Osteoarthritis Flashcards
(20 cards)
What are the risk factors for osteoarthritis?
Obesity Age Gender (W more than M) Occupation Participation in certain sports Hx of joint injury or surgery Genetic predisposition
How do you delay the progression of OA?
Non-pharmacologic
Examples: Weight loss, exercise, heat/cold, knee braces, use of assistive device
What pharmacologic option is 1st line
APAP
Less effective than NSAIDs but lower risk of GI/CV adverse events
Max dose 3g per day
If a pt is on low dose aspirin, what NSAID should you use?
Avoid ibuprofen, consider naproxen
Do NOT use celecoxib!
Use PPI in addition
How do you determine GI risk?
High risk would be history of previous ulcer or presence of 2 or more risk factors
Moderate risk would be 1-2 risk factors (age over 65, high dose NSAID therapy, previous history of uncomplicated ulcer, concurrent use of aspirin)
Low GI low CV what do you use
Ibuprofen, Naproxen
Low GI high CV what do you use
Naproxen
Moderate GI low CV what do you use
Celecoxib alone
NSAID plus PPI or misoprostol
NSAID plus high dose H2 blocker (2nd line)
Moderate GI high CV what do you use
Naproxen plus PPI
Naproxen plus high dose H2 blocker (2nd line)
High GI risk low CV what do you use
Avoid NSAIDS
Celecoxib plus PPI
High GI risk High CV risk what do you use
No NSAIDs whatsoever like damn
When should NSAIDs be avoided
GFR less than 30 mL/min
When are topical NSAIDs preferred
Preferred to oral NSAIDs in age over 75
What topical is used for hand OA only
Capsacin
What do pts use when APAP/NSAIDs fail?
Tramadol
What add-on therapy is there with APAP/NSAIDs?
Duloxetine
Useful in comorbid conditions and neuropathic pain
When do we use injectable therapies? How? What are the options?
Use for knee OA
Once weekly for 3 or 5 weeks
Synvisc, Orthovisc - 3 injections
Hyalgan, Supatz - 5 injections
TM is a 62 year old female who was diagnosed with osteoarthritis following 3 months of dull aching pain in both knees. Her PMH is significant for: hypertension, chronic obstructive pulmonary disease (COPD), coronary artery disease, and overactive bladder. Current medications include: ramipril 10 mg daily, amlodipine 10 mg daily, aspirin 81 mg daily, oxybutynin ER 5 mg tablet daily, and Combivent (albuterol/ipratropium) Respimat Inhaler, Inhale 1 puff every 6 hours PRN shortness of breath. The BEST treatment option for management of TM’s osteoarthritis is:
A: Topical capsaicin, apply to affected area(s) 3 to 4 times daily
B: Ibuprofen 400 mg, 1 tablet PO three times daily
C: Acetaminophen 325 mg, 1 to 2 tablets PO every 6 hours
D: Hydrocodone 5/325 mg 1 tablet PO every 8 hours
C: Acetaminophen 325 mg, 1 to 2 tablets PO every 6 hours
OA 3
PY is a 71 year old male who presents to clinic today for evaluation of osteoarthritis and selection of therapy to manage his pain. His PMH is significant for: atrial fibrillation, hypertension, hyperlipidemia and type 2 diabetes. Current medications include: amlodipine 10 mg daily, lisinopril 40 mg daily, metoprolol 100 mg twice daily, metformin 1000 mg twice daily, warfarin 5 mg daily, and atorvastatin 40 mg daily. How many risk factors for development of GI complications with NSAID therapy are present in PY? ᅞ
A: 0
B: 1
C: 2
D: 3
C: 2
PY is a 71 year old male who presents to clinic today for evaluation of osteoarthritis and selection of therapy to manage his pain. His PMH is significant for: atrial fibrillation, hypertension, hyperlipidemia and type 2 diabetes. Current medications include: amlodipine 10 mg daily, lisinopril 40 mg daily, metoprolol 100 mg twice daily, metformin 1000 mg twice daily, warfarin 5 mg daily, and atorvastatin 40 mg daily. PY¶s physician would like to start him on an NSAID for management of his osteoarthritis-related pain. However, he is concerned about the risk of ulceration and GI bleeding and wishes to add a medication to prevent NSAID-related GI complications. Which of the following is the BEST option for PY?
A: Add lansoprazole 30 mg daily ᅞ
B: Change the NSAID to an enteric coated formulation ᅞ
C: Add misoprostol 200 mcg four times daily ᅞ
D: Add sucralfate 1 gram four times daily
A: Add lansoprazole 30 mg daily ᅞ
