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Therapy: year 3 > osteoarthritis > Flashcards

osteoarthritis Flashcards

1
Q

Inflammatory or noninflammatory disorder?

A

noninflammatory

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2
Q

What’s it a disbalance of ?

A

systemic disorder due to imbalance between joint destruction and repair

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3
Q

what are some risk factors?

A

female, obesity, advancing age, family history

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4
Q

do we treat the disease or the symptoms?

A

symptomatic relief

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5
Q

what are some of the clinical presentations

A

pain
stiffness
deformity
crepitation
decreased ramge of motion
joint enlargemnt
inflammation

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6
Q

is it bilateral or unilateral involvement?

A

unilateral

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7
Q

joints affected?

A

hands, knees, hips, spine, feet

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8
Q

what does screening for OA encompass?

A
  • age 45 or above
  • activity-related joint pain
  • no morning joint-related stiffness or stiffness that lasts less than 30 mins
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9
Q

what kind of referrals can you give to someone with OA?

A

physiotherapist
occupational therapist
dieticain

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10
Q

what are the treatment options?

A

topical NSAIDS
Acetaminophen
NSAID
IA steroid injections

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11
Q

what are some non-pharm measures?

A

loss weight
active joints are helathier joints
acupunction
hot/cold therapy
surgery

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12
Q

what are the topical NSAIDS and what joinst are they for?

A

diclofenac - OA of hand and knee
capsaicin - OA of knee

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13
Q

What is the to be noted with capsaicin in partiuclar?

A

causes burning but you get used to it after using for a while can not be PRN or burning will never cease

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14
Q

what is the first oral drug we try? is it recommended by all?

A

acetaminophen - NA guidlines say try it, international guildlines tend to skip it

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15
Q

what are some concersnwhat should we screen for before acetaminophen use?

A

liver - haptoxicity
so how much alchol do they have?
old people are especially at risk

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16
Q

what is the maximum daily dose of acetaminophen? normal? elderly? high-risk user?

A

less than 4 g/ day

3200 mg /day

2600 mg /day

17
Q

What is an important counseling point concerning acetaminophen dosing?

A

account for ALL sources of acetaminophen

18
Q

what should we try after acetaminphen?

A

NSAIDS

19
Q

what should we asses a patient for prior to NSAID use?

A

GI risk
CV risk
Renal risk

20
Q

if we have hypertension and OA what do we do?

A

can use NSID but must monitor BP

21
Q

if we have CV risk and OA what do we do?

A

use low-dose NSAID and titrate up as needed (risk increases as dose increases)

22
Q

what NSAID carry the highest CV risk?

A

diclofemnac, celecoxib, and high dose ibuprofen

23
Q

what NSAID is the safest for CV risk?

A

Naproxen

24
Q

can we use multiple NSAID at once?

A

NO - only low dose aspirin can be used when there is a CV risk along with an NSADI for OA

25
Q

what NSAID is the safest for GI risk?

A

celecoxib

26
Q

how do we monitor for renal function and NSAID use?

A

most elderly people have renal insufficiency
- drugs such as antihypertensives are given - ACE, ARB, diuretics
- we can moniot kidney function and switch their anitihypertensives to hopefully get the desires results

27
Q

What kind of OA what Duloxtine be used for? Evidence? what kind of drug is it?

A

SNRI
- OA of knee
- limited evidence though found to be better then a placebo so can try

28
Q

What role do opioids and tramadol play in OA?

A

they should not be used

29
Q

What role do natural health products play in OA?

A

we have glucosamine and chondroitin - placebo - do nothing if you have the money you can try the placebo for 3 months

30
Q

What kind of steroids can we use for OA?

A

injectable storids only - not oral

31
Q

what joint do sterois help for?

A

OA of the knee

32
Q

how many injections of steroids can we get yeraly?

A

3 to 4

33
Q

when moniotring how often should the pharamcist monitor?

A

days 3, 7, and 14

34
Q

how long do we try a therpay before concluding if failed?

A

14 days

35
Q

if we find an appropriate therapy for pain managment how do we proceed?

A

find lowest possible effective dose

36
Q

if pain is improving but not optimized?

A

can try adjunct agent (i.e topical )

37
Q

what can we do to minmize GI upset?

A

take with food

38
Q

what lab values should be monitored?

A

Acetaminohen - baseline LFTS for those at high risk of hepatoxicity

NSADIS - SCR and CrCL for patoent with pre-existing renal disease and takjing meds that affect kidney function (diuretics, ACEI) renal function needs to be asses every 7-10 days

39
Q

what do we monitor if a patient has hypertension and is on NSAIDS

A

Blood pressure every 2-4 weeks for 1-2 months

  • uncontrolled every 1-2 weeks

Therapy: year 3 (14 decks)

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