osteoarthritis

Question 1

Inflammatory or noninflammatory disorder?

Answer 1

noninflammatory

Question 2

What’s it a disbalance of ?

Answer 2

systemic disorder due to imbalance between joint destruction and repair

Question 3

what are some risk factors?

Answer 3

female, obesity, advancing age, family history

Question 4

do we treat the disease or the symptoms?

Answer 4

symptomatic relief

Question 5

what are some of the clinical presentations

Answer 5

pain
stiffness
deformity
crepitation
decreased ramge of motion
joint enlargemnt
inflammation

Question 6

is it bilateral or unilateral involvement?

Answer 6

unilateral

Question 7

joints affected?

Answer 7

hands, knees, hips, spine, feet

Question 8

what does screening for OA encompass?

Answer 8

• age 45 or above
• activity-related joint pain
• no morning joint-related stiffness or stiffness that lasts less than 30 mins

Question 9

what kind of referrals can you give to someone with OA?

Answer 9

physiotherapist
occupational therapist
dieticain

Question 10

what are the treatment options?

Answer 10

topical NSAIDS
Acetaminophen
NSAID
IA steroid injections

Question 11

what are some non-pharm measures?

Answer 11

loss weight
active joints are helathier joints
acupunction
hot/cold therapy
surgery

Question 12

what are the topical NSAIDS and what joinst are they for?

Answer 12

diclofenac - OA of hand and knee
capsaicin - OA of knee

Question 13

What is the to be noted with capsaicin in partiuclar?

Answer 13

causes burning but you get used to it after using for a while can not be PRN or burning will never cease

Question 14

what is the first oral drug we try? is it recommended by all?

Answer 14

acetaminophen - NA guidlines say try it, international guildlines tend to skip it

Question 15

what are some concersnwhat should we screen for before acetaminophen use?

Answer 15

liver - haptoxicity
so how much alchol do they have?
old people are especially at risk

Question 16

what is the maximum daily dose of acetaminophen? normal? elderly? high-risk user?

Answer 16

less than 4 g/ day

3200 mg /day

2600 mg /day

Question 17

What is an important counseling point concerning acetaminophen dosing?

Answer 17

account for ALL sources of acetaminophen

Question 18

what should we try after acetaminphen?

Answer 18

NSAIDS

Question 19

what should we asses a patient for prior to NSAID use?

Answer 19

GI risk
CV risk
Renal risk

Question 20

if we have hypertension and OA what do we do?

Answer 20

can use NSID but must monitor BP

Question 21

if we have CV risk and OA what do we do?

Answer 21

use low-dose NSAID and titrate up as needed (risk increases as dose increases)

Question 22

what NSAID carry the highest CV risk?

Answer 22

diclofemnac, celecoxib, and high dose ibuprofen

Question 23

what NSAID is the safest for CV risk?

Answer 23

Naproxen

Question 24

can we use multiple NSAID at once?

Answer 24

NO - only low dose aspirin can be used when there is a CV risk along with an NSADI for OA

Question 25

what NSAID is the safest for GI risk?

Answer 25

celecoxib

Question 26

how do we monitor for renal function and NSAID use?

Answer 26

most elderly people have renal insufficiency - drugs such as antihypertensives are given - ACE, ARB, diuretics - we can moniot kidney function and switch their anitihypertensives to hopefully get the desires results

Question 27

What kind of OA what Duloxtine be used for? Evidence? what kind of drug is it?

Answer 27

SNRI - OA of knee - limited evidence though found to be better then a placebo so can try

Question 28

What role do opioids and tramadol play in OA?

Answer 28

they should not be used

Question 29

What role do natural health products play in OA?

Answer 29

we have glucosamine and chondroitin - placebo - do nothing if you have the money you can try the placebo for 3 months

Question 30

What kind of steroids can we use for OA?

Answer 30

injectable storids only - not oral

Question 31

what joint do sterois help for?

Answer 31

OA of the knee

Question 32

how many injections of steroids can we get yeraly?

Answer 32

3 to 4

Question 33

when moniotring how often should the pharamcist monitor?

Answer 33

days 3, 7, and 14

Question 34

how long do we try a therpay before concluding if failed?

Answer 34

14 days

Question 35

if we find an appropriate therapy for pain managment how do we proceed?

Answer 35

find lowest possible effective dose

Question 36

if pain is improving but not optimized?

Answer 36

can try adjunct agent (i.e topical )

Question 37

what can we do to minmize GI upset?

Answer 37

take with food

Question 38

what lab values should be monitored?

Answer 38

Acetaminohen - baseline LFTS for those at high risk of hepatoxicity NSADIS - SCR and CrCL for patoent with pre-existing renal disease and takjing meds that affect kidney function (diuretics, ACEI) renal function needs to be asses every 7-10 days

Question 39

what do we monitor if a patient has hypertension and is on NSAIDS

Answer 39

Blood pressure every 2-4 weeks for 1-2 months - uncontrolled every 1-2 weeks