Week 11: Osteoarthritis

Question 1

mild to moderate OA

Answer 1

acetaminophen

Question 2

acetaminophen MOA;

when see benefit for OA?

Answer 2

• action on CNS and COX = decreases prostaglandin synthesis.
• analgesic and antipyretics
• NO anti-inflammatory/anti-platelet like NSAIDs

takes 1 week; take ON schedule

Question 3

NSAIDs (ibuprofen, naproxen, voltaren gel, indomethacin) MOA

Answer 3

inhibits conversion of arachidonic acid to prostaglandins, prostacyclin, and thromboxane which are pain mediatrs = anti-inflammatory and pain

Question 4

ibuprofen, naproxen, voltaren gel, indomethacinc/c

Answer 4

• no preg
• beers (caution elderly)
• NO < 30 GFR
• > 6 months ok
• voltaren gel for > 75 yo pts (less GI & systemic absorption for hand/knee OA)

Question 5

ibuprofen, naproxen, voltaren gel, indomethacin

ADE’s

Answer 5

BBW: increase risk of heart attack and stroke, thrombotic events, GI bleeding, ulcerations [take with food]

indomethacin: worsen depression or psych disturbances

-edema, dizziness, skin rash 
platelet agg ( more bleeding)

Question 6

tramadol indication and MOA

Answer 6

3rd line for OA if not responsive to APA & NSAIDs

MOA: mu opioid receptor agonist that binds to ascending pain pathway to inhibit it
-inhibits reuptake of serotonin and norepinephrine in pain pathway

Question 7

tramadol c/c

Answer 7

-lowers seizure threshold (no hx)
-caution renal/hep impairment, peds, elderly, with other CNS depressants
NO < 12 yrs, ok > 18

Question 8

tramadol ADE

Answer 8

mu agonist: 
-Constipation
-Dependency
-Euphoria
-Respiratory depression 
-drowsiness
serotonin syndrome 
-nausea, drowsiness