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OU Module GI/Rheum > Treatment of Osteoarthritis Exam 1 > Flashcards

Treatment of Osteoarthritis Exam 1 Flashcards

1
Q

What are the possible treatment for OA?

A
  • NSAIDs
  • APAP
  • Opioids
  • Tramadol
  • Duloxetine
  • ASA
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2
Q

monitoring parameters for NSAIDs

A
  • edema
  • weight
  • urinalysis
  • Cr (renal function)
  • CBC
  • GI discomfort
  • K levels
  • LFT’s
  • CNS effects
  • skin reactions
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3
Q

monitoring parameters for APAP

A

Live function (LFTs)

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4
Q

monitoring parameters for opioids

A
  • weakness
  • fractures
  • falls
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5
Q

monitoring parameters for tramadol

A
  • seizure episodes
  • QT interval
  • diaphoresis
  • myoclonus
  • shivering
  • fever
  • tachycardia
  • semicomatose
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6
Q

monitoring parameters for duloxetine

A

CNS effects

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7
Q

monitoring parameters for ASA

A
  • CBC

- GI discomfort

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8
Q

What are the non-drug treatment of OA?

A
  • pt education and self-mgmt
  • social support
  • diet + weight reduction
  • PT / OT
  • surgery
  • genetic manipulation
  • misc. therapies
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9
Q

What are examples of PT / OT?

A
  • Low impact aerobic exercise
  • Assistive devise
  • Joint protection
  • Heat
  • TENS
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10
Q

What are examples of supplements that patients may take?

A
  • fish oil, evening primrose oil vitamins or minerals; herbal pills (may contain corticosteroids); honey and apple cider vinegar; golden raisins and gin
  • Flavocoxid (Limbrel) – medical food (inhibits COX 1 & 2 & lipoxygenase); reports of acute liver injury
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11
Q

What are the types of surgery that can be performed?

A
  • joint debridement
  • osteophyte removal
  • joint replacement
  • joint fusion
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12
Q

What are misc non-drug therapies?

A
  • relaxation therapy
  • massage
  • prayer
  • copper bracelet
  • magnets
  • DMSO
  • urine injections
  • WD40
  • bee stings
  • ant or snake venom
  • acupuncture / acupressure
  • balneotherapy (thermal mineral baths)
  • mud packs
  • topical marijuana
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13
Q

Acetaminophen (Tylenol) dosing

A

Limit to 650 mg/dose, 3250 mg/d; if pt has liver disease, restrict to 2g/day

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14
Q

Tramadol (Ultram) clinical pearls

A
  • decreases seizure threshold
  • can prolong QTc interval
  • risk for serotonin syndrome if used with tricyclic antidepressants or selective serotonin reuptake inhibitors
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15
Q

Duloxetine (Cymbalta)

A
  • FDA-approved for OA

- affects CNS pain pathways

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16
Q

MOA of NSAIDs

A
  • if non-selective, block COX 1 and 2

- some NSAIDs can inhibit the lipoxygenase pathway but not proven to be better than other NSAIDs

17
Q

COX 1

A

found in most tissues esp gastric mucosa

18
Q

COX 2

A

increased during inflammation and regulates prostacyclin

19
Q

NSAIDs and pregnancy

A

Avoid NSAIDs late in pregnancy because may inhibit labor and possibly cause early narrowing of the ductus arteriosus

20
Q

NSAID contraindications

A
  • Celecoxib is contraindicated in patients with sulfonamide allergies
  • NSAIDs contraindicated in patients with recent coronary artery bypass grafts (CABG)
21
Q

absorption of NSAIDs

22
Q

distribution of NSAIDs

A
  • Highly plasma protein bound primarily to albumin

- exceptions: ASA, lipid soluble NSAIDs, weak acids

23
Q

metabolism of NSAIDs

A
  • Main elimination route

- Hepatic biotransformation

24
Q

excretion of NSAIDs

25
response of NSAIDs
Response at 6-14 days predicts response at 6-12 wk
26
plasma concentrations and therapeutic effects (NSAIDs)
• No good correlation shown for plasma concentrations and therapeutic effects (except salicylate and naproxen)
27
Tramadol MOA
weak atypical opioid analgesic
28
Duloxetine MOA
serotonin & norepinephrine reuptake inhibitor & weak inhibitor of dopamine reuptake
29
Corticosteroids place in therapy
- Systemic not recommended; can give extended pain relief | - Given IA q4-6 months
30
Hyaluronan place in therapy
- May decrease pain, improve function - approved for knee OA - Give IA weekly (?)
31
Hyaluronan MOA
Increases viscoelasticity of synovial fluid to cushion and protect knee joint
32
Counterirritants place in therapy
- Pain relief | - Apply cream 3-4x/day
33
Counterirritants MOA
- Produces warmth without redness or blistering | - depletes substance P from peripheral sensory nerves at site of application
34
Diclofenac gel dosing
QID
35
Diclofenac topical solution place in therapy
Improvement in pain, function, global assessment; contains DMSO
36
Diclofenac topical solution dosing
40 gtt each knee QID; 10 gtt at a time, spread, repeat
37
ACR treatment for knee OA
* Conditionally recommend one of: acetaminophen, oral NSAIDs, topical NSAIDs, tramadol, intra-articular corticosteroid injections * Conditionally recommend NOT using chondroitin sulfate, glucosamine, topical capsaicin * No recommendations for use of intra-articular hyaluronates, duloxetine, opioid analgesics
38
ACR treatment for hip OA
* Conditionally recommend one of: acetaminophen, oral NSAIDs, tramadol, intra-articular corticosteroid injections * Conditionally recommend NOT using chondroitin sulfate, glucosamine * No recommendations for use of topical NSAIDs, intra-articular hyaluronates, duloxetine, opioid analgesics
39
ACR treatment for hand OA
* Conditionally recommend one or more of: topical capsaicin, topical NSAIDs, oral NSAIDs including COX-2 selective inhibitors, tramadol * Persons ≥ 75 yo should use topical rather than oral NSAIDs * Conditionally recommend NOT using intra-articular therapies, opioid analgesics

OU Module GI/Rheum (30 decks)

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