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Spring 15 - Pharm Unit I > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

OA Risk Factors

A
  • age, gender
  • genetic predisposition
  • occupational and recreational activities w/ repetitive motion
  • hx of joint trauma
  • obesity
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2
Q

Pathophys of OA

A
  • loss of cartilage in joint
  • local inflammation
  • pathologic changes in underlying bone
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3
Q

OA Clinical Presentation

A
  • pain typically worse with use, relieved w/ rest (early OA)
  • morning stiffness and “gelling” of joints
  • bony enlargement, crepitus on motion and limited joint motion
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4
Q

Tx Goals

A
  • educate pt and caregivers
  • relieve pain and stiffness
  • maintain or improve joint mobility
  • limit functional impairment
  • preserve joint integrity
  • maintain or improve QOL
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5
Q

Non-Pharm Therapy

A
  • pt education
  • strengthening and ROM exercises (PT)
  • use of assistive devices (OT)
  • joint protection
  • weight loss as needed
  • surgery
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6
Q

What is pharm therapy used for in treating OA?

A
  • used only for symptom management

- meds do not change the course of dz

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7
Q

APAP Regimen

A
  • up to 4 gm/day

- reduce dose by 50-75% for renal or hepatic failure or EtOH abuse

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8
Q

APAP Advantages

A
  • effective for mild to moderate pain

- low risk of AEs

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9
Q

APAP Disadvantages

A
  • not effective for pain assoc. w/ inflamation

- use w/ caution for pts with hepatic dysfunction

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10
Q

N-NSAIDs Advantages

A

-effective for moderate to severe pain

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11
Q

N-NSAIDs Disadvantages

A
  • GI side effects
  • renal dysfunction
  • precautions: renal failure, CHf, HTN
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12
Q

Drug Interactions of APAP

A
  • warfarin: increased risk of bleeding (does not change INR)
  • diuretics, ACEIs, ARBs: may decrease effect (b/c NSAIDs can increase BP)
  • lithium: increases Li levels
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13
Q

Why should indomethacin be avoided with hip OA?

A

long term use assoc w/ accelerated joint destruction in this setting

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14
Q

Use of Diclofenac Gel

A
  • topical NSAID

- recommended for pts > 75

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15
Q

Nonacetylated Salicylates Regimen

A
  • salsalate 500-750 mg BID

- choline magnesium trisalicylate 500-750 mg TID

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16
Q

Nonacetylated Salicylates Advantages

A
  • effective for mod to severe pain
  • less risk of GI toxicity compared to other N-NSAIDs
  • do not affect platelet aggregation
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17
Q

Nonacetylated Salicylates Disadvantages

A
  • potential for GI adverse effects, renal dysfunction

- use w/ caution for pts with renal failure, CHF, HTN

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18
Q

Nonacetylated Salicylates Drug Interactions

A
  • warfarin
  • diuretics, ACEIs, ARBs: decreased effect
  • lithium: increased Li levels
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19
Q

COX-2 Inhibitor Regimen

A

celecoxib 100 mg BID or 200 mg qday

20
Q

COX-2 Inhibitor Advantages

A
  • effective for mod to severe pain
  • less risk of GI toxicity compared to N-NSAIDs
  • do not affect platelet aggregation
21
Q

COX-2 Inhibitor Disadvantages

A
  • potential for GI adverse effects, renal dysfunction
  • use w/ caution for pts with renal failure, CHFl, HTN
  • CI in pts with allergy to sulfa products
  • possible increased risk of CV events
22
Q

COX-2 Inhibitor Drug Interactions

A
  • warfarin
  • diuretics, ACEIs, ARBs: decreased effect
  • lithium: increased Li levels
23
Q

When should COX-2 use be considered?

A

-pts with high GI risk and low CV risk

24
Q

Tramadol Category

A

1/3 mu receptor agonist, 2/3 SNRI

25
Q

Tramadol Regimen

A

50-100 mg q4-6hr (max 400 mg/day, 300 for geriatric)

26
Q

Tramadol Disadvantages

A
  • sedation, confusion, seizures
  • urinary incontinence
  • adjust dose to q12hr for CrCl < 30 ml/min
27
Q

When should tramadol use be considered?

A
  • for mod to severe pain

- no response, AEs or CIs to APAP and NSAIDs

28
Q

Intraarticular Steroids Regimen

A
  • various

- methylprednisolone 4-80 mg q1-5 weeks based on joint size

29
Q

Intraarticular Steroids Advantages

A

-effective for knee OA

30
Q

Intraarticular Steroids Disadvantages

A

-not effective for hip OA

31
Q

Intraarticular Hyaluronic Acid Regimen

A

-Hyalgan, Synvisc, Supartz

32
Q

Intraarticular Hyaluronic Acid Advantages

A

-duration of relief may last up to 6 months

33
Q

Intraarticular Hyaluronic Acid Disadvantages

A
  • delated onset of action
  • not approved for hip OA
  • some clinical trial results similar to placebo
  • use w/ caution if allergies to avian proteins and egg products
34
Q

Duloxetine/Cymbalta Indication

A

indicated for chronic musculoskeletal pain 2ary to lower back pain and OA

35
Q

Duloxetine/Cymbalta Regimen

A
  • start at 30 mg/day x 1 week to decrease nausea

- do not exceed 60 mg/day for pain

36
Q

When should Duloxetine/Cymbalta be considered?

A

if analgesics are not sufficient and there is concurrent depression

37
Q

Opioids Disadvantages

A
  • constipation, sedation, confusion

- meperidine not recommended due to accumulation in the elderly

38
Q

Topical Capsaicin MOA

A

-releases and depletes substance P from nociceptive pain nerve fibers

39
Q

Topical Capsaicin Regimen

A

-apply to symptomatic joint TID-QID

40
Q

Topical Capsaicin Advantages

A

-avoid systemic side effects

41
Q

Topical Capsaicin Disadvantages

A
  • local irritation/burning sensation
  • delayed response up to 2 weeks
  • nonadherence
  • no recommended for knee OA
42
Q

Glucosamine Sulfate +/- Chondroitin Regimen

A

500 mg PO TID

43
Q

Glucosamine Sulfate +/- Chondroitin Disadvantages

A
  • potential allergic reaction in pts with shellfish allergy
  • may cause GI upset and nausea
  • not recommended for hip or knee OA
44
Q

Which pharm options does the College of Rheumatology recommend using for hip and knee OA?

A
  • APAP
  • oral or topical NSAIDS
  • tramadol
  • intraarticular corticosteroid injections
45
Q

Which pharm options does the College of Rheumatology NOT recommend using for hip and knee OA?

A
  • chondroitin sulfate
  • glucosamine
  • topical capsaicin

Spring 15 - Pharm Unit I (6 decks)

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