Pharm of Osteoarthritis and Joint Inflamm

Question 1

analgesics for osteoarthritis?

Answer 1

acetaminophen
tramadol
codein

Question 2

anti-inflamm agents for OA?

Answer 2

NSAIDs
NSAIDs + gastric anti-secretory agent
triamcinolone

Question 3

this analgesic agent is the 1st step for pain relief in OA?

Answer 3

Acetaminophen

Question 4

complications and risks from acetaminophen overdose?

Answer 4

serious, potentially lethal liver toxicity

Question 5

acetaminophen OD leads to overproduction of __

Answer 5

NAPQI –> deplete cells glutathione content, catastrophic cell damage –> centrilobular necrosis

Question 6

findings 72-96 hrs from acetaminophen OD?

Answer 6

This is lethal stage:
N/V
abdominal pain
Increased AST/ALT
coagulopathy
kidney failure
COMA 
DEATH

Question 7

antidote for acetaminphen OD?

Answer 7

N-Acetylcysteine: replenishes GSH pool

give as early as possible during 1st 24 hrs

Question 8

a pt has mild, symptomatic OA and tried acetaminophen for 2 weeks. the symptoms persisted/progressed with more pain and inflame. next step?

Answer 8

prescribe NSAID, 2 wks prn, re-assess

Question 9

only US NSAID in injectable formulation?

Answer 9

Ketorolac

Question 10

only a single NSAID should be used at any given time, except:

Answer 10

use of a cardioprotective dose of ASA (81-325 mg/day) with other NSAIDs

Question 11

what should you switch to if a pt has been taking an NSAID has side effectors or intolerance, or the pt profile changes?

Answer 11

switch to a different chemical class of NSAIDs
OR
switch to NSAID (Diclofenac) + PG (Misoprostol)
OR
switch to Coxib-class NSAID (less GI adverse events)

Question 12

ibuprofen and naproxen belong to what NSAID class?

Answer 12

arylpropionic acids

Question 13

indomethacin and sulindac belong to what NSAID class?

Answer 13

indoles

Question 14

celecoxib belongs to what NSAID class?

Answer 14

heteroaryl

Question 15

why was Rofecoxib removed from the drug market?

Answer 15

CV risk –> Coxibs confer risk in coronary disease. sparing COX-1 allows platelets to aggregate–> further imbalance of TxA2&raquo_space; PGI2

Celecoxib is safe

Question 16

if OA symptoms persist/worsen and NSAID fail, next strep?

Answer 16

Intra-articular anti-inflamm steroid

Question 17

Triamcinolone acetonide and Triamcinolone hexonide are what drugs?

Answer 17

intra-articular anti-inflamm steroid

Question 18

Triamcinolone (acetonide) effect on COX 2 mRNA and protein induction?

Answer 18

repressed by corticoids

Question 19

what narcotic analgesics for OA?

Answer 19

tramadol and codeine –> short-term

Question 20

receptors for morphine, codeine, and tramadol?

Answer 20

Mu receptor agonists –> analgesia

Question 21

GI effects of opioids?

Answer 21

n/v as well as constipation

Question 22

this drug is a moderate mu-agonist, analgesic for moderate pain, inhibits catecholamine reuptake, and associated with seizures

Answer 22

Tramadol