Medications

Question 1

Only __ in __ RA pt’s take their meds as prescribed in >80% adherence.

Answer 1

1/5

Question 2

Often ___ and ____ around medication

Answer 2

fear; stigma

Question 3

PT role in medication or adherence?

Answer 3

1. reassurance

2. education

Question 4

3 categories of barriers to medication adherence?

Answer 4

1. patient related factors
2. drug related factors
3. other factors

Question 5

Arthritis medications groups?

Answer 5

1. analgesics

2. disease modifiers

Question 6

Point of analgesics?

Answer 6

1. control pain

2. control some inflammation

Question 7

Disease modifiers control disease by modifying or suppressing ______ _______ response

Answer 7

immune inflammatory

Question 8

5 example of analgesics?

Answer 8

1. acetaminophen/paracetamol
2. NSAIDs
3. steroids
4. drugs for off label use
5. opioids

Question 9

Drugs for off label use are used in what types of pain?

Answer 9

1. central pain

2. neuropathic pain

Question 10

4 types of disease modifying drugs?

Answer 10

1. NSAIDs
2. corticosteroids
3. DMARDs
4. Biologic DMARDs

Question 11

NSAIDs are only used as a disease modifying drug in _______

Answer 11

spondylitis

Question 12

Acetaminophen primarily controls inflammation in the ____

Answer 12

CNS

Question 13

_______ is the first line of rx in OA

Answer 13

acetaminophen

Question 14

How long does acetaminophen take to take effect

Answer 14

1-2 hours

Question 15

Precautions for PT with acetaminophen?

Answer 15

none

Question 16

More than _____mg a day of acetaminophen + alcohol can result in liver damage

Answer 16

4000

Question 17

NSAIDs 3 examples ?

Answer 17

1. aspirin
2. ibuprofen
3. naproxen

Question 18

Fx of NSAIDS?

Answer 18

Decrease pain, swelling, stiffness and fever

Question 19

NSAIDs primarily used n ____

Answer 19

OA

Question 20

High NSAID intake slows new bone formation in individuals with increased _____ only

Answer 20

CRP

Question 21

How long for analgesia and steady state to take effect w/ NSAIDS ?

Answer 21

1. analgesia 30-60 mins

2. steady state = 2 days

Question 22

5 NSAID precautions for PT?`

Answer 22

1. raises BP
2. increase CV event risk (but risk lower than smoking or HTN)
3. make sure not combining 2 types together
4. GI upset with long term use
5. topicals have similar benefits and safer

Question 23

5 examples of opioids?

Answer 23

1. codeine
2. hydromorphone
3. oxycodone
4. fentanyl
5. morphine

Question 24

______ are second line rx for moderate to severe OA pain, not commonly used as often risk>benefit

Answer 24

opiods

Question 25

Opioids work within _ hour

Answer 25

1

Question 26

3 precautions for PT w/ opioids?

Answer 26

1. drowsiness, dizziness, constipation 2. opiod tolerance with prolonged use can sensitize pain 3. risk of dependence with chronic use

Question 27

Example of "other" category analgesics?

Answer 27

serotonin-norepinephrine reuptake inhibitor (SNRI)

Question 28

Fx of SNRIs?

Answer 28

second line analgesic agent where no/partial response to acetaminophen / NSAIDS

Question 29

SNRI's take effect within __ week

Answer 29

1

Question 30

Use of SNRIs?

Answer 30

neuropathic pain in OA

Question 31

2 precautions for PT with SNRIs?

Answer 31

1. dizziness / light headedness | 2. may raise BP

Question 32

4 things opioids may be prescribed for?

Answer 32

1. acute/chronic pain resulting from disease, sx or injury 2. moderate to severe cough and diarrhea 3. to treat addiction to other opioids such as heroin or oxycodone 4. controlling pain in terminal illness

Question 33

Long term use of opioids can lead to what 3 things?

Answer 33

1. increased tolerance to the drug so that more needed to produce same pain relieving effect 2. dependence 3. withdrawal symptoms

Question 34

Bulk of its who need relief from chronic moderately-severe non-cancer pain have ____ _____ or ____

Answer 34

back pain;OA

Question 35

________ ________ used for control of abnormal inflammatory pathways in inflammatory arthritis

Answer 35

disease modifiers

Question 36

1st line treatments in disease modifiers?

Answer 36

DMARDs

Question 37

2nd line treatments in disease modifiers?

Answer 37

Biologics

Question 38

3 adjuncts to disease modifiers?

Answer 38

1. corticosteroids 2. analgesics 3. NSAIDS

Question 39

Example of DMARD?

Answer 39

methotrexate

Question 40

Methotrexate can take up to ___ months for full effect

Answer 40

3

Question 41

4 disease methotrexate used for?

Answer 41

1. RA 2. JIA 3. psoriatic arthritis 4. lupus

Question 42

Precautions for PT w/ methotrexate?

Answer 42

side effects can include nausea and fatigue day after with use of methotrexate

Question 43

Biologics can be taken in what two ways?

Answer 43

1. subcutaneous injection | 2. IV infusion

Question 44

Fx of biologics?

Answer 44

same as DMARDs, used for pts who don't respond to DMARDs

Question 45

2 diseases biologics used for?

Answer 45

1. RA | 2. axial spondylitis

Question 46

2 precautions for PT w/ biologics?

Answer 46

1. increased risk of serious infections | 2. sterile technique is dry needling, keep environment hygienic

Question 47

_____ drugs are large, complex proteins made from living cells through highly complex manufacturing process

Answer 47

biologics

Question 48

______ tends to be more variable and structurally complex than chemically synthesized drugs

Answer 48

biologics

Question 49

______ are drugs that enter the market subsequent to a previously authorized version who patent has expired

Answer 49

biosimilars

Question 50

Biosimilars are approved only after showing that it is highly similar to an approved biological product in terms of what 4 things ?

Answer 50

1. safety 2. purity 3. potency 4. efficacy

Question 51

2 examples of ways you can take corticosteroids?

Answer 51

1. oral tablet | 2. injection

Question 52

Type of prescription oral tablet corticosteroid?

Answer 52

prednisone

Question 53

______ = most efficacious anti-inflammatory drug available

Answer 53

corticosteroids

Question 54

Oral corticosteroids take effect within __-__ days

Answer 54

1-4

Question 55

2 disease corticosteroids used for?

Answer 55

1. OA | 2. inflammatory arthritis

Question 56

7 PT precautions with pts taking corticosteroids > 2 months?

Answer 56

1. decreased bone density and risk of # 2. increased blood sugar 3. increased muscle wasting 4. increased infection risk 5. small risk of avascular necrosis 6. dont combine alcohol or large amounts of NSAIDS 7. risk of GI ulceration

Question 57

Axial spondylitis rx = strongly recommended to use ____ as 1st line rx

Answer 57

NSAIDs

Question 58

Axial spondylitis rx = strongly recommended anti-___ inhibitors for people who do not respond to NSAIDs

Answer 58

TNF (biologics)

Question 59

General recommendation for pts with high level inflammation = use of corticosteroids despite risk of cartilage / tendon effects, as long as you're not on it too long (T/F)

Answer 59

TRUE (benefits > risks)