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Muscoskeletal > Osteoarthritis Day 1 > Flashcards

Osteoarthritis Day 1 Flashcards

1
Q

What are the risk factors of Osteoarthritis?

A

Age, Obesity, Occupation, sports, trauma, genetics

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2
Q

What is the pathophysiology of Osteoarthritis?

A

it is inflammation of the joint
it is characterized by damage to the joint and surrounding cartilage
it can be primary or secondary

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3
Q

What are the 3 types of sites of osteoarthritis?

A

localized (1-2 sites)
generalized (3 or more sites)
erosive (erosion and proliferation)

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4
Q

What is Normal cartilage?

A

It is a protective, highly compressible surface covering bone. It enables smooth joint movement, distributes the load, absorbs shock and promotes stability. The nutrient supply is provided through synovial fluid which increases movement

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5
Q

What are chondrocytes?

A

only cell in cartilage. They repair and restore cartilage. They regulate the extracellular matrix. They control hemostasis of the cartilage. It synthesizes collage, proteoglycan. It secretes enzymes which break down cartilage

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6
Q

What happens when there is damage to the cartilage?

A

increased chondrocyte activity in the attempt to repair. There is an imbalance of cartilage breakdown and chondrocytes. There is cartilage loss which causes joint space narrowing and this causes deformities and pain

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7
Q

What happens when there is eburnarion?

A

cartilage is eroded that causes subchondral bone becomes dense and smooth. it causes brittle bones

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8
Q

What forms to help stabilize joints?

A

osteophytes and this causes inflammation

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9
Q

How do you diagnose Osteoarthritis?

A

clinical presentation, physical exam, can use radiographic findings and lab values

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10
Q

What is the clinical presentation of Osteoarthritis?

A

in older patients, the symptoms are typically in the hands, feet, knees, hips and spine

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11
Q

What are the symptoms of osteoarthritis?

A

deep, aching pain with motion, with rest later in disease
stiffness in joints: morning stiffness <30 minutes that resolves with movement
limited joint movement
instability of weight bearing joints
often related to weather

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12
Q

What do you look for in osteoarthritis?

A 
may involve 1 or more joints
assymetrical involvement
tenderness on palpatations
bony enlargment
crepitus
limited range of motion
MILD inflamation may be present
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13
Q

What do you look for in a physical exam in the hands?

A

Herbeden’s nodes and Bouchard’s nodes

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14
Q

What do you look for in a physical exam in the knees?

A

pain with climbing stairs and genu varum (bow-leg)

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15
Q

What do you look for in a physical exam in the hips?

A

groin pain during wt. bearing activities
stiffness
limited joint motion

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16
Q

What do you look for in a physical exam in the spine?

A

L3 and L4 are most commonly involved

nerve root compression: radicular pain, parasenthesis, loss of reflexes

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17
Q

What do you look for in a physical exam in the feet?

A

typically in 1st metatarsophalangeal joints

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18
Q

What are the radiologic findings in osteoarthritis?

A

often absent in early or mild
Progressive OA: joint space narrowing, subchondral bone sclerosis, marginal osteophytes
Late OA: abnormal joint alignment and effusions

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19
Q

Is there a cure for asteoarthritis?

A

No

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20
Q

What are the treatment goals of osteoarthritis?

A 
educate patient and caregiver
relieve pain and stiffness
maintain/improve joint mobility
reduce functional limitations
maintain/improve QOL
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21
Q

What is the non- pharmologic treatment of osteoarthrits?

A

patient education
wt. reducation
exercise(walking, stretching and strength training)
physical therapy
assisstive devices
patellar taping, neoprene sleeve, fitted knee brace, heat, wedged shoe insoles

22
Q

What are the pharmologic recommendations for OA?

A 
Acetominophen
Topical agents
NSAIDS
Tramadol
Opiods
Intraarticular injections
Duloxitine
Glucosamine/chondrotin
23
Q

What therapy agent is typically first line?

A

Acetominophen

24
Q

What is the MOA of acetaminophen?

A

inhibits prostaglandin synthesis in the CNS

25
Q

What are the Pharmacokinetics of acetaminophen?

A

high oral absorption
onset in 1 hour
metabolism: hepatically through glucuronidation, small amount by CYP 2E1 to N- acetyl-p-benzoquineimine
excreted renally

26
Q

What is the efficacy of acetaminophen?

A

like ASA and NSAIDs

27
Q

What is the dosing of Acetominophen?

A

325-500 mg scheduled 4-6 hours
max of 4 g/day
max of 2 g/day in liver impaired

28
Q

What are the adverse effects of acetaminophen?

A

Hepatotoxicity and renal toxicity

29
Q

What are the drug interactions of acetaminophen?

A

may enhance Warfarin.

It is isoniazid may increase APAP concentrations

30
Q

What is the MOA of topical capsaicin?

A

depletes substance P from afferent nerve fibers. It prevents transmission of pain signals

31
Q

What is the dose of topical capsaicin?

A

.025-.1 % applied 2-4 times a day

32
Q

What is the adverse effects of topical capsaicin?

A

localized burning, stinging, redness

33
Q

What is the topical NSAID that is used?

A

Diclofenac gel 1%

34
Q

What is the mechanism of action of topical NSAIDs?

A

inhibits COX 1 and 2 as well as inhibits prostoglandin synthesis

35
Q

What is the topical NSAID dosing?

A

2 g applied to upper extremities 4x/day

4g applied to lower extremities 4x/day

36
Q

What is the adverse effects of topical NSAIDs?

A

localized puritis, burning, pain, dry skin, rash

37
Q

When is topical NSAIS recommended?

A

patients over the age of 75

38
Q

When is NSAIDs used?

A

in patients uncontrolled on or unable to take APAP

39
Q

What are the Pharmacokinetics of NSAIDs?

A

readily absorbed orally. Sulindac and nabumetone require hepatic activation. it is hepatically metabolized and has little renal elimination

40
Q

What is the is the dosing of Etodolac?

A

800-1200 mg/day in divided doses

41
Q

What is the is the dosing of Diclofenac?

A

100-150 mg/day in divided doses

42
Q

What is the is the dosing of Nabumetone?

A

500-1000mg 1-2 daily

43
Q

What is the is the dosing of IBU?

A

1200-3200 mg/day in 3-4 doses

44
Q

What is the is the dosing of naproxen?

A

250-500 mg BID

45
Q

What is the is the dosing of naproxen sodium?

A

275-550 mg BID

46
Q

What is the is the dosing of piroxicam?

A

10-20 mg daily

47
Q

What is the is the dosing of meloxicam?

A

7.5 mg daily

48
Q

What is the is the dosing of celicoxib?

A

100 mg BID or 200 mg daily

49
Q

What are the adverse effects of NSAIDs?

A

nausea, dyspepsia, adominal pain, diarrhea, BLEEDING

50
Q

What ate risk factors for GI bleed?

A 
Age >70
use multiple NSAIDs
oral corticosteroid use
history of peptic ulcer disease
history of upper GI bleed
oral anticoagulant use
51
Q

What can you do to reduce GI bleeding risk?

A

use cox 2 inhibitor
add misoprostal (protects against GI bleeds, ulcers)
add PPI
less data with H2 inhibitor

52
Q

Can you use misoprostal in pregnancy?

A

NO

Muscoskeletal (9 decks)

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