Osteoarthritis Flashcards
Does OA risk go up with age?
yes until you reach 70
Who is at higher risk to get OA?
older, women, non-hispanic whihtes and blacks, not completed high school, physically inactive, overweight
What is the joint distribution for men and women?
Men and women equal <55; men higher hiop and knee, women higher hands over 55
primary and secondary causes?
wear and tear; trauma, injury, infections
what joints on the hand are affected?
Both: Heberdens nodes and Bouchards Nodes
Whats used to tx APAP overdose?
n-acetylcysteine
Normal role of prostaglandins is to do what?
inhibit gastric acid secretion, inc bicarbonate output, inc cytoprotective mucus protection, maintians mucosal blood lfow
How does NSAIDs induce GI injury?
It inhibits prostaglandin synthesis, the protective measure in the GI
What are risk factors of GI bleeding with NSAID use?
hx of ulcers or gi bleed, concomitant anticoagulant use, advanced age, comorbid conditions (HD), high dose or multiple NSAIDs, concomitant steroid use
What are examples of the following: Cox 1 specific, cox nonspecific, cox 2 pregerential, cox 2 specific
low dose apirin; ibuprofen, naproxen, indomethacin; diclofenac, nabumetone, meloxicam, etodolac; celecoxib
Cox 2 preferential inhibitors are how many more times more cox 2 inhibition?
7-10 times more
All NSAID other than aspirin carry the BBW for ___ risk.
CV
NSAID are contraindicated for pts immediatly post-operative from _____ surgery
CABG
Is celecoxib safer than naproxen and ibuprofen for GI risk?
Yes
can celecoxib be used for mild to moderate renal insufficiency? Severe?
Yes, No
pts who use _________ are at risk of renal failure with NSAIDs
renal disease, pts>65, hx of HTN and CHF, concomitant use of diuretics and ACE-I
renal problems with NSADIS
fluid and electrolyte abnormalities, HTN, CHF, ARF, nephrotic syndrome, papillary necrosis
greatest BP elevation when taking NSAIDs occured in pts taking _____ and ______
ACE inhibitors and Beta blockers
Who can you use COX2 on and who to avoid it in;
use in GI bleed from NSAIDs instead of using NSAIDs, even then use low dose, short time; use in pts with LOW CV risk; avoid in pts with HIGh CV risk
When do you use Tramadol?
when NSAIDs fail or are contraindicated
what are some side effects of tramadol?
N/Constipation/Drowsiness of opioids
What pt population do u need to avoid tramadol in?
abuse potential pts
What pts are indicated for Sodium Hyaluronate? Whjat is the brand name?
pts who fail NSAID and other tx; Hyalgan?
how many injections and how far apart for Hyalgan?
5 injections all 1 wk apart; need anesthetic prior to jyaluronan injection
how long does Hyalgan provide pain relief?
6 months; equivalent to 500mg naproxen BID for 6 months
What is Hylan G-F20?
series of 3 injections directly into thknee joints at weekly intervals (Synvisic)
Glucosamine and Chondroitin
unconvincing data; claimed to halt and reverse osteoarthritis; well tolerated, present in mea, fish and poultry
How is glucosamine used ?
used in the biosynthesis of proteoglycans and glycosaminoglycans (GAGs); integral part of cartilage
Glucosamine readily passes through bilogic membreanse, T OR F?
True
What is glucomsaine mebaolized to?
water, CO2 and urea
SE of glucosamine?
GI/HA/leg pain/edema/itching
What does chondrotin sulfate do?
Blocks enzymes that breakdown old cartilage
What does capsaicin inhibit and how long does it take to work?
substance P; up to 2 wks to work
What is a DMOAD?
Disease Modifying OA drug
What does a DMOAD do?
inhibiting articular breadown by matrix metalloproteinases or stimulating repair activites by chondrocytes
How would Nerve Growth Factor inhibiotrs work?
to higher pain threashold
in pts older than 75 should they use topical or oral?
topical; GI issues
ESR and RF less than 20 indicates ___
OA
What is the drug of choice of OA?
APAP 4g/day max out first before trying other things
