Osteoarthritis Flashcards

1
Q

T/F: Osteoarthritis is not inflammatory

A

True

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2
Q

What are risk factors of OA

A

Age, Obesitsy (most preventable), Men younger than 45 or women older than 45, occupation, sports, history of joint injury

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3
Q

What are signs of OA

A

Pain, Stiffness, crepitus, osteophytes, effusions

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4
Q

T/F: Lab testing for inflammatory markers (ESR/CRP, CBC, and CMP) are good indicators for OA

A

False: Often inflammatory markers are normal in OA

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5
Q

What is localized OA, generalized OA, erosive OA

A

1 to 2 sites affected, 3 or more sites affected, erosions present on Xray

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6
Q

What are the non- pharmacological ways to treat OA, what is special about them

A

Education, Weight loss, Exercise/ Only treatment shown to delay the progression of OA

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7
Q

What are the recommended medications for hand OA, what is preferred if greater than 75

A

Topical capsaicin, Topical NSAIDs, Oral NSAIDs, Tramadol/ Topical NSAIDs

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8
Q

What are the recommended medications for Knee OA

A

Acetaminophen, Oral NSAIDs, Topical NSAIDs, Tramadol, Intrarticular corticosteroid injections

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9
Q

What drugs are not recommended for knee OA

A

Chrondroitin sulfate, Glucosamine, Topical Capsaicin

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10
Q

What is the MOA of acetaminophen, regular dose, lower max dose, monitoring parameters

A

Block COX in CNS lowering prostaglandin synthesis, 650-1000 every 4 to 6 hours, 2-3 grams, LFTs for chronic use

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11
Q

T/F: Patients have many different individual responses to NSAIDs, ibuprofen may not work but Naproxen will

A

True

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12
Q

What NSAID is an acetylated salicyclate

A

Aspirin

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13
Q

What NSAIDs are acetic acids

A

Etodolac, Diclofenac, Indomethacin, Nabumetone

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14
Q

What NSAIDs are propionic acids

A

Ibuprofen, Naproxen, Oxaprozin

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15
Q

What NSAIDs are oxicams

A

Piroxicam and Meloxicam (more COX 2 selective)

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16
Q

What NSAIDs are Coxibs, what must be considered about it

A

Celecoxib (Celebrex), cant be used in those with a SULFA allergy

17
Q

What are the pertinent adverese effects of NSAIDs

A

GI (take with food), Asthma exacerbations, Cardiovascular (HTN, stroke, MI), Coagulation issues, Renal toxicty

18
Q

What should be monitored if a patient is taking NSAIDs

A

Blood pressure, CBCs, sCR, and LFTs

19
Q

When should patients not be given NSAIDs

A

CKD Stage 4 or 5

20
Q

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

A

Cox-2 inhibitor in combination OR a nonselective NSAID with a PPI, Cox-2 inhibitor with a PPI

21
Q

T/F: If a patient is on a low dose aspirin for cardioprotection use a nonselective NSAID other than ibuprofen in combination with PPI

A

True

22
Q

T/F: If a person has Aspirin hypersensivity all NSAIDSs should be avoided

A

True

23
Q

What NSAIDS are known for displacing warfarin

A

Salisalates

24
Q

What must be considered when using Celecoxib

A

Metabolized by CYP450 2C9 so inhibition of 2C9 increases celecoxib, inhibits 2D6 causing an incrase in drugs metabolized by 2D6

25
Q

What happens when NSAIDs are mixed with furosemide, ACE inhibitors

A

Lower diuretic effects, lower natriuertic effect and anti-HTN leading to renal dysfunction and severe HTN

26
Q

T/F: Patients using topical NSAIDs should be cautious about the same side effect profiles due to possible systemic circulation

A

True

27
Q

What is the MOA of capsaicin, what is the tip about it

A

Depletes substance P from afferent nerves, medication should not be stopped until a few weeks have passed

28
Q

Which meds for OA work quickly (1-2 days) but doesn’t last long, how often can it be used

A

Corticosteroid injections (Triamcinolone and Methylprednisolone), only 3 times a year (every 3 months at least)

29
Q

What are hyaluronic acid products indicated for, how often are the used, what is a key counseling point

A

Knee OA only and fail CSI, every 6 months, AVOID strenuous activity for 48 hours after injection

30
Q

What is the MOA of tramadol , what patients should avoid tramadol

A

acts on mu-opiod receptios and inhibits the reuptake of norepinephrine and seotonin/ Age greater than 65, CrCl less than 30, liver impairment

31
Q

What drug-drug interactions does Tramadol have

A

TCAs and cyclobenzaprine (lower seizure threshold), duloxetine (serotonin syndrome)

32
Q

T/F: Narcotics (hydro Odom’s oxcodone morphine)can be used for chronic pain but must be at lowest dose with ONE prescriber

A

True

33
Q

What SNRI is indicated for pain due to OC

A

Duloxetine

34
Q

What OTCs do patients like to use but the guidelines advise against due to know evidence to say they work

A

Glucosamine

35
Q

What are the COX-1 inhibiting NSAIDs (less mucus secretion and bicarbonate)

A

Aspirin, naproxen, indomethacin,piroxicam

36
Q

What are the COX-2 inhibiting NSAIDs (increase risk of stroke and MI)

A

Etodolac, Diclofenac, celecoxib, Meloxicam

37
Q

What is the nonselective NSAID

A

Ibuprofen