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Flashcards in Arthritis Deck (29):
1

Non-Drug Therapy

Rest
Physical Therapy
ROM
Muscle Strengthening
Assistive Devices

2

Analgesics for OA

Acetaminophen/NSAIDS
Topical Capsaicin
Topical NSAID
Glucosamin/chondroitin
Intra-articular injections
Opioids
Tramadol

3

Acetaminophen

Reduce pain but not inflammation

4

NSAID

Analgesic effect at lower doses
Anti-inflammatory effect at higher doses
Affects platelet function - but is reversible (unlike ASA)

Monitor Cr, BUN for renal toxicity

Monitor CBC, Stool guaiac for GI bleeding

5

Topical Capsaicin

Inhibits release of Substance P in peripheral nerves

Initially has stinging and burning

Maximal efficacy after 2-4 weeks

6

Glucosamine

Crabs and Crustaceans

Substrate for articular cartilage - produce glycosaminoglycans

improved at 4-8 weeks

7

Chondroitin Sulfate

From bovine or porcine cartilage

later response than NSAIDS

8

Corticosteroids in OA

Intra-articular injections
Triamcinolone acetonide, methylprednisolone

short term improvments

every three months over 2 years (limit to 3-4x year)

ORAL CORTICOSTEROIDS NOT RECOMMENDED IN OA

9

Viscosupplementation

Intraarticular injections

hyaluronic acid

viscous lubricant - may reduce need for NSAIDs

10

Opioid Analgesics

Codeine/oxycodone/hydrocodone
tramadol
many combined with acetaminophen

11

Hand Osteoarthritis Medications

USE:
- topical capsaicin
- topical nsaids (prefered in elderly)
- Oral NSAIDS
- COX 2 inhibitors

12

DO NOT USE THESE IN HAND OSTEOARTHRITIS

- intra-articular therapies
- opioid analgesics

13

Knee Osteoarthritis Medications

- acetaminophen
- oral NSAIDs
- topical NSAIDs
- tramadol
- Intra-articular injections

14

DO NOT USE THESE IN KNEE OSTEOARTHRITIS

- glucosamine/chondroitin
- topical capsaicin

No recomendations for:
- inta-articular hyaluronates
- opiate analgesics

15

Hip Osteoarthritis Medications

- acetaminophen
- orals NSAIDs
- tramadol
- intra-articular corticosteroid injections

16

DO NOT USE THESE IN HIP OSTEOARTHRITIS

- glucosamine/chondroitin

No recomendations for:
- topical NSAIDs
- intra-articular hyaluronate injection
- opioid analgesics

17

Nonpharmacologic treatment for RA

- rest, OT, PT, assistive devices
- Weight reduction or managment
- splinting, joint protection

18

DMARDS

Disease modifying anti-rheumatic drugs

19

when should you start DMARDS

within 3 months

20

Nonbiologic DMARDS

- hydroxychloroquine
- methotrexate
- sulfasalazine
- leflunomide
- minocycline

21

Biologics Non-TNF DMARDS

- abatacept
- Rituximab
- Tociluzimab

22

Biologics Anti- TNF DMARDS

- etanercept
- adalimumab
- infliximab
- golimumab
- certolizumab pegol

23

DMARD monotherapy

MTX
SSZ
HCQ
LEF

24

Double DMARD

MTX+SSZ
MTX+HCQ
SSZ+HCQ
or combo with LEF

25

Triple DMARD therapy

MTX+SSZ+HCQ

26

Hydroxychloroquine

Antimalarial for mild disease or incombination

pretty fast onset (2-6 mo) d/c if no improvment w/in 6 months

minimal monitoring
- OPHTHALMOLOGIC EXAM TWICE YEARLY FOR RENAL TOXICITY

ADR: n/v/d, ocular toxicity, pruritis, rash, alopecia, skin pigmentation, HA, insomnia, vertigo

CONTRADICTED IN PTS WITH VISUAL, HEPATIC OR RENAL IMPAIRMENT

27

Methotrexate

Immunosuppressive and anti-inflammatory

mono or combo - mainstay for pts not responding to NSAIDs

onset 2 weeks - 2 months
survival benefit: CV mortality

Monitor for hepatic liver enzymes, LFTs, CBC, bilirubin, Hep B&C, serum creatinine, albumin (every 1-2 months)

28

Sulfasalizine

PRODRUG metabilized to sulfapyradine (anti-rheumatic)

monitor: baseline CBC every week for 1 month then every 1-2 months

ASE: n/v/d, anorexia, HA

29

Leflunomide

reversible inhibitor of DHODH

reduces pain and inflamation

ADR: HA, nausea, diarrhea, rash, alopecia

monitor CBC & ALT monthly then every 6-8 weeks