Drugs for Osteoarthritis, Joint Disease - Fitz

Question 1

Easy drug for analgesia (PAIN CONTROL) in osteoarthritis?

Powerful ones?

Answer 1

Acetaminophen

Tramadol (narcotic)
Codeine (narcotic)

Question 2

Oral drugs for ANTI-INFLAMMATION in osteoarthritis?

IF NSAIDs FAIL, drug for anti-inflammation of joint?

MoA?

Answer 2

NSAIDs, Coxib

Triamcinolone (steroid injection)

Represses COX-2 transcription and translation, thus can’t be turned on

Question 3

Patient presents to ER w/ emesis, jaundice, altered mental status. Recently been depressed/despondent. Has severe osteoarthritis.

What is found in blood?

What does this molecule do?

Answer 3

Acetaminophen OD (hepatic centrolobular necrosis)

Elevated NAPQI (metabolite)

Binds glutathione, uses it up, then does damage in liver

Question 4

How long does it take for acetaminophen toxicity to see full toxicity/toxic effects?

Will first see symptoms when?

Answer 4

3 days

Within the 1st day

Question 5

Treatment for acetaminophen toxicity

Does what?

Answer 5

N-acetylcysteine

Replenishes glutathione

Question 6

Mild OA, minimal inflammation…drug?

Takes it for 2 weeks, only gets worse…drug?

Answer 6

Acetaminophen

NSAID

Question 7

Giving an NSAID for OA. Be cautious of what?

Answer 7

• GI risk profile
• CV risk profile
• Hypersensitivity (sulfa)

Question 8

Best NSAIDs to give for short term OA relief (4)

Answer 8

Ibuprofen
Naproxen
Diclofenac
Celecoxib

Question 9

Best NSAIDs to give for longer term OA relief - 1x per day (2)

Answer 9

Piroxicam

Nabumetone

Question 10

Can multiple NSAIDs be taken at the same time? Why?

Answer 10

NO - will compete for absorption and increase risk for GI bleeding/ulcer

Question 11

Way to avoid GI bleeding/ulcer risk when taking NSAID?

Answer 11

Taking w/ Misoprostol (PGE1) or PPI (Omeprazole)

Question 12

Narcotics for pain

MoA?

Toxicity?

Cure?

Answer 12

Morphine, Codeine, Tramadol

Mu-receptor agonists (analgesia)

Pupil constriction, respiratory depression

Naloxone/Naltrexone

Question 13

Patient presents w/ pupillary constriction and respiratory depression. Current med history of severe osteoarthritis. Dx?

Treatment?

Patient returns 24 hours later. Why? What should you have done?

Answer 13

Narcotic overdose

Naloxone/Naltrexone

Acetaminophen overdose (combo drug w/ narcotic)

Given N-acetylcysteine when first presented