Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Adv. Immunology > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

Osteoarthritis

A

-Inflammation of bone + cartilage
-Structural and functional failure of synovial joints
-Muscle weakness results in joint pain, instability, and functional limitations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors of OA?

A

i. Advanced age
ii. Female
iii. Obesity
iv. History of joint trauma
v. Lack of osteoporosis
vi. Repetitive motion
vii. Previous occupation
viii. Sports
ix. Genetics
x. Diabetes
xi. Quadriceps weakness
xii. Calcium crystal deposition disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most preventable risk factor?

A

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pathophysiology of OA?

A

Damage to the cartilage–> increase chondrocyte activity = cartilage swelling–> increase water content = cartilage thickening–> increased MMP (mediator tumorigenesis) secretion–> proteoglycan breakdown–> increase cartilage permeability and destruction bony remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of OA?

A
  • Nearly all patients have pain in the affected joints (hands, knees, and hips being the most common)
  • Pain is most commonly associated with motion, but pain in late disease can occur with rest
  • Morning joint stiffness (usually < 30 mins) resolves with motion; recurs with rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of OA?

A
  • Crepitus, a crackling or grating sound heard with joint movement that is caused by irregularity of joint surfaces may be present
  • Limited range of motion that may be accompanied by joint instability
  • Late stage disease is associated with joint deformity
  • Heberden (protrusion of DIP) and Bouchard (protrusion of the interphalangeal) nodes extra bony protrusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some test you can do for OA?

A
  • Radiologic test
    • Joint space narrowing, appearance of osteophytes (bone spurs)in moderate disease
    • Abnormal alignment of joints and joint effusion in late disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is strongly recommended for hand OA?

A

Oral NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is conditionally recommended for hand OA?

A
  1. Topical NSAIDS (preferred over PO for those > 75 years old)
  2. Intraarticular steroids
  3. Acetaminophen
  4. Duloxetine
  5. Tramadol
  6. Chondroitin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is conditionally recommended against hand OA?

A
  1. Non-tramadol opioids
  2. Colchicine
  3. Fish oil
  4. Vitamin D
  5. Topical capsaicin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is strongly recommended against hand OA?

A
  1. Bisphosphonates
  2. Glucosamine
  3. Hydroxychloroquine
  4. Methotrexate
  5. Biologics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is strongly recommended for knee OA?

A
  1. Topical NSAIDs
  2. Oral NSAIDs
  3. Intranasal steroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is conditionally recommended for knee OA?

A
  1. Topical capsaicin
  2. Acetaminophen
  3. Duloxetine
  4. Tramadol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is conditionally reocommended against knee OA?

A
  1. Non-tramadol opioids
  2. Colchicine
  3. Fish oil
  4. Vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is strongly recommended against hip OA?

A
  1. Bisphosphonates
  2. Glucosamine
  3. Chondroitin
  4. Hydroxychloroquine
  5. Methotrexate
  6. Biologics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the MOA of Acetaminophen?

A

Inhibition of central prostaglandin synthesis

17
Q

What is the MOA of NSAIDs?

A

Block prostaglandin synthesis via inhibition of COX1/COX2

18
Q

What are drug drug interactions with NSAIDs?

A

warfarin, clopidogrel, SSRIs, ASA

19
Q

What are some risk factors for GI injury due to NSAIDs?

A

a. History of GI bleeding
b. Antiplatelet drugs (including aspirin)
c. Age > 70
d. Multiple NSAIDs
e. History of peptic ulcer
f. Anticoagulant drugs
g. Chronic steroid use
h. Dyspepsia

20
Q

What do you give high-risk patients when they’re on NSAIDs?

A
  • Add daily PPI
    • Preferred, most evidence to support
  • Add misoprostol 200 mcg QID
  • Add full dose H2RA (least evidence to support)
    • Sucralfate not recommended
21
Q

Voltaren (Diclofenac) 1% Gel

A
  • Commonly used topical NSAIDs
  • Reduces pain/stiffness in hand and knee
22
Q

What is the max dose of Voltaren (Diclofenac) 1% Gel?

A

Total body dose should not exceed 32 g/day
or for more than 21 days on more than 1 body part

23
Q

What is the adverse effects of Voltaren (Diclofenac) 1% Gel?

A
  1. Local burning
  2. Stinging
  3. Erythema
  4. Systemic absorption (6-10% of oral dose)
24
Q

What are some topical NSAID Pearls?

A
  1. Works well as PO NSAIDs on localized areas
  2. Reduces long term PO NSAIDs
  3. Lower risk for systemic side effects
  4. Combination with PO NSAID no better than oral NSAID alone
25
Q

Tramadol

A

MOA: Binds to mu-opioid receptor + inhibits reuptake of norepinephrine and serotonin
* Partial opioid agonist

26
Q

What is the max dosing of tramadol?

A
  • 400 mg/daily
  • For elderly, 300 mg/daily
27
Q

What are the adverse effects of Tramadol?

A
  1. Sedation
  2. Constipation
  3. Can potentially lower seizure threshold
28
Q

Duloxetine (Cymbalta)

A
  • MOA: Selective norepinephrine reuptake inhibitor (SNRI)
  • Approved for chronic musculoskeletal pain
  • Reduces pain and improves function with knee OA
29
Q

When would you consider Duloxetine?

A
  1. Neuropathic component to pain
  2. Concomitant depression
  3. Inadequate response or contraindications to other agents
30
Q

What are the adverse effects of Duloxetine?

A
  • Nausea
  • headache
  • dizziness
  • sleep disturbances
  • sexual dysfunction
  • urinary retention
31
Q

What are some clinical pearls of Duloxetine?

A
  • Moderate CYP2D6 inhibitors
    • Interacts with SSRIs, NSAIDs, tramadol
  • Renally limited (not recommended with CrCl < 30 mL/min)
32
Q

Capsaicin

A

MOA: Derived from hot peppers. Releases and ultimately depletes substance P from different nociceptive nerve fibers (pain transmission)

33
Q

What is the patch formulation of Capsaicin?

A
  • Apply 1 patch to affected area for up to 8 hours (max 4 patches/day)
  • Do not use more than 5 consecutive days
34
Q

What are the adverse effects of Capsaicin?

A
  • Stinging
  • itching
  • erythema
  • burning
35
Q

Glucosamine/chondroitin

A
  • Normal components of cartilage
  • MOA: Used in proteoglycan synthesis
    -Slow onset—symptom reduction in 2 months
    -Discontinue after 6 months if no response
36
Q

What are the local side effects of intraarticular injections?

A
  1. Post-injection pain flare
  2. Crystal synovitis
  3. Hemarthrosis
  4. Joint sepsis
  5. Articular cartilage atrophy
37
Q

What are the systemic side effects of intraarticular injections?

A
  1. Hyperglycemia
  2. Weight gain
  3. Osteoporosis
  4. Fluid retention

Adv. Immunology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions