Osteoarthritis

Question 1

Osteoarthritis is most commonly observed in what type of patients?

Answer 1

elderly, female

Question 2

Which joints are most commonly affected by osteoarthritis?

Answer 2

distal interphalangeal, knees, hips

Question 3

What are the clinical manifestations of osteoarthritis?

Answer 3

(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

Question 4

What are the 5 steps in the approach to treat osteoarthritis?

Answer 4

(1) non-pharmacologic
(2) acetaminophen
(3) NSAID
(4) opioid analgesic/intra-articular CS
(5) surgery

Question 5

Give some examples of nonpharmacologic treatment options for osteoarthritis.

Answer 5

(1) psychological support
(2) rest
(3) heat/ice
(4) physical activity
(5) PT/OT
(6) weight loss

Question 6

Patients at risk for hepatotoxicity with acetaminophen use are:

Answer 6

those with pre-existing liver disease and who drink a lot (even more than pharmacy students lol)

Question 7

max dose of diclofenac 1% gel

Answer 7

16g/day to one joint

Question 8

Name three other topical remedies for OA treatment.

Answer 8

BenGay (menthol/camphor/oil of wintergreen)
Zostrix (capsaicin)
glucosamine/chondroitin

Question 9

dosing of glucosamine/chondroitin

Answer 9

glucosamine: 500mg
chondroitin: 400mg

both TID

Question 10

adverse effects of glucosamine/chondroitin

Answer 10

gas, bloating, cramp, nausea

Question 11

How long is it recommended to try step 2 treatment before moving on to step 3?

Answer 11

3 months

Question 12

How long is it recommended to try an option from step 2 before trying another option from step 2 of OA treatment?

Answer 12

2-4 weeks

Question 13

major adverse events of NSAIDs

Answer 13

(1) GI upset
(2) bleeding
(3) nephrotoxicity
(4) increased BP
(5) GI ulcers

Question 14

monitoring parameters for NSAID use

Answer 14

(1) BP
(2) edema
(3) BUN/SCr q3 months
(4) Hgb/Hct q6-12 months
(5) signs of dehydration

Question 15

benefits and risks of COX-2 inhibitors

Answer 15

lower incidence of GI bleeding, but increased risk of CV disease

Question 16

adverse effects of opioids

Answer 16

constipation
nausea
dizziness
somnolence

Question 17

dosing of tramadol

Answer 17

25-50 mg q4-6h

Question 18

This drug is only indicated for knee therapy as an adjunct to first line therapy.

Answer 18

Duloxetine (Cymbalta)

helps with neuropathic and musculoskeletal pain

Question 19

Duloxetine should be avoided with which drug commonly used in step 4 OA treatment?

Answer 19

Tramadol

Question 20

Peak pain relief from intra-articular CS can be expected how long after injection?

Answer 20

7-10 days

Question 21

Intra-articular CS injections should be given no more often than _______.

Answer 21

once every 4-6 months

Question 22

hyaluronate injection dosing

Answer 22

one injection weekly for 3-5 weeks

Question 23

Maximum benefit from hyaluronate injections occurs after ______ weeks.

Answer 23

8-12

Question 24

general monitoring parameters for OA patients

Answer 24

(1) ROM
(2) x-rays
(3) pain
(4) risk of fall
(5) weight
(6) degree of disability