MEDICATION Flashcards
What are some pharmacological treatment goals for osteoarthritis patients
- Decreased pain
- Decreased damage
- Increase/maintain function
- Increase/maintain QOL
- Increase /maintain work productivity
What are some pharmacological treatment goals for osteoarthritis physicians
- Same as patient PLUS - Prevent comorbidities - Prevent complications - Delay need for surgery
What are some pharmacological treatment goals for inflammatory arthritis patients
Same as OA: - Decreased pain - Decreased damage - Increase/maintain function - Increase/maintain QOL - Increase /maintain work productivity PLUS: - Stop joint swelling, pain, stiffness, fatigue, damage (=remission)
What are some pharmacological treatment goals for inflammatory arthritis physicians
Same as patient PLUS: - Prevent comorbidities - Prevent complications - Delay need for surgery - Induce remission where possible
Why is medication adherence important for physiotherapy
Good disease control:
- Better participation in PT
- Increase physical activity
- ADLs
- Work productivity
- life roles
What is the result of poor medication adherence
major cause of disease progression + disability, morbidity, health care cost
___/5 RA patients take medications as prescribed at >80% adherence
1/5
What is the physiotherapists role in medication adherence
- Educate on importance of pain & disease control for their quality of life and function
- Redirect to pharmacist/MD for ore detailed information or follow up
- Reassure
What are the 3 categories of barriers to medication adherence
- Patient-related factors
- Drug-related factors
- Other factors
What are the patient-related factors which may be a barrier to medication adherence
socio-demographics, psycho-social profile, comorbidities, cognitive ability, health literacy = health beliefs
What are the drug-related factors which may be a barrier to medication adherence
- Number of drugs taken
- Adverse effects
- Administration regimens
What are the “other factors” which may be a barrier to medication adherence
- Patient-prescriber relationship
- Access to medication
- Social support
What are the two main groups of arthritis medications
- analgesia
- disease modifiers
What is the goal of analgesia use in arthritis treatment
- Control pain (& some inflammation)
What are some examples of analgesia used in arthritis treatment
- Acetaminophen/paracetamol
- NSAIDs
- Steroids (short course)
- Drugs for off-label use (central or neuropathic pain)
- Opioids
What is the goal of the use of a disease modifier in arthritis treatment
Control disease by modifying or suppressing immune inflammatory response
What are some examples of disease modifying drugs used to treat arthritis
- NSAIDs (only in spondylitis)
- Corticosteroids
- Disease modifying antirheumatic drugs (DMARDs)
- Biologic disease modifying antirheumatic drugs (biologics or biologic DMARDs
What is a brand name of acetaminophen
tylenol
What is the function, use, and precaution for treatment with acetaminophen
Function: decrease pain, reduce fever
Use: 1st line for OA, control of mild to mod joint pain. 1-2 hours to take effect
Precautions: Tolerated better than NSAIDS and safe in elderly with comorbidities. Safe to take in combo with NSAID or other arthritis meds. Risk of liver failure if too much or in combo with alcohol
What is the function, use, and precaution for treatment with NSAIDS
Function: Decrease pain, swelling, stiffness, fever
Use:
- Primariy is OA, spondylitis for joint pain + inflammation.
- High NSAID intake slows new bone formation in individuals with hight c-reactive protein only
- Analgesia 30-60mins, steady state after 2 days
- Few days 1/week for optimal anti-inflammatory effects
Precautions:
- Raises BP
- Increased cardiovascular event risk (non-aspirin NSAIDS), but the risk is lower than smoking or hypertension
- Make sure not combining 2 types together
- Topical have similar benefits and safer
What are some types of NSAIDS
Aspirin, ibuprofen, naproxen
What is the function, use, and precaution for treatment with Serotonin-norepinephrine reuptake inhibitory
Function: Second-line analgesis agen where no/partial response to acetaminophen/NSAIDs. Takes effect within 1 week
Use: neuropathic pain in OA
Precations: Side effects include dizziness/light headedness. may raise BP
What is the function, use, and precaution for treatment with Opioids
Function: Decrease pain
Use:
- Second line Rx for moderate to severe OA pain; not commonly used as often risk>benefit
- No data on benefit for inflammatory arthritis past 6 weeks
- work within 1 hour
Precautions:
- Side effects can include drowsiness, dizziness, constipation
- Opioid tolerance with prolonged use can sensitize to pain
- Risk of dependence with chronic use
What are opioids prescribed for
- Acute/chronic pain resulting from disease, surgery or injury
- Moderate to severe coughs & diarrhea
- To treat addiction to other opioids such as heroin or oxycodone
- Controlling pain in terminal illness
