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PHAR 255 > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

Peak onset age of OA?

A

50-60yrs

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2
Q

Primary OA?

A

No identifiable factor

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3
Q

Secondary OA?

A

other metabolic factors identified

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4
Q

Pathogenesis of OA?

A

imbalance between cartilage maintenance and destruction;
- malfunction of chondrocytes
- results in loss of proteoglycans and water
- formation of osteophytes
Inflammatory cytokines play a role

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5
Q

Modifiable risks of OA?

A

Obesity
Joint Trauma

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6
Q

Non-modifiable risks of OA?

A

age
genetics
sex
joint misalignment/deformity

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7
Q

Stage of progression of OA?

A

aricular cartilage changes
bone remodeling
synovial inflammation
soft tissue inflammation

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8
Q

Onset of OA?

A

gradual;
intial absence of inflammation or joint swelling
pain and stiffness w/ activity
no systemic sx

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9
Q

Pain stages of OA?

A

Stage 1: predicatable sharp pain brought on by activity
Stage 2: pain becomes more constant, epsidoes of stiffness
Stage 3: constant dull/aching pain, chronic stiffness, episodes of intense exhausting pain

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10
Q

When does pain tend to be worse in OA?

A

late afternoon/ early evening (as day goes on)

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11
Q

Common joints affected by OA?

A

distal interphalangeal,
proximal itnerphalangeal,
joints of thumb,
cervical and lumbar spine
hip
knee
metotarsophalangeal joint

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12
Q

Whereis the heberden;s nodes deformity located?

A

Distal interphalangeal

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13
Q

Where is Bouchard’s node deformity located?

A

Proximal interphalangeal

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14
Q

What tests used to daignose OA?

A

Persistent usage-related pain
> 45
little early morning stiffness, more in evening

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15
Q

WHen is additional testing done for OA daignosis?

A

younger
atypical sx
wt loss

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16
Q

3 components of diagnosis?

A

history
physical exam
imaging;
- X-ray may be helpful but does not necessarily correlate to pain

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17
Q

Treatment goals?

A

focus specific lifestyle changes
reduce pain
maitain or improve joint motility
limit functional disability
improve spef-management

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18
Q

4 pillars of treatment for OA?

A

pt education
rehabilitation
medications
referals (surgical/non-surgical)

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19
Q

What is the initial drug of choice for OA?

A

acetaminophen

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20
Q

Dosing for acet / timeframe?

A

1g QID
used max dose 2-3 weeks to judge efficacy then use lowest effective dose thereafter

21
Q

DI of acetaminophen?

A

Warfarin
Alcohol use
Isoniazid

22
Q

Topical NSAIDs used?

A

Diclofenac
Ketoprofen

23
Q

Benefits of topical NSAIDs?

A

saftey issues and DI unlikely
application directly to site
can be used BID-QID

24
Q

Capsaicin MOA?

A

deplete substance P and down regulate nociceptive fibers

25
Q

How must capsaicin be used?

A

consistently for 2-4 weeks to see benefit, needs to deplete substance P

26
Q

Methyl salicylate good?

A

not much evidence to support use
avoid in ASA allergic pts
potential Warfarin interaction

27
Q

Oral NSAIDs better or worse than Acet?

A

More effective but,
risk of GI/ CV/ renal toxicity

28
Q

When is oral NSAID preffered over topical NSAID?

A

if topical NSAID failed, multiple joints affected, hip and spine OA

29
Q

Oral NSAIDs?

A

Dico
Naproxen
Ibu
Indomethacin
Ketoprofen
Meloxicam
Celecoxib

30
Q

Monitoring for long-term oral NSAID therapy?

A

BP
Electrolytes
Renal function
CBC
INR in pts w/ anticoagulants

31
Q

Opioid place in therapy of OA?

A

last line

32
Q

WHen is duloxetine used in OA?

A

second-line agent; especially used if neuropathic pain present, OA of knee

33
Q

Duloxetine AE’s?

A

headache
dry mouth
constipation
sedation
fatigue
dizziness
sweating
appetite lose
High doses: BP and HR increase

34
Q

CI of duloxetine?

A

narrow angle glaucoma
ESRD
Hepatic impairment
Seizure history

35
Q

Injectable CS’s?

A

Triamcinolone
Methylprednisolone
hydrocortisone
dexamethasone

36
Q

MOA of injectable CS’s?

A

interrupt inflammatory cascade at several levels

37
Q

When are injectable CS’s considered?

A

in hip, knee, shoulder OA

38
Q

Efficacy of Injectable CS’s?

A

short term relief, no long term benefit

39
Q

How long do injectable CS’s last?

A

4-8 weeks

40
Q

How many injections per joint per year?

A

3-4

41
Q

Hyaluronic acid MOA?

A

component of synovial fluid

42
Q

Use of hyaluronic acid?

A

Knee OA

43
Q

Downside of hyaluronic acid?

A

$$$ uncertain benefit

44
Q

Hyaluronic acid dosing?

A

IA injection once weekly for 2-4 weeks, can repeate every 6 months

45
Q

AE’s of Hyaluronic acid?

A

arthalgia
injection site pain/reaction
post injection flare

46
Q

How long dose glucosamine need to be used to see benefit?

A

atleast 3 months

47
Q

Dosing of glucosamine?

A

500mg TID or 1500mg OD

48
Q

Chrondroitin dosing?

A

1200mg/d

PHAR 255 (14 decks)

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