Osteoarthritis

Question 1

Does OA risk go up with age?

Answer 1

yes until you reach 70

Question 2

Who is at higher risk to get OA?

Answer 2

older, women, non-hispanic whihtes and blacks, not completed high school, physically inactive, overweight

Question 3

What is the joint distribution for men and women?

Answer 3

Men and women equal <55; men higher hiop and knee, women higher hands over 55

Question 4

primary and secondary causes?

Answer 4

wear and tear; trauma, injury, infections

Question 5

what joints on the hand are affected?

Answer 5

Both: Heberdens nodes and Bouchards Nodes

Question 6

Whats used to tx APAP overdose?

Answer 6

n-acetylcysteine

Question 7

Normal role of prostaglandins is to do what?

Answer 7

inhibit gastric acid secretion, inc bicarbonate output, inc cytoprotective mucus protection, maintians mucosal blood lfow

Question 8

How does NSAIDs induce GI injury?

Answer 8

It inhibits prostaglandin synthesis, the protective measure in the GI

Question 9

What are risk factors of GI bleeding with NSAID use?

Answer 9

hx of ulcers or gi bleed, concomitant anticoagulant use, advanced age, comorbid conditions (HD), high dose or multiple NSAIDs, concomitant steroid use

Question 10

What are examples of the following: Cox 1 specific, cox nonspecific, cox 2 pregerential, cox 2 specific

Answer 10

low dose apirin; ibuprofen, naproxen, indomethacin; diclofenac, nabumetone, meloxicam, etodolac; celecoxib

Question 11

Cox 2 preferential inhibitors are how many more times more cox 2 inhibition?

Answer 11

7-10 times more

Question 12

All NSAID other than aspirin carry the BBW for ___ risk.

Answer 12

CV

Question 13

NSAID are contraindicated for pts immediatly post-operative from _____ surgery

Answer 13

CABG

Question 14

Is celecoxib safer than naproxen and ibuprofen for GI risk?

Answer 14

Yes

Question 15

can celecoxib be used for mild to moderate renal insufficiency? Severe?

Answer 15

Yes, No

Question 16

pts who use _________ are at risk of renal failure with NSAIDs

Answer 16

renal disease, pts>65, hx of HTN and CHF, concomitant use of diuretics and ACE-I

Question 17

renal problems with NSADIS

Answer 17

fluid and electrolyte abnormalities, HTN, CHF, ARF, nephrotic syndrome, papillary necrosis

Question 18

greatest BP elevation when taking NSAIDs occured in pts taking _____ and ______

Answer 18

ACE inhibitors and Beta blockers

Question 19

Who can you use COX2 on and who to avoid it in;

Answer 19

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

Question 20

When do you use Tramadol?

Answer 20

when NSAIDs fail or are contraindicated

Question 21

what are some side effects of tramadol?

Answer 21

N/Constipation/Drowsiness of opioids

Question 22

What pt population do u need to avoid tramadol in?

Answer 22

abuse potential pts

Question 23

What pts are indicated for Sodium Hyaluronate? Whjat is the brand name?

Answer 23

pts who fail NSAID and other tx; Hyalgan?

Question 24

how many injections and how far apart for Hyalgan?

Answer 24

5 injections all 1 wk apart; need anesthetic prior to jyaluronan injection

Question 25

how long does Hyalgan provide pain relief?

Answer 25

6 months; equivalent to 500mg naproxen BID for 6 months

Question 26

What is Hylan G-F20?

Answer 26

series of 3 injections directly into thknee joints at weekly intervals (Synvisic)

Question 27

Glucosamine and Chondroitin

Answer 27

unconvincing data; claimed to halt and reverse osteoarthritis; well tolerated, present in mea, fish and poultry

Question 28

How is glucosamine used ?

Answer 28

used in the biosynthesis of proteoglycans and glycosaminoglycans (GAGs); integral part of cartilage

Question 29

Glucosamine readily passes through bilogic membreanse, T OR F?

Answer 29

True

Question 30

What is glucomsaine mebaolized to?

Answer 30

water, CO2 and urea

Question 31

SE of glucosamine?

Answer 31

GI/HA/leg pain/edema/itching

Question 32

What does chondrotin sulfate do?

Answer 32

Blocks enzymes that breakdown old cartilage

Question 33

What does capsaicin inhibit and how long does it take to work?

Answer 33

substance P; up to 2 wks to work

Question 34

What is a DMOAD?

Answer 34

Disease Modifying OA drug

Question 35

What does a DMOAD do?

Answer 35

inhibiting articular breadown by matrix metalloproteinases or stimulating repair activites by chondrocytes

Question 36

How would Nerve Growth Factor inhibiotrs work?

Answer 36

to higher pain threashold

Question 37

in pts older than 75 should they use topical or oral?

Answer 37

topical; GI issues

Question 38

ESR and RF less than 20 indicates ___

Answer 38

OA

Question 39

What is the drug of choice of OA?

Answer 39

APAP 4g/day max out first before trying other things