD
anticoagulants
antiplatelets
glucocorticoids
What patients are at greatest risk for nephrotoxicity with NSAIDs?
CHF
HTN
Renal dysfunction
Dehydration
What patients are at greatest risk for cardiovascular adverse effects with NSAIDs?
CHF
CVD
