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Advanced Immunology > osteoarthritis > Flashcards

osteoarthritis Flashcards

1
Q

what is the primary site of damage in osteoarthritis

A

articular cartilage

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2
Q

most common risk factors for OA

A

female, age, obesity, injury to or overuse of a particular joint, family history, muscle weakness

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3
Q

most preventable risk factor OA

A

obesity– weight loss of 5 kg decreases risk by 50%

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4
Q

what occurs upon damage to cartilage

A

increased chondrocyte activity leading to cartilage swelling–> increased water content and cartilage thickening–> MMP secretion–> proteoglycan breakdown–> increased cartilage permeability and destruction–> bony remodeling

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5
Q

typical age at presentation

A

> 50

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6
Q

how long does morning stiffness last OA

A

<30 minutes

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7
Q

the pain in OA is associated with ___

A

motion

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8
Q

signs of OA

A

crepitus

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9
Q

indicators of OA

A

osteophytes, bouchard nodes, heberden nodes, joint space narrowing

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10
Q

what are the primary joints affected in OA

A

DIP, CMC

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11
Q

joint characteristics in OA vs RA

A

OA hard and bony
RA soft and spongey

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12
Q

lab findings in OA?

A

RF, ACPA
NORMAL ESR AND CRP

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13
Q

strongly recommend in hand OA

A

oral NSAIDs

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14
Q

conditionally recommend in hand OA

A

topical NSAIDs (pref over PO for those >75 yo)
intraarticular steroids
APAP
duloxetine
tramadol
chondroitin

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15
Q

strongly recommend against in all OA

A

bisphosphonates
glucosamine
HCQ
MTX
biologics

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16
Q

conditionally recommend against in all OA

A

non-tramadol opioids
colchicine
fish oil
vitamin D

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17
Q

strongly recommend in knee OA

A

topical NSAIDs
oral NSAIDs
intraarticular steroids

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18
Q

conditionally recommend in knee OA

A

topical capsaicin
APAP
duloxetine
tramadol

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19
Q

strongly recommend in hip OA

A

oral NSAIDs
intraarticular steroids

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20
Q

conditionally recommend in Hip OA

A

APAP
duloxetine
tramadol

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21
Q

APAP mech

A

inhibition of central prostaglandin synthesis

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22
Q

APAP dosing

A

325-650 mg q4-6h
or 1000 mg 3-4x/day

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23
Q

APAP max

A

4 g daily or 2 g for alcoholic cirrhosis

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24
Q

APAP warnings

A

liver disease

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25
Q

APAP side effects

A

PO well tolerated, GI effects with IV

26
Q

APAP counseling

A

always account for all APAP containing products

27
Q

APAP advantages

A

multiple available strengths, no cardiac or renal toxicity

28
Q

APAP limitations

A

may increase bleeding with warfarin
multiple daily dosing

29
Q

NSAID mech

A

block prostaglandin synthesis via inhibition of COX1/COX2

30
Q

ibuprofen dosing

A

400 mg PO TID

31
Q

naproxen dosing

A

220 mg PO BID

32
Q

low vs high dose NSAIDs

A

low dose for pain
higher doses for inflammation and swelling (gout and RA)

33
Q

GI effects with long term NSAID

A

bleeding, ulcers, perforations

34
Q

drug interactions with NSAIDs

A

warfarin, clopidogrel, SSRIs, ASA

35
Q

ASA/NSAID together counseling

A

take ASA 30 minutes before NSAID

36
Q

risk factors for GI injury

A

antiplatelets, anticoagulants, chronic steroid use, age >70

37
Q

nsaid GI precautions

A

take w/ food or milk, use lowest effective dose
for high risk: add a PPI
can add H2RA but least evidence
can add misoprostol but it is contraindicated in pregnancy

38
Q

total body dose not to exceed for voltaren

A

32 g per day

39
Q

voltaren dosing lower extremities

40
Q

voltaren dosing upper extremities

41
Q

do not use voltaren for more than __ days or on >_ body parts at the same time

42
Q

voltaren adverse effects

A

local burning, stinging, erythema

43
Q

tramadol mech

A

binds to mu-opioid receptor and inhibits reuptake of norepinephrine and serotonin: partial opioid agonist

44
Q

tramadol dosing

A

initial 25 mg/d
max 400 mg/d (300 elderly)
renal/hepatic adjustments

45
Q

tramadol adverse

A

sedation, constipation, lower seizure threshold

46
Q

when to use tramadol

A

for severe pain after NSAIDs, APAP, adjunctive therapies fail

47
Q

duloxetine mech

A

selective norepinephrine reuptake inhibitor (SNRI)

48
Q

duloxetine dose

A

limit to 60 mg/day
higher doses increase side effects

49
Q

duloxetine adverse effects

A

nausea, headache, dizzy, sleep disturbance, sexual dysfunction, urinary retention

50
Q

duloxetine drug interactions

A

SSRIs, NSAIDs, tramadol (CYP2D6)

51
Q

capsaicin mech

A

derived from hot peppers; releases and ultimately depletes substance P from different nociceptive nerve fibers (pain transmission)

52
Q

capsaicin adverse

A

stinging, itching, erythema, burning (wear gloves when applying)

53
Q

glucosamine when to avoid

A

vegans (shark)

54
Q

chondroitin when to avoid

A

shellfish allergy
prostate and skin cancer

55
Q

when to use intra-articular corticosteroids

A

not responding to oral meds, experiencing moderate to severe pain
strong rec in hip OA
conditional in hand/knee OA

56
Q

if using intra-articular steroids for hip OA what is recommended

A

ultrasound guided administration

57
Q

maximum frequency of intra-articular corticosteroids

A

every 3 months

58
Q

onset of intra-articular corticosteroids

A

at least 1 week and lasts for 6

59
Q

local side effects intra-articular corticosteroids

A

post injection pain flare, crystal synovitis, hemarthrosis, joint sepsis, articular cartilage atrophy

60
Q

systemic side effects intra-articular corticosteroids

A

hyperglycemia, weight gain, osteoporosis, fluid retention

61
Q

intra-articular hyaluronidase onset

A

13 weeks; lasts 6 months

Advanced Immunology (6 decks)

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