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Therapeutics 1 > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

Define: Osteoarthritis (OA)

A

Aka: Degenerative joint disease or degenerative arthritis. Most common joint disease, responsible for disability and loss of productivity. Caused by destabilization of the normal coupling of degradation and synthesis of articulation cartilage

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2
Q

What are the Risk Factors of Osteoarthritis (OA)?

A

Older age, obesity, activities involving prolonged and repetitive motion (occupation, sports, trauma)

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3
Q

What are the symptoms of osteoarthritis?

A

Pain localized to affected joint, joint stiffness, limited range of motion

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4
Q

What joints are affected by OA?

A

Hands, knee, hip, foot, spine, shoulder

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5
Q

What are the goals of therapy when treating osteoarthritis?

A
  1. Educate
  2. Relieve pain and stiffness
  3. Limit functional impairment
  4. Maintain or improve joint mobility
  5. Maintain or improve quality of life
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6
Q

What physical, psychological, and mind-body (non-pharmacological) are strongly recommended for OA

A

Physical/occupational therapy, exercise, weight loss, tai chi(balance)

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7
Q

What adverse gastrointestinal(GI) effects are a concern with NSAIDs?

A

-nausea, dyspepsia, anorexia, abdominal pain, flatulence, diarrhea
-gastric and duodenal mucosal bleeding that lead to ulcerations
-monitor complete blood count (CBC)
-risk factors: history of ulcer, high dose of NSAID therapy, concurrent use of aspirin or anticoagulants or corticosteroids

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8
Q

What adverse renal effects are a concern with NSAIDs?

A

do not use if CrCl <30 ml/min
-monitor: serum creatinine at baseline and within 3-7 days of drug initiation (then once a year)
-risk factors: age>65, disease states such as-renal failure, heart failure, cirrhosis, certain medications

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9
Q

What adverse cardiovascular effects are a concern with NSAIDs?

A

-increased risk of heart attack and stroke
-monitor: blood pressure and possibly lipids
-risk factors: pre-existing cardiovascular disease, duration of use (longer the use the higher the risk)
beware of using COX-2 selective inhibitor in patients with cardio risk factors

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10
Q

What general adverse effects are a concern with NSAIDs?

A

-GI effects such as nausea, diarrhea, abdominal pain but especially mucosal bleeding that lead to ulcerations
-renal effects since NSAIDs are metabolized by the kidney
-cardiovascular risk especially risk of heart attack and stroke
-allergic reactions
-drowsiness, dizziness, headaches, confusion
-increased bleeding risk especially with concurrent use with anticoagulants (ex. Warfarin)
use caution in pregnant women

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11
Q

What drug interactions are a concern with NSAIDs?

A

-WARFARIN since NSAIDs can displace from protein binding which reduces platelet aggregation and induce GI bleeding
-diuretics since NSAIDs reduce their effects
-antihypertensives since NSAIDs may cause sodium retention

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12
Q

What is the benefit of using a COX-2 selective inhibitor (Celecoxib)?

A

less GI toxicities, but increase risk of cardiovascular toxic effects

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13
Q

What type(s) of osteoarthritis are oral NSAIDs recommended for?

A

all types!

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14
Q

What type(s) of osteoarthritis are topical NSAIDs recommended for?

A

knee and potentially hand, but not recommended for hip due to the depth of the joint below the skin
typically considered before oral NSAIDs due to less systemic effects

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15
Q

Can you combine use of oral NSAIDs and topical NSAIDs?

A

not recommended unless benefit outweigh risk

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16
Q

What is the dosing of the topical NSAID diclofenac gel 1%?

A

maximum total body dose of 32g/day
-lower extremities= apply 4 g gel to affected area 4x/day (max 16g/joint)
-upper extremities= apply 2 g gel to affected area 4x/day (max 8g/joint)

17
Q

What are the patient counseling point for diclofenac gel 1%?

A

-avoid wearing clothing for 10 minutes
-do not wash area for 1 hour following application
-avoid sunlight exposure
-avoid occlusive dressing /heat applications of treated area

18
Q

What is the dosing of diclofenac solution 2%?

A

only use on knee
apply 2 pumps to each affected knee twice daily

19
Q

What type(s) of osteoarthritis are intraarticular glucocorticoid injections recommended for?

A

knee and hip and potentially hand

20
Q

What are the patient counseling points for intraarticular glucocorticoid injections?

A

-minimize activity/stress for several days after injection
-initial pain relief at 24-72 hours and lasts for 4-8 weeks but generally injections are limited to 3-4x/year

21
Q

What is the recommended use of acetaminophen for OA?

A

possible relief in OA but minimal benefit seen, but better safety profile than NSAIDs

22
Q

What is the dosing of acetaminophen?

A

325-650mg q4-6h or 1g 3-4x/day
max dose= 4g/4000mg/day

23
Q

What adverse effects are a concern with acetaminophen?

A

hepatotoxicity, use caution in chronic alcohol users and liver disease (monitor liver function tests)

24
Q

What is the recommended use of tramadol for OA?

A

modest benefit seen but risk of opioid like side effects so used in patients that have a contraindication to NSAIDs or no other therapy has proved effective

25
Q

What is the dosing of tramadol?

A

max dose 300-400mg/day
-initiate at lower dose (100mg/day) and titrate to higher dose (200 mg/day) for pain control
-renal impairment(CrCl <30mL/min)= max 200mg/day dosed q12h
-hepatic impairment= 50 mg q12h
-age >75= max dose 300mg/day

26
Q

What is the recommended use of duloxetine for OA?

A

FDA approved indication for OA, 30mg/day for 1 week then increase to 60mg/day- not recommended for patients with hepatic impairment

27
Q

What is the recommended use of capsaicin for OA?

A

possible use for knee OA but recommended against for hand OA due to risk of burning and stinging

28
Q

What drugs are strongly recommended for hand OA?

A

oral NSAIDs

29
Q

What drugs are conditionally recommended for hand OA?

A

topical NSAIDs, intraarticular glucocorticoid injection, acetaminophen, duloxetine, tramadol

30
Q

What drugs are strongly recommended for knee OA?

A

topical or oral NSAIDs, intraarticular glucocorticoid injection

31
Q

What drugs are conditionally recommended for knee OA?

A

acetaminophen, duloxetine, tramadol, topical capsaicin

32
Q

What drugs are strongly recommended for hip OA?

A

oral NSAIDs, intraarticular glucocorticoid injection

33
Q

What drugs are conditionally recommended for hip OA?

A

acetaminophen, duloxetine, tramadol

Therapeutics 1 (16 decks)

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