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Intro to D&D Midterm > Saad - Osteoarthritis Part 1 > Flashcards

Saad - Osteoarthritis Part 1 Flashcards

1
Q

true or false

osteoarthritis is the least common form of arthritis

A

FALSE - most common

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2
Q

osteoarthritis increases with ___

is the incidence higher in women or men

A

age
higher in women

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3
Q

the incidence rates of symptomatic hand, hip and knee OA increase rapidly around _______ years of age and level off after age ______

A

50, 70

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4
Q

true or false

OA is a costly condition for the US

A

true - because of replacements mainly

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5
Q

true or false

increasing age is a non modifiable risk factor for OA

A

true

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6
Q

true or false

genetic mutations are a modifiable risk factor in OA

A

false

non modifiable

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7
Q

true or false

being female is a nonmodifiable risk factor for OA

A

true

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8
Q

true or false

excess body weight is a modifiable risk factor for OA

A

true

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9
Q

is repetitive joint use considered a modifiable OA risk factor

A

yes

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10
Q

___ tear is a risk factor for OA

A

meniscus

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11
Q

joint _____ is a risk factor for OA

A

morphology

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12
Q

leg length inequality is a risk factor for OA
how can this be controlled?

A

by using orthotics

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13
Q

name the 3 joints most affected by OA

A

knees
hips
distal interphalangeal joints

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14
Q

the diagnosis of OA is made through what 4 things?

A

history
physical exam
radiographic findings
lab tessting

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15
Q

what is crepitus

A

cracking sound when the joint is moved

sign of OA

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16
Q

how is stiffness a sign of OA

A

lasting less than 30 mins in the morning, or after a long period of not moving

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17
Q

true or false

swelling is not a sign of OA

A

false - it is

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18
Q

true or false

bony hypertrophy is a sign of OA

A

true

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19
Q

state if bilateral or unilateral is more common for the following joints:

knee
hip
hand

A

knee - bilateral more common
hip - unilateral more common
hand - usually more severe in dominant hand

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20
Q

in a person with OA, what might the XRAY findings show?

A

decreased joint space
loss of cartilage
bony spur formation

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21
Q

what is ESR

A

erythrocyte sedimentation rate

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22
Q

is ESR normal or elevated in OA patients?

A

NORMAL

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23
Q

just by looking at a patient’s hand, how can you determine if they have OA and why

A

nodes form around the joints
because of the loss of space between the joints

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24
Q

what are heberden’s and bouchard’s nodes

A

heberdens node – most distal joint node on finger

bouchards node - joint node proximal to the heberden node

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25
Q

what are osteophytes

A

bone spurs that form in OA patients

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26
Q

what is osteosclerosis

A

abnormal hardening of bone - present in hip OA patients

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27
Q

explain how the etiology of OA used to be viewed vs the modern approach to etiology

A

previously - joint disease with articular cartilage loss – less emphasis on repair process

now - disease is due to FAILED CARTILAGE REPAIR – why is it not repairing itself?

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28
Q

how sets out the osteoarthritis treatment guidelines in America

A

the American College of Rheumatology
(ACR)

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29
Q

when was the most recent OA american college of rheumatology guideline published

A

2019/2020

30
Q

according to ACR, what are the goals of treating OA

A

to relieve pain and inflammation and improve function of the joint, as well as quality of life and independence of the patient (Ultimate goal)

31
Q

true or false

the ACR put out nonpharmacologic interventions for treating OA

A

true

32
Q

how is weight loss considered at non pharmacologic intervention for treating OA

A

because you’re putting less strain on the joint

33
Q

how is exercise a nonpharmacologic treatment for OA

A

because youre keeping the strength in muscles/bones/joints

34
Q

can a cane help in OA patients?

A

yes, it’s a non pharm intervention
you’re putting less pressure on the joint

35
Q

thermal interventions are a nonpharm treatment for OA

if the area is inflamed and swollen would it be best to use hot or cold compress

A

cold

36
Q

name 3 categories of pharmacologic management of OA, published by ACR

A

drugs
surgery
new modaliteis

37
Q

how can surgery be a pharmcologic measure in OA patients

A

by either cleaning out the joint or replacing it

38
Q

name 2 new modalities used in OA patients

A

stem cell therapy
platelet rich plasma
stimulate joint to repair itself

39
Q

what drug is strongly recommended for all 3: hand, knee, hip

A

oral NSAIDS

40
Q

for which is topical NSAIDS STRONGLY recommended:
hand, hip, knee? justify

A

knee

hand - not convenient to have gel on your hand
hip - it’s a deep joint. the gel will probably not get to the site or action - no recommendation

41
Q

for which is(are) IA glucorticoid injections strongly recommended?
hand/hip/knee

A

hip and knee

42
Q

is acetaminophen strongly recommended for all (hand/hip/knee) OA?

A

NO
conditionally

Oral NSAIDS are all strongly recommended

43
Q

what category of recommendations do opioids fall into and why?
(not tramadol)

A

conditionally recommended against - they have high abuse potential and OA is chronic - not good to keep them on forever

44
Q

true or false

DMARDS used in RA patients have NO place in OA patients

A

TRUE - it’s not an autoimmune disease

45
Q

true or false

biologics, methotrexate, and hydroxychloroquine are strongly recommended against in OA patients

A

true

46
Q

how can acetaminophen be used in OA?
is it recommended?

A

conditionally recommended –in case of patients who have intolerance or contraindication to NSAIDS

for short term/PRN use

47
Q

patients who receive acetaminophen on a regular basis should be undergoing what?

A

regular monitoring for hepatotoxicity (liver)

48
Q

state the max daily dose for acetaminophen for extra strength tabs (500mg) and regular strength (325mg)

A

X strength - 3000mg (3g)

reg - 3250mg

49
Q

compare the efficacies for treating OA pain for ibuprofen vs acetaminophen

A

for mild-moderate pain - both are comparable

for severe pain - ibuprofen better

50
Q

what is the PRESCRIPTION max daily dose of acetaminophen

A

4g

51
Q

acetaminophen is used with caution in which patients?
in which patients is it avoided?

A

used in caution - pts with liver disease
avoided - chronic alcohol abuser

52
Q

who is considered a chronic alcohol abuser

A

someone who has greater than 3 drinks a day

53
Q

what is the max dose of acetaminophen in ETHANOL DRINKERS or those with liver disease??????

A

2g

54
Q

true or false

if used at equivalent doses, ALL NSAIDS are equally effective for treating OA pain

A

true

55
Q

what are some safety concerns with NSAIDS

A

they inhibit COX1 – responsible for producing GI protective prostaglandins
can cause stomach ulceration

56
Q

TRUE OR FALSE

COX1 inhibitors are easier on the stomach than COX2 inhibitors

A

FALSE- other way aorund

however, COX2 inhibitors have concern because blocking PGI2 formation – clot concern

57
Q

what is the recommended dosing for NSAIDS to treat osteoarthritis pain

A

use lowest effective dose
if synovitis - start at mod-high dose

58
Q

name a non acidic NSAIDS

A

nabumetone

59
Q

if someone has an allergy to an NSAID, can we give them an NSAID but in a different class?

ie: allergic to an oxicam, can we give a propionic acid

A

there can still be cross reactivity, but we can possibly try it

60
Q

the main concern with NSAIDS is _____ toxicity

A

GI

61
Q

name some adverse events of NSAIDS and how to prevent
(not serious toxicities)

A

nausea
dyspepsia
abdominal pain
flatulence
diarrhea

TAKE WITH FOOD OR MILK

62
Q

name some SERIOUS NSAID toxicities

A

gastric and duodenal ulcers, and gastric perforation (bleeding) as a complication

63
Q

what are some signs and symptoms of an ulcer/perforation

A

blood in stool, dizziness, fatigue, hemoglobin drop, dyspepsia

64
Q

as mentioned, a serious toxicity of NSAIDS is gastric and duodenal ulcers

how can this be prevented

A

by taking another drug to provide protection, such as misoprostol or a PPI

65
Q

which are better at protecting the GI and giving with an NSAID - PPI or H2 antagonist

A

PPI

66
Q

as mentioned, misoprostol can be given with an NSAID to reduce the risk of bleeding
what is the issue with this

A

it can give diarrhea

67
Q

true or false

if an OA patient has a history of GI issues, they should stay away from NSAIDS

A

true

68
Q

name some risk factors for having a GI complication when taking NSAIDS

A

greater than 65 y/o
previous GI issue
using steroids at same time
taking oral platelets/anticoag
upper GI comorbidities
smoking and alc use
H. pylori infection - can cause ulceration in itself

69
Q

how does taking anti platelets/anticoags with NSAIDS increase the risk of GI complications

A

additive effect

these drugs make the blood flow better by themselves

70
Q

true or false

CV disease is a risk factor for having NSAID GI complications

A

true

71
Q
A

Intro to D&D Midterm (29 decks)

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