Osteoarthritis Flashcards
T/F: Osteoarthritis is not inflammatory
True
What are risk factors of OA
Age, Obesitsy (most preventable), Men younger than 45 or women older than 45, occupation, sports, history of joint injury
What are signs of OA
Pain, Stiffness, crepitus, osteophytes, effusions
T/F: Lab testing for inflammatory markers (ESR/CRP, CBC, and CMP) are good indicators for OA
False: Often inflammatory markers are normal in OA
What is localized OA, generalized OA, erosive OA
1 to 2 sites affected, 3 or more sites affected, erosions present on Xray
What are the non- pharmacological ways to treat OA, what is special about them
Education, Weight loss, Exercise/ Only treatment shown to delay the progression of OA
What are the recommended medications for hand OA, what is preferred if greater than 75
Topical capsaicin, Topical NSAIDs, Oral NSAIDs, Tramadol/ Topical NSAIDs
What are the recommended medications for Knee OA
Acetaminophen, Oral NSAIDs, Topical NSAIDs, Tramadol, Intrarticular corticosteroid injections
What drugs are not recommended for knee OA
Chrondroitin sulfate, Glucosamine, Topical Capsaicin
What is the MOA of acetaminophen, regular dose, lower max dose, monitoring parameters
Block COX in CNS lowering prostaglandin synthesis, 650-1000 every 4 to 6 hours, 2-3 grams, LFTs for chronic use
T/F: Patients have many different individual responses to NSAIDs, ibuprofen may not work but Naproxen will
True
What NSAID is an acetylated salicyclate
Aspirin
What NSAIDs are acetic acids
Etodolac, Diclofenac, Indomethacin, Nabumetone
What NSAIDs are propionic acids
Ibuprofen, Naproxen, Oxaprozin
What NSAIDs are oxicams
Piroxicam and Meloxicam (more COX 2 selective)
What NSAIDs are Coxibs, what must be considered about it
Celecoxib (Celebrex), cant be used in those with a SULFA allergy
What are the pertinent adverese effects of NSAIDs
GI (take with food), Asthma exacerbations, Cardiovascular (HTN, stroke, MI), Coagulation issues, Renal toxicty
What should be monitored if a patient is taking NSAIDs
Blood pressure, CBCs, sCR, and LFTs
When should patients not be given NSAIDs
CKD Stage 4 or 5
What is the recommendation for a patient with a history of GI ulcer but NO bleed within the past year, GI bleed within one year
Cox-2 inhibitor in combination OR a nonselective NSAID with a PPI, Cox-2 inhibitor with a PPI
T/F: If a patient is on a low dose aspirin for cardioprotection use a nonselective NSAID other than ibuprofen in combination with PPI
True
T/F: If a person has Aspirin hypersensivity all NSAIDSs should be avoided
True
What NSAIDS are known for displacing warfarin
Salisalates
What must be considered when using Celecoxib
Metabolized by CYP450 2C9 so inhibition of 2C9 increases celecoxib, inhibits 2D6 causing an incrase in drugs metabolized by 2D6
What happens when NSAIDs are mixed with furosemide, ACE inhibitors
Lower diuretic effects, lower natriuertic effect and anti-HTN leading to renal dysfunction and severe HTN
T/F: Patients using topical NSAIDs should be cautious about the same side effect profiles due to possible systemic circulation
True
What is the MOA of capsaicin, what is the tip about it
Depletes substance P from afferent nerves, medication should not be stopped until a few weeks have passed
Which meds for OA work quickly (1-2 days) but doesn’t last long, how often can it be used
Corticosteroid injections (Triamcinolone and Methylprednisolone), only 3 times a year (every 3 months at least)
What are hyaluronic acid products indicated for, how often are the used, what is a key counseling point
Knee OA only and fail CSI, every 6 months, AVOID strenuous activity for 48 hours after injection
What is the MOA of tramadol , what patients should avoid tramadol
acts on mu-opiod receptios and inhibits the reuptake of norepinephrine and seotonin/ Age greater than 65, CrCl less than 30, liver impairment
What drug-drug interactions does Tramadol have
TCAs and cyclobenzaprine (lower seizure threshold), duloxetine (serotonin syndrome)
T/F: Narcotics (hydro Odom’s oxcodone morphine)can be used for chronic pain but must be at lowest dose with ONE prescriber
True
What SNRI is indicated for pain due to OC
Duloxetine
What OTCs do patients like to use but the guidelines advise against due to know evidence to say they work
Glucosamine
What are the COX-1 inhibiting NSAIDs (less mucus secretion and bicarbonate)
Aspirin, naproxen, indomethacin,piroxicam
What are the COX-2 inhibiting NSAIDs (increase risk of stroke and MI)
Etodolac, Diclofenac, celecoxib, Meloxicam
What is the nonselective NSAID
Ibuprofen
