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Pharm I: Exam 2 > OA > Flashcards

Flashcards in OA Deck (19):
1

What is Osteoarthritis?

(Degenerative Joint Disease) Non-inflammatory disorder primarily observed in weight-bearing joints

  • Loss of articular cartilage with formation of bony spurs
  • Unilateral presentation (asymmetric)
  • Reported evening pain

2

What are risk factors of OA? (7)

  • Age (positive correlation)
  • Gender (2:1 older women to older men at knee and hand)
  • Obesity (INC body weight strongly associated with OA)
  • Activities (daily repetitive use, trauma)
  • Genetics (certain types of OA have predisposed alteration in cartilage matrix)
  • Race (2X likely Knee OA in African-American women)
  • OSTEOPOROSIS (inverse relationship between bone density and OA; less dense = better distributed load across joint)

3

What are the major functions of cartilage?

  • Enable movement within required ROM
  • Distribute loading across joint tissues (prevent damage)
  • Stabilized joint during use

4

What is the pathophysiology of OA?

  • Damage to collagen fiber network
  • DEC collagen interaction leads to loss of cartilage, bony growth, severe pain
  • End phase: joint failure
  • Two Types: Primary OA and Secondary OA

5

What is Primary OA?

(idiopathic) failure of the cartilage in the absence of any known underlying predisposing factor

6

What is Secondary OA?

Occurs due to other disease states/trauma (e.g. metabolic, endocrine, congenital)

7

What is Non-drug TX for OA? (5)

  • Rest PT
  • ROM
  • Muscle Strengthening 
  • Assistive devices
  • Diet-weight loss

8

What is the goal of drug TX for OA?

To relieve pain and inflammation (DOES NOT PREVENT PROGRESSION OF DISEASE)

9

What analgesics are utilized in TX OA?  

  • Acetaminophen
  • NSAIDs
  • Topical capsaicin
  • Glucosamine
  • Chrondroitin Sulfate
  • Intra-articular injections
    • Corticosteriods
    • Viscosupplementation
  • Opiates
  • Tramadol

 

10

How does Topical Capsaicin function?

Inhibits release of Substance P in peripheral nerves (reduces pain in periarticular structures – REMEMBER: Substance P not found in cartilage)

11

What are ADRs observed with Topical Capsaicin?

Initial Application: burning and stinging (subsided with continued use)

12

How is Glucosamine prepared?

From shells of crab and other crustaceans (substrate for the production of articular cartilage – glycosaminoglycans)

13

How is Chondroitin sulfate prepared?

From bovine/porcine cartilage sources (Mucopolysaccharides used in synthesis of cartilage)

14

What are corticosteroids (2) utilized in short-term TX OA? 

  • Triamcinolone acetonide
  • Methylprednisolone

15

What limitation, if any, exist TX OA with corticosteroids?

  • MAX 3-4 injections per year (more frequent TX could precipitate progressive cartilage damage
  • Oral corticosteriods NOT recommended in OA

16

How does Hyaluronic Acid function?

  • Naturally-occurring glycosaminoglycan (assist in production of articular cartilage)
  • Intraarticular injection (acts as viscous lubricant – may reduce need for NSAIDs)

17

What are recommendations for Hand OA? 

  • Use one or more of the following:
    • Topical capsaicin
    • Topical NSAIDs (preferred for patients ≥75Y/O)
    • Oral NSAIDs (COX-2 inhibitors)
  • DO NOT USE
    • Intra-articular injections
    • Opiate analgesics

18

What are recommendations for Hip OA?

  • Recommend one of the following:
    • APAP
    • Oral NSAIDs
    • Tramadol
    • Intra-articular injections (corticosteroids)
  • DO NOT USE:
    • Glucosamine/Chondroitin

19

What are recommendations for Knee OA?

  • Recommend one of the following:
    • APAP
    • Oral NSAIDs
    • Topical NSAIDs
    • Tramadol
    • Intraarticular injections (corticosteroids)
  • DO NOT USE:
    • Glucosamine/Chondroitin
    • Topical Capsaicin