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Pnt Exam 1 > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

What is the most common joint disease

A

Osteoarthiritis

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2
Q

Which joints are most susceptible to osteoarthritis

A

weight bearing joints - hips and knees

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3
Q

What causes osteoarthritis

A

when breakdown of cartilage is greater than resynthesis due to destruction of proteoglycans, bone spurs and inflammation form

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4
Q

Risk factors for osteoarthritis

A 
increasing age
obesity
occupation/sports with repetitive motion
trauma
genetics
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5
Q

primary osteoarthritis cause

A

idiopathic

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6
Q

how many sites for localized osteoarthritis

A

1-2 sites

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7
Q

how many sites for generalized osteoarthritis

A

3+ sites

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8
Q

What is erosive osteoarthritis

A

erosion and proliferation of interphalangeal joints of the hands

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9
Q

What is secondary osteoarthritis

A

osteoarthritis with a known cause

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10
Q

symptoms of osteoarthritis

A

pain w/ or w/o motion
stiffness in joints (hand, knee, hip) that resolves with motion and occurs after rest (gelling) typically <30 minutes
instability of weight bearing joints
limitations of activities of daily living

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11
Q

Signs of osteoarthritis

A 
asymmetrical joint involvement
bouchard's or heberden nodes
abnormal alignment of joints
crepitus (crackling of joints) 
limited ROM
localized tenderness
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12
Q

heberden’s nodes are where

A

most distal joint of fingers

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13
Q

bouchard’s nodes are where

A

middle joint of fingers

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14
Q

goals of therapy for osteoarthritis

A 
education
control pain and relief stiffness
maintain or improve joint mobility 
limit functional impairment
maintain or improve QOL
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15
Q

Non-pharm therapy for osteoarthritis

A

patient education
PT/OT
weight loss
low impact, aerobic, and aquatic exercise
warm baths and thermal agents
support braces, orthotics, and assistive devices
surgery

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16
Q

APAP dosing for osteoarthritis

A

325-650 mg Q4-6H

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17
Q

First line therapy for all osteoarthritis

A

APAP

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18
Q

NSAIDs MOA

A

inhibits prostaglandin synthesis through COX 1 and 2 inhibition

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19
Q

COX-2 Inhibitors MOA

A

Inhibits prostaglandin synthesis through COX 2 inhibition

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20
Q

Ibuprofen dose in osteoarthritis

A

1200-3200 mg/day in 3-4 divided doses

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21
Q

Naproxen dose in osteoarthritis

A

275-550 mg BID (max 1375 mg/day)

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22
Q

Watch celecoxib with what allergies

A

sulfonamide

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23
Q

Celecoxib brand name

A

celebrex

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24
Q

celecoxib dose in osteoarthritis

A

100 mg BID or 200 mg QD (max 200 mg/day)

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25
Q

AEs with Nsaids and Cox -2 Inhibitors common

A 
hyperkalemia
HTN
edema
weight gain
CNS effects (drowsiness, dizziness, HA) 
upset stomach
dyspepsia
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26
Q

Avoid NSAIDs in which pt populations

A

HTN and heart failure

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27
Q

Serious AEs with NSAIDs/Cox 2 Inhibitors

A

Acute Kidney Injury
GI ulceration/perforations, GI bleed (greater with NSAIDS)
Inhibition of platelet aggregation (greater with Cox 2)

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28
Q

High risk populations for AKI with NSAIDS/COX 2

A 
Chronic NSAID use
Dual NSAID use
Dehydration
Volume or sodium depletion
Ascites/liver failure
CHF
Age 70+ 
Use of diuretics, ACEi, cyclosporine, aminoglycosides
CKD, nephrotic syndrome
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29
Q

Risk factors for a GI bleed/ulcer with NSAIDS/Cox 2

A 
high dose NSAID
multiple NSAIDs
AGe 70 + 
corticosteroids, anticoagulants
Hx of ulcer/upper GI bleed
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30
Q

Treatment of OA for pts with high CV risk and High GI risk

A

Naproxen + PPI

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31
Q

treatment of OA for pts with high CV risk and low GI risk

A

Naproxen + PPI

32
Q

What is safest NSAID in terms of CV risk

A

Naproxen

33
Q

Treatment of OA for pts with low CV risk and High GI risk

A

Cox 2 or Naproxen + PPI

34
Q

Treatment of OA for pts with low CV risk and low GI risk

A

Naproxen + PPI

35
Q

symptomatic monitoring for NSAIDS/Cox 2

A 
abdominal pain
heartburn
nausea
blood in stools
HTN
Edema, weight gain
36
Q

Lab monitoring for NSAIDS/Cox 2

A

SCr
CBC
LFTs
at baseline and Q6-12 months

37
Q

Drug interactions with NSAIDS

A

Increased effects of: ASA, warfarin, oral hypoglycemics, lithium
Decreased effects of: antihypertensives (ACE, ARB, beta blocker, diuretics)

38
Q

Drug interactions with COX 2

A

Increased effects of: ASA, warfarin (lesser then NSAID), Oral hypoglycemics, lithium
Decrease effects of: antihypertensives (ACE, ARB, beta blockers, diuretics)

39
Q

Topicals used for OA

A

capsaicin

topical NSAIDs

40
Q

MOA of capsaicin

A

depletes substance P

41
Q

AEs of capsaicin

A

local burning, stinging, redness

42
Q

Capsaicin dose

A

QID, regularly, may take 2 weeks to see effect

43
Q

Topical NSAID used in OA

A

diclofenac gel 1%

44
Q

diclofenac gel MOA

A

local inhibition of Cox 2

45
Q

at what age should topical NSAIDS be used over po

A

75+

46
Q

AEs of diclofenac gel

A

pruritus, burning, rash, phototoxicity

47
Q

diclofenac gel brands

A 
solaraze gel (3%)
Pennsaid solution (1.5%) 
Voltaren gel (1%) 
Flector patch (1%)
48
Q

Solaraze dosing

A

twice daily to lesion area

49
Q

Pennsaid dosing

A

40 drops per knee QID

50
Q

Voltaren dosing

A

4 grams foot, knee, or ankle QID
2 grams hand, elbow, wrist QID
MAX 16g/day for any single joint of lower extremity
MAX 8 g/day for any joint upper extremity
MAX 32g/day total

51
Q

Flector patch dosing

A

1 patch q12h

52
Q

Glucosamine/Chondroitin MOA

A

stimulates proteoglycan synthesis from articular cartilage

53
Q

Glucosamine AEs

A

mild gas, bloating, cramps, may increase blood glucose

54
Q

Watch glucosamine/chondroitin with what allergy

A

shellfish

55
Q

Glucosamine/chondroitin dose

A

1500 mg glucosamine
1200 mg chondroitin
per day

56
Q

Intraarticular injections for OA

A

glucocorticoids

hyaluronate

57
Q

glucocorticoids MOA

A

decreases inflammation

58
Q

relief from glucocorticoid injections

A

24-72 hours, peak 7-10 days

59
Q

How often glucocorticoid injections

A

3-5 per year

60
Q

AEs from glucocorticoid injections

A

hyperglycemia
edema
increased BP
post injection flare - mild symptoms for a few days

61
Q

hyaluronate MOA

A

unknown, facilitates lubrication/shock absorbancy

62
Q

how often hyaluronate injections

A

3-5 weekly for prolonged relief (26 weeks)

63
Q

AEs of hyaluronate injections

A 
acute joint swelling
effusion
stiffness
skin reactions
pruritus
64
Q

Tramadol MOA

A

weak opiate receptor inhibition and weak reuptake inhibitor of Norepinephrine and serotonin

65
Q

Tramadol dose

A

MAX 400 mg/day

66
Q

Tramadol AEs

A

N/V
somnolence
constipation
dizziness

67
Q

TRamadol drug interactions

A

MAOIs

68
Q

Precautions with tramadol

A

lowers the seizure threshold

69
Q

Monitoring for OA

A

assess improvement in QOL

70
Q

First line therapy for all OA

A

APAP max dose ATC

71
Q

Alternate initial agents for Hand OA

A

topical capsaicin
Topical NSAID
ORal NSAID/Cox 2
Tramadol

72
Q

Last line therapies for hand OA

A

intra-articular injections
Opiates/tramadol
Glucosamine/chondroitin

73
Q

other initial therapies for Knee OA

A

oral NSAIDs/Cox 2
Topical NSAIDs
Tramadol
intra articular corticosteroids

74
Q

last line therapies for knee OA

A

topical capsaicin
opiates
intra articular hyaluronate
glucosamine/chondroitin

75
Q

other initial therapies for hip OA

A

oral NSAIDs/Cox 2
Tramadol
Intra-articular corticosteroids

76
Q

last line therapies for hip OA

A

topical NSAIDS
Opiates
Intra articular hyaluronate
glucosamine/chondroitin

Pnt Exam 1 (6 decks)

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