Osteoarthritis Flashcards
Osteoarthritis is most commonly observed in what type of patients?
elderly, female
Which joints are most commonly affected by osteoarthritis?
distal interphalangeal, knees, hips
What are the clinical manifestations of osteoarthritis?
(1) pain (worsens with movement)
(2) crepitus (cracking)
(3) morning stiffness lasting <60 mins
(4) asymmetric involvement
(5) little inflammation except in advanced disease
(6) osteophyte (bony projection)
(7) muscle atrophy
(8) instability of weight bearing joints
What are the 5 steps in the approach to treat osteoarthritis?
(1) non-pharmacologic
(2) acetaminophen
(3) NSAID
(4) opioid analgesic/intra-articular CS
(5) surgery
Give some examples of nonpharmacologic treatment options for osteoarthritis.
(1) psychological support
(2) rest
(3) heat/ice
(4) physical activity
(5) PT/OT
(6) weight loss
Patients at risk for hepatotoxicity with acetaminophen use are:
those with pre-existing liver disease and who drink a lot (even more than pharmacy students lol)
max dose of diclofenac 1% gel
16g/day to one joint
Name three other topical remedies for OA treatment.
BenGay (menthol/camphor/oil of wintergreen)
Zostrix (capsaicin)
glucosamine/chondroitin
dosing of glucosamine/chondroitin
glucosamine: 500mg
chondroitin: 400mg
both TID
adverse effects of glucosamine/chondroitin
gas, bloating, cramp, nausea
How long is it recommended to try step 2 treatment before moving on to step 3?
3 months
How long is it recommended to try an option from step 2 before trying another option from step 2 of OA treatment?
2-4 weeks
major adverse events of NSAIDs
(1) GI upset
(2) bleeding
(3) nephrotoxicity
(4) increased BP
(5) GI ulcers
monitoring parameters for NSAID use
(1) BP
(2) edema
(3) BUN/SCr q3 months
(4) Hgb/Hct q6-12 months
(5) signs of dehydration
benefits and risks of COX-2 inhibitors
lower incidence of GI bleeding, but increased risk of CV disease
adverse effects of opioids
constipation
nausea
dizziness
somnolence
dosing of tramadol
25-50 mg q4-6h
This drug is only indicated for knee therapy as an adjunct to first line therapy.
Duloxetine (Cymbalta)
helps with neuropathic and musculoskeletal pain
Duloxetine should be avoided with which drug commonly used in step 4 OA treatment?
Tramadol
Peak pain relief from intra-articular CS can be expected how long after injection?
7-10 days
Intra-articular CS injections should be given no more often than _______.
once every 4-6 months
hyaluronate injection dosing
one injection weekly for 3-5 weeks
Maximum benefit from hyaluronate injections occurs after ______ weeks.
8-12
general monitoring parameters for OA patients
(1) ROM
(2) x-rays
(3) pain
(4) risk of fall
(5) weight
(6) degree of disability
