Week 4 Flashcards
Joints commonly affected in osteoarthritis
- Hands (tips of fingers)
- Large weight bearing joints (hips, knees)
In osteoarthritis are the joints effected symmetrically or asymmetrically?
- Either but usually asymmetrical
In osteoarthritis are symptoms systemic or localized
localized
What might would we expect to find in synovial fluid analysis in someone with osteoarthritis?
- Mild leukocytes
How long do patients with osteoarthritis generally experience morning stiffness?
30 minutes
What joints are commonly affected in RA?
- Fingers, toes, feet (GIP spared - happens in osteo)
Does RA have systemic or local symptoms
Systemic
Which lab value would we expect to see elevated in RA?
ESR (erythrocyte sedimentation rate)
- indicates inflammatory process in the body
In RA, what might would we expect to find in synovial fluid?
- Leukocytes and cloudy
How long do patients with RA generally experience morning stiffness?
- 60 minutes or more
What are the goals of treatment for RA?
- Manage symptoms, prevent further joint damage, reduce pain and inflammation and stiffness, slow progression, maintain joint function and range of motion, minimize systemic involvement
What are the typical pharmacologic treatments for RA?
- NSAIDS
- Glucocorticoids
- Prednisone
- Antimalarials (Planequil)
- DMARDS (disease modifying antirheumatic drugs)
- Conventional
- methotrexate
- Biological
- Adalimumab
- humira
- Targeted
- Tofactinib
What baseline assessment and/or data needed before starting any DMARD?
- CBC
- TB
- Liver/renal function
- ALT/AST
- s/s infection
- skin assessment to check for malignancies
- rule out pregnancy
We need baseline ophthalmologic and cardiac exam for which DMARD?
- Hydroxychloroquine
What are the names of some conventional DMARDS?
- Methotrexate
- Leflunomide
- sulfasalazine
- hydroxychloroquine
What are the names of some biologic DMARDS?
(Enbrel, humera)
* Adalimumab
* certolizumab
What is the MOA of Methotrexate?
- Folate antagonist – inhibits DNA synthesis and cellular replication
-may be effective due to suppression of B and T lymphocytes
Within how many months of RA diagnosis should Methotrexate be started and why?
- Within the first three months to help decrease further joint damage
What routine monitoring is needed for Methotrexate?
- Routine liver and kidney function testing
What blood level do we expect to see elevated in a patient with gout?
Uric Acid
What is the first-line treatment(s) for acute gout?
- NSAIDS for less than 3 flares per year
- Colchicine
- corticosteriods
What is the typical treatment regimen for chronic gout?
- Low dose colchicine
- Allopurinol
- Febuxostat
- Probenecid
What is the MOA of Febuxostat?
- Inhibits xanthine oxidase to prevent the formation of uric acid
What is the initial dosage of colchicine for acute gout?
- 1.2mg at first dose and then 0.6mg 1 hour later
- Daily dose not to exceed 1.2 mg (0.6mg 1-2x per day until flare resolves)
What is required to diagnose Osteoporosis?
- DXA – neck of femur or spine
- T-score less than -2.5 is osteoporosis OR T-score -1-2.5 (low bone mass) plus a 10-year probability of hip fx of 3% or more OR 10 year probability of another osteoporosis related fx of 20% or more (FRAX score)
What is the most common fracture seen in Severe Osteoporosis?
- Hip and vertebrae
What is the first-line treatment of osteoporosis?
- Bisphosphonate
- Alendronate
- Ibandronate (upright 60 minutes)
- Risedronate
- Zoledronic acid
- Calcium & vitamin D
What Pt education should we provide regarding Bisphosphonates?
- Swallow pill whole with a full glass of water and remain upright for 30-60 min after taking
- Take first thing in the morning with nothing in the stomach except for water
- Do not take vitamins/minerals/other meds within 1 hour of taking this medication as it can impede absorption
- No eating within 30 minutes
What are some potential adverse effects of Bisphosphonates?
- Esophagitis
- Osteonecrosis of jaw and hip
- Hip fractures
What is the MOA of Bisphosphonates?
- Inhibit osteoclast activity and reduce bone resorption turnover
What is the black box warning for Raloxifene?
- Increased risk of thrombolytic events venous (DVT, PE) and death from stroke in postmenopausal women with a risk for CAD
When are Bisphosphonates contraindicated?
- Esophageal disorders that impede swallowing, patients that can’t stay upright for 30 minutes
- Active upper GI problems
- Creatinine below 30-35
- Low CA and vit D levels need to be corrected prior to starting
What electrolyte imbalance are patients taking Denosumab at higher risk for?
- Calcium and magnesium
What baseline data is needed before starting bisphosphonates, denosumab or raloxifene?
- DXA
- Height
- CA and vit D levels
- Creatinine
- Pregnancy
- Densumab –> oral exam
- Raloxifene – mammogram
