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Muscoskeletal > Osteoarthritis Day 2 > Flashcards

Osteoarthritis Day 2 Flashcards

1
Q

What are the renal effects of NSAIDs?

A

actue renal insufficiency (constriction of afferent arteriole)
tubulointerstitial nephropathy
hyperkalemia
renal papillary necrosis
worsened by medications that decrease renal blood flow (ACEI, ARB, Diuretics)

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2
Q

WHat do you need to caution with NSAIDs?

A

caution in asthma pts with ASA allergy

Celecoxib has sulfer in it (sulfa allergy)

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3
Q

What do you need to monitor in NSAIDs?

A

pain management, renal function, bleeding

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4
Q

What is the MOA of tramadol?

A

Mu receptor agonist, it inhibits signal transmission, inhibits NE and serotonin reuptake

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5
Q

When is tramadol useful?

A

moderate to severe OA

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6
Q

What is the dose of tramadol?

A

50-100 mg every 6 hours up tp 400 mg/day

max 200 mg/day in CrCl <30

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7
Q

What are the adverse effects of Tramadol?

A

N/V, constipation
Headache
Dizziness, solmnolance

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8
Q

What is the dosing of Triamcinolone?

A

10-20 mg 3-4 injections/year

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9
Q

What is the dosing of Methylprednisolone?

A

20-40 mg 3-4 injections/ year

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10
Q

What is the efficacy of corticosteroids?

A

initial relief in 24-72 hours
peak is 7-10 days
lasts 4-8 weeks

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11
Q

What are the systemic adverse effects of corticosteroids?

A

hyperglycemia, edema, elevated BP, Dyspepsia, adrenal suppression

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12
Q

What are the local adverse effects of corticosteroids?

A

joint infection, osteonecrosis, tendon rupture, skin atropy

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13
Q

What is the MOA of Hyaluronic Acid?

A

component of synovial fluid. may reduce inflammation

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14
Q

When is Hyaluronic acid injected?

A

injected once weekly for 3-5 weeks

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15
Q

What is the adverse effects of Hyaluronic Acid?

A

joint swelling, increased pain, stiffness, skin reactions

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16
Q

What is the last line agent for moderate to severe OA?

A

Opioids

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17
Q

What are common opioids?

A

oxycodone, morphine, hydromorphone, fentanyl

18
Q

What are adverse effects of opioids?

A

constipation, nausea, dizziness, solmnance, respiratory depression

19
Q

What is the MOA of duloxetine?

A

SNRI

pain relief through blockade of central pain transmitter

20
Q

What is the dose of Duloxetine?

A

30 mg daily for 1 week then 60 mg daily

21
Q

What are common adverse effects of duloxetine?

A

nausea, dry mouth, constipation, anorexia, fatigue, somnolence, dizziness
RARE- SJS, liver failure

22
Q

How long can duloxetine take to work?

A

several weeks

23
Q

What is the MOA of Glucosamine and Chondroitin?

A

shifts cartilage metabolism

stimuates proteoglycan synthesis

24
Q

Where is Glucosaminefound and what does it do?

A

found in cartilage matrix and synovial fluid. It decreases joint spacing narrowing

25
Q

Where is Chondroitin and what does it do?

A

found in proteoglycans and helps cartilage resist compression

26
Q

What is the dosing of Glucosamine?

A

1500 mg daily

27
Q

What is the dosing of Chondroitin?

A

800-1200 mg daily

28
Q

How long with it take for Glucosamine and Chondroitin to take effect?

A

4-8 weeks

29
Q

When do patients use the option of surgery?

A

patient have functional disiability and/or severe pain unresponsive to other therapy

30
Q

What are the benefits of total joint arthroplasty?

A

may restore prior activity level and QOL

31
Q

What are the risks of total joint arthroplasty?

A

thrombosis, infection, dislocation of joint, anestheisa risk

32
Q

What are the contraindications of total joint arthroplasty?

A

long rehabilitation, anticoagulation, duration of prosthesis

33
Q

What are other surgical options?

A

joint fussion for small painful joints

osteotomy to correct misalignment

34
Q

What is recommended with Knee OA?

A 
APAP
Oral NSAIDs
Topical NSAID above age 75
Tramadol
Intraarticular corticosteroids
35
Q

What is not recommended with Knee OA?

A

Glucosamine
Chondroitin
Topical Capasian

36
Q

What is recommended for hand OA?

A

Topical capasian
Topical NSAIDs above the age of 75
oral NSAID
Tramadol

37
Q

What is not recommended for hand OA?

A

Intraarticular injections

Opioid anagesics

38
Q

What is recommended for hip OA?

A

APAP
Oral NSAIDs
Tramadol
Intraarticular corticosteroids

39
Q

What is not recommended for hip OA?

A

Glucosamine

Chondroitin

40
Q

What do you monitor in Osteoarthritis?

A

joint pain function, range of motion, radiographs, quality of life, adverse effects of therapy

Muscoskeletal (9 decks)

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