Osteoarthritis Flashcards
- Which one of the following is characteristic of osteoarthritis (OA)?
A. Unilateral joint pain upon waking
B. Joint stiffness in the morning lasting 45 minutes
C. Elevated C-reactive protein (CRP) level
D. Elevated erythrocyte sedimentation rate (ESR)
E. All of the above
A
- All of the following are considered risk factors for OA except:
A. Heavy physical activity
B. Age
C. Obesity
D. Ethnicity
E. Joint trauma
D
- Which one of the following is the most appropriate treatment approach in a
patient at risk for developing OA?
A. Promote lifestyle changes targeted at risk factors for OA
B. Initiate tramadol 50 mg every 4 to 6 hours as needed
C. Initiate ibuprofen 200 mg every 6 hours as needed
D. Initiate acetaminophen 325 mg every 4 to 6 hours as needed, and
promote lifestyle changes targeted at risk factors for OA
E. Initiate ibuprofen 200 mg every 6 hours as needed, and promote lifestyle
changes targeted at risk factors for OA
A
- Therapy with celecoxib, rather than a non-selective NSAID, would be most
appropriate for which of the following patients?
a. 58-year-old woman with metabolic syndrome and gastroesophageal reflux
disease
b. 69-year-old man with a history of Helicobacter pylori peptic ulcer disease
c. 53-year-old woman with a strong family history of myocardial infarction and
previous GI upset with ibuprofen use
d. 47-year-old man with a history of GI bleed from previous indomethacin use
e. 70-year-old woman with chronic renal insufficiency who takes low-dose
aspirin for cardioprotection
D
- Treatment with naproxen monotherapy, rather than another non-selective
NSAID, would be most appropriate for which of the following patients?
A. 49-year-old woman with metabolic syndrome and history of MI
B. 70-year-old man with a history of Helicobacter pylori peptic ulcer disease
C. 58-year-old man with a strong family history of myocardial infarction and
previous GI bleed with ibuprofen use
D. 67-year-old man with a history of GI bleed from previous indomethacin
use
E. 70-year-old woman with chronic heart failure
A
- Which one of the following regimens is considered an adequate trial of
acetaminophen before assessing treatment success or failure?
A. 325 mg every 6 hours for 1 month
B. 325 mg every 6 hours for 2 months
C. 1000 mg every 6 hours for 1 month
D. 500 mg every 8 hours for 2 months
E. 325 mg every 4 to 6 hours for 1 month
C
- Compared with oral NSAIDs, topical NSAIDs are:
A. More effective for hip OA
B. More effective for knee OA
C. Less effective for hand OA
D. Associated with fewer systemic toxicities
E. All of the above
D
- For which of the following patients would concomitant naproxen and a PPI be
most appropriate?
A. 49-year-old woman with metabolic syndrome
B. 70-year-old man with a history of Helicobacter pylori peptic ulcer disease
C. 58-year-old man with a history of myocardial infarction and previous
gastric ulcer with ibuprofen use
D. 67-year-old man with a history of GI bleed from previous indomethacin
use
E. 70-year-old woman with chronic heart failure
C
- Nonpharmacologic therapies for OA include which of the following?
A. Stretching
B. Application of heat
C. Weight loss
D. Occupational therapy
E. All of the above
E
10.Which of the following circumstances warrants consideration to initiating chronic
opioid therapy?
a. Untreated moderate to severe OA.
b. Moderate to severe OA refractory to acetaminophen.
c. Moderate to severe OA refractory to acetaminophen and a history of
chronic heart failure.
d. Mild to moderate OA refractory to acetaminophen.
e. All of the above
C
11.Compared to nonselective NSAIDs, COX-2—selective agents:
A. Reduce OA-related pain to a greater extent
B. Have a lower risk for cardiovascular adverse events
C. Have a lower risk for adverse renal effects
D. Have a lower risk of gastrointestinal bleeds
E. All of the above
D
12.Which of the following statements is true regarding the use of
glucosamine/chondroitin for OA?
A. Treatment benefit is moderate but consistent among all types and
severities of OA.
B. Because glucosamine/chondroitin is regulated as a dietary supplement, product standards are consistent and reliable.
C. Glucosamine/chondroitin is generally well tolerated, but treatment benefits
are uncertain.
D. Both glucosamine and chondroitin pose a high risk for anaphylaxis in
patients with shellfish allergy.
E. Glucosamine-containing products are contraindicated in patients with
uncontrolled disease
C
13.Which of the following is true regarding intraarticular corticosteroid use in a
patient achieving a partial response to naproxen 500 mg twice daily for left knee
OA?
A. Pain relief will occur rapidly and persist for up to 6 months.
B. Intraarticular corticosteroids should not be used concomitantly with
naproxen.
C. Intraarticular corticosteroids are useful for polyarticular symptoms due to
their systemic mechanism of action.
D. The affected joint can be injected monthly until response.
E. Intraarticular corticosteroids may be more effective if an inflammatory
component is present.
E
- Which one of the following drug regimens is most appropriate for a patient with OA who has with chronic renal insufficiency (creatinine clearance 28 mL/min [0.47 mL/s]) and who has failed acetaminophen monotherapy?
A. Nabumetone 50 mg twice daily
B. Celecoxib 100 mg twice daily
C. Naproxen 500 mg twice daily
D. Tramadol 100 mg three times daily
E. Oxycodone 5 mg immediate-release every 4 to 6 hours as needed
D
15.Patients attempting treatment with topical capsaicin should be counseled on
which of the following?
A. Do not allow contact with eyes or mucous membranes
B. When applying to knee, wash hands after application
C. May take 2 weeks of daily treatment to experience benefit
D. May experience burning sensation at application site
E. All of the above
E
- Which one of the following is a pathophysiologic characteristic of osteoarthritis (OA)?
A. Thinning of subchondral bone and the joint capsule
B. Damage to diarthrodial joints
C. Cartilage thickening
D. Elevated erythrocyte sedimentation rate (ESR)
B
- Which of the following is considered a risk factor for OA:
A. Male sex
B. Genetic predisposition
C. Alcohol consumption
D. Smoking
B
- All of the following are recommended nonpharmacologic approaches to prevention and treatment of osteoarthritis EXCEPT:
A. Provision of counseling and educational programs
B. Increased aerobic or strength-training exercise
C. Utilization of modified shoes or wedged insoles
D. Utilization of a carpometacarpal orthosis
C
- In which of the following patients would an oral NSAID be a reasonable pharmacologic option for treatment of OA?
A. 59-year-old woman with hyperlipidemia and heart failure
B. 70-year-old man with chronic kidney disease
C. 64-year-old man with controlled hypertension
D. 67-year-old man with a past history of GI bleed from previous indomethacin use
C
- Compared with oral NSAIDs, topical NSAIDs are:
A. Similarly effective for hip OA
B. More effective for knee OA
C. Less effective for ankle OA
D. Similarly effective for hand OA
D
- Which of the following is the most appropriate exercise therapy for patients with knee OA?
A. Stretching exercises targeting the vulnerable joint
B. Isokinetic and isotonic exercises performed weekly
C. High-impact exercise
D. Repetitive exercises targeting the knee
A
- In which of the following circumstances would duloxetine therapy be most appropriate?
A. A patient with untreated moderate to severe hand OA pain
B. A patient with moderate to severe knee OA pain characterized as dull and aching
C. A patient with moderate to severe hip OA pain described as burning and tingling
D. A patient with severe hand OA pain characterized as grating and stiff, refractory to topical NSAID use
C
- Compared to COX-2-selective agents, nonselective NSAIDs:
A. Reduce OA-related pain to a greater extent
B. Have an increased risk for blood pressure elevation
C. Have an increased risk for adverse renal effects
D. Have an increased risk for gastrointestinal bleeds
D
- Which of the following is a treatment goal for patients with OA?
A. Exercise programs to maintain body weight
B. Reversal of joint degeneration
C. Complete remission of pain
D. Maintaining or restoring mobility
D
- Which of the following is true regarding treatment of OA with tramadol?
A. Tramadol should be tried after treatment failure with other opioids.
B. Tramadol should be avoided in patients taking monoamine oxidase inhibitors.
C. Tramadol is well tolerated with low risk for treatment discontinuation.
D. The topical formulation is preferred over oral therapy.
B
- A 64-year-old man presents to the clinic with chronic left hip OA and inflammation. He has had moderate relief with ibuprofen 800 mg three times daily but still feels that the pain is contributing to a functional decline in his life. Which of the following is the most appropriate change in therapy for this patient?
A. Discontinue ibuprofen, start hyaluronic injections every 3 months.
B. Continue ibuprofen, start intra-articular glucocorticoid injections every 3 months.
C. Discontinue ibuprofen, start topical diclofenac and oral acetaminophen.
D. Continue ibuprofen, start intra-articular glucocorticoid injections monthly
B
- A 65-year-old woman presents to clinic with OA and chronic renal insufficiency
(creatinine clearance 28 mL/min [0.47 mL/s]). Which of the following drug regimens is the most appropriate oral therapy option?
A. Nabumetone 50 mg twice daily
B. Celecoxib 100 mg twice daily
C. Oxycodone 5 mg three times daily
D. Acetaminophen 325 mg four times daily
D
- A 58-year-old man presents to clinic with a history of OA of the hip and previous gastric bleed associated with ibuprofen use. Which of the following regimens would be the most appropriate for this patient?
A. Naproxen 500 mg twice daily
B. Oxycodone 5 mg every 4 to 6 hours
C. Naproxen 500 mg twice daily and a proton-pump inhibitor (PPI)
D. Celecoxib 100 mg twice daily and a PPI
D
- A 71-year-old man comes to the pharmacy with a new diagnosis of OA of the hip. He is looking for an appropriate over-the-counter option for what he characterizes as persistent
minor pain despite using ibuprofen 200 mg three times daily without complete relief.
What would be the most appropriate recommendation for this patient?
A. Use of a cane when ambulating
B. Add diclofenac 1% gel 4 g four times daily
C. Add acetaminophen 500 mg three times daily
D. Vitamin D supplementation
C
- A 47-year-old-woman presents to the clinic for worsening knee OA. Her past medical history is significant for GI bleed from previous indomethacin use. She has already attempted an adequate acetaminophen trial without relief. What would be the most appropriate treatment regimen for this patient?
A. Celecoxib 100 mg twice daily and a proton pump inhibitor (PPI)
B. Naproxen 500 mg twice daily
C. Diclofenac sodium 1% gel apply 2 g four times daily
D. Oxycodone 5 mg every 4 to 6 hours
C
