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Pnt Exam 1 > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

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1
Q

What is the most common joint disease

A

Osteoarthiritis

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2
Q

Which joints are most susceptible to osteoarthritis

A

weight bearing joints - hips and knees

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3
Q

What causes osteoarthritis

A

when breakdown of cartilage is greater than resynthesis due to destruction of proteoglycans, bone spurs and inflammation form

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4
Q

Risk factors for osteoarthritis

A 
increasing age
obesity
occupation/sports with repetitive motion
trauma
genetics
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5
Q

primary osteoarthritis cause

A

idiopathic

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6
Q

how many sites for localized osteoarthritis

A

1-2 sites

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7
Q

how many sites for generalized osteoarthritis

A

3+ sites

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8
Q

What is erosive osteoarthritis

A

erosion and proliferation of interphalangeal joints of the hands

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9
Q

What is secondary osteoarthritis

A

osteoarthritis with a known cause

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10
Q

symptoms of osteoarthritis

A

pain w/ or w/o motion
stiffness in joints (hand, knee, hip) that resolves with motion and occurs after rest (gelling) typically <30 minutes
instability of weight bearing joints
limitations of activities of daily living

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11
Q

Signs of osteoarthritis

A 
asymmetrical joint involvement
bouchard's or heberden nodes
abnormal alignment of joints
crepitus (crackling of joints) 
limited ROM
localized tenderness
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12
Q

heberden’s nodes are where

A

most distal joint of fingers

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13
Q

bouchard’s nodes are where

A

middle joint of fingers

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14
Q

goals of therapy for osteoarthritis

A 
education
control pain and relief stiffness
maintain or improve joint mobility 
limit functional impairment
maintain or improve QOL
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15
Q

Non-pharm therapy for osteoarthritis

A

patient education
PT/OT
weight loss
low impact, aerobic, and aquatic exercise
warm baths and thermal agents
support braces, orthotics, and assistive devices
surgery

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16
Q

APAP dosing for osteoarthritis

A

325-650 mg Q4-6H

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17
Q

First line therapy for all osteoarthritis

A

APAP

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18
Q

NSAIDs MOA

A

inhibits prostaglandin synthesis through COX 1 and 2 inhibition

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19
Q

COX-2 Inhibitors MOA

A

Inhibits prostaglandin synthesis through COX 2 inhibition

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20
Q

Ibuprofen dose in osteoarthritis

A

1200-3200 mg/day in 3-4 divided doses

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21
Q

Naproxen dose in osteoarthritis

A

275-550 mg BID (max 1375 mg/day)

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22
Q

Watch celecoxib with what allergies

A

sulfonamide

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23
Q

Celecoxib brand name

A

celebrex

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24
Q

celecoxib dose in osteoarthritis

A

100 mg BID or 200 mg QD (max 200 mg/day)

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25
AEs with Nsaids and Cox -2 Inhibitors common
``` hyperkalemia HTN edema weight gain CNS effects (drowsiness, dizziness, HA) upset stomach dyspepsia ```
26
Avoid NSAIDs in which pt populations
HTN and heart failure
27
Serious AEs with NSAIDs/Cox 2 Inhibitors
Acute Kidney Injury GI ulceration/perforations, GI bleed (greater with NSAIDS) Inhibition of platelet aggregation (greater with Cox 2)
28
High risk populations for AKI with NSAIDS/COX 2
``` Chronic NSAID use Dual NSAID use Dehydration Volume or sodium depletion Ascites/liver failure CHF Age 70+ Use of diuretics, ACEi, cyclosporine, aminoglycosides CKD, nephrotic syndrome ```
29
Risk factors for a GI bleed/ulcer with NSAIDS/Cox 2
``` high dose NSAID multiple NSAIDs AGe 70 + corticosteroids, anticoagulants Hx of ulcer/upper GI bleed ```
30
Treatment of OA for pts with high CV risk and High GI risk
Naproxen + PPI
31
treatment of OA for pts with high CV risk and low GI risk
Naproxen + PPI
32
What is safest NSAID in terms of CV risk
Naproxen
33
Treatment of OA for pts with low CV risk and High GI risk
Cox 2 or Naproxen + PPI
34
Treatment of OA for pts with low CV risk and low GI risk
Naproxen + PPI
35
symptomatic monitoring for NSAIDS/Cox 2
``` abdominal pain heartburn nausea blood in stools HTN Edema, weight gain ```
36
Lab monitoring for NSAIDS/Cox 2
SCr CBC LFTs at baseline and Q6-12 months
37
Drug interactions with NSAIDS
Increased effects of: ASA, warfarin, oral hypoglycemics, lithium Decreased effects of: antihypertensives (ACE, ARB, beta blocker, diuretics)
38
Drug interactions with COX 2
Increased effects of: ASA, warfarin (lesser then NSAID), Oral hypoglycemics, lithium Decrease effects of: antihypertensives (ACE, ARB, beta blockers, diuretics)
39
Topicals used for OA
capsaicin | topical NSAIDs
40
MOA of capsaicin
depletes substance P
41
AEs of capsaicin
local burning, stinging, redness
42
Capsaicin dose
QID, regularly, may take 2 weeks to see effect
43
Topical NSAID used in OA
diclofenac gel 1%
44
diclofenac gel MOA
local inhibition of Cox 2
45
at what age should topical NSAIDS be used over po
75+
46
AEs of diclofenac gel
pruritus, burning, rash, phototoxicity
47
diclofenac gel brands
``` solaraze gel (3%) Pennsaid solution (1.5%) Voltaren gel (1%) Flector patch (1%) ```
48
Solaraze dosing
twice daily to lesion area
49
Pennsaid dosing
40 drops per knee QID
50
Voltaren dosing
4 grams foot, knee, or ankle QID 2 grams hand, elbow, wrist QID MAX 16g/day for any single joint of lower extremity MAX 8 g/day for any joint upper extremity MAX 32g/day total
51
Flector patch dosing
1 patch q12h
52
Glucosamine/Chondroitin MOA
stimulates proteoglycan synthesis from articular cartilage
53
Glucosamine AEs
mild gas, bloating, cramps, may increase blood glucose
54
Watch glucosamine/chondroitin with what allergy
shellfish
55
Glucosamine/chondroitin dose
1500 mg glucosamine 1200 mg chondroitin per day
56
Intraarticular injections for OA
glucocorticoids | hyaluronate
57
glucocorticoids MOA
decreases inflammation
58
relief from glucocorticoid injections
24-72 hours, peak 7-10 days
59
How often glucocorticoid injections
3-5 per year
60
AEs from glucocorticoid injections
hyperglycemia edema increased BP post injection flare - mild symptoms for a few days
61
hyaluronate MOA
unknown, facilitates lubrication/shock absorbancy
62
how often hyaluronate injections
3-5 weekly for prolonged relief (26 weeks)
63
AEs of hyaluronate injections
``` acute joint swelling effusion stiffness skin reactions pruritus ```
64
Tramadol MOA
weak opiate receptor inhibition and weak reuptake inhibitor of Norepinephrine and serotonin
65
Tramadol dose
MAX 400 mg/day
66
Tramadol AEs
N/V somnolence constipation dizziness
67
TRamadol drug interactions
MAOIs
68
Precautions with tramadol
lowers the seizure threshold
69
Monitoring for OA
assess improvement in QOL
70
First line therapy for all OA
APAP max dose ATC
71
Alternate initial agents for Hand OA
topical capsaicin Topical NSAID ORal NSAID/Cox 2 Tramadol
72
Last line therapies for hand OA
intra-articular injections Opiates/tramadol Glucosamine/chondroitin
73
other initial therapies for Knee OA
oral NSAIDs/Cox 2 Topical NSAIDs Tramadol intra articular corticosteroids
74
last line therapies for knee OA
topical capsaicin opiates intra articular hyaluronate glucosamine/chondroitin
75
other initial therapies for hip OA
oral NSAIDs/Cox 2 Tramadol Intra-articular corticosteroids
76
last line therapies for hip OA
topical NSAIDS Opiates Intra articular hyaluronate glucosamine/chondroitin

Pnt Exam 1 (6 decks)

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