osteoarthritis Flashcards
Inflammatory or noninflammatory disorder?
noninflammatory
What’s it a disbalance of ?
systemic disorder due to imbalance between joint destruction and repair
what are some risk factors?
female, obesity, advancing age, family history
do we treat the disease or the symptoms?
symptomatic relief
what are some of the clinical presentations
pain
stiffness
deformity
crepitation
decreased ramge of motion
joint enlargemnt
inflammation
is it bilateral or unilateral involvement?
unilateral
joints affected?
hands, knees, hips, spine, feet
what does screening for OA encompass?
- age 45 or above
- activity-related joint pain
- no morning joint-related stiffness or stiffness that lasts less than 30 mins
what kind of referrals can you give to someone with OA?
physiotherapist
occupational therapist
dieticain
what are the treatment options?
topical NSAIDS
Acetaminophen
NSAID
IA steroid injections
what are some non-pharm measures?
loss weight
active joints are helathier joints
acupunction
hot/cold therapy
surgery
what are the topical NSAIDS and what joinst are they for?
diclofenac - OA of hand and knee
capsaicin - OA of knee
What is the to be noted with capsaicin in partiuclar?
causes burning but you get used to it after using for a while can not be PRN or burning will never cease
what is the first oral drug we try? is it recommended by all?
acetaminophen - NA guidlines say try it, international guildlines tend to skip it
what are some concersnwhat should we screen for before acetaminophen use?
liver - haptoxicity
so how much alchol do they have?
old people are especially at risk
what is the maximum daily dose of acetaminophen? normal? elderly? high-risk user?
less than 4 g/ day
3200 mg /day
2600 mg /day
What is an important counseling point concerning acetaminophen dosing?
account for ALL sources of acetaminophen
what should we try after acetaminphen?
NSAIDS
what should we asses a patient for prior to NSAID use?
GI risk
CV risk
Renal risk
if we have hypertension and OA what do we do?
can use NSID but must monitor BP
if we have CV risk and OA what do we do?
use low-dose NSAID and titrate up as needed (risk increases as dose increases)
what NSAID carry the highest CV risk?
diclofemnac, celecoxib, and high dose ibuprofen
what NSAID is the safest for CV risk?
Naproxen
can we use multiple NSAID at once?
NO - only low dose aspirin can be used when there is a CV risk along with an NSADI for OA
what NSAID is the safest for GI risk?
celecoxib
how do we monitor for renal function and NSAID use?
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
What kind of OA what Duloxtine be used for? Evidence? what kind of drug is it?
SNRI
- OA of knee
- limited evidence though found to be better then a placebo so can try
What role do opioids and tramadol play in OA?
they should not be used
What role do natural health products play in OA?
we have glucosamine and chondroitin - placebo - do nothing if you have the money you can try the placebo for 3 months
What kind of steroids can we use for OA?
injectable storids only - not oral
what joint do sterois help for?
OA of the knee
how many injections of steroids can we get yeraly?
3 to 4
when moniotring how often should the pharamcist monitor?
days 3, 7, and 14
how long do we try a therpay before concluding if failed?
14 days
if we find an appropriate therapy for pain managment how do we proceed?
find lowest possible effective dose
if pain is improving but not optimized?
can try adjunct agent (i.e topical )
what can we do to minmize GI upset?
take with food
what lab values should be monitored?
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
what do we monitor if a patient has hypertension and is on NSAIDS
Blood pressure every 2-4 weeks for 1-2 months
- uncontrolled every 1-2 weeks
