Osteoarthritis

Question 1

T/F: Osteoarthritis is not inflammatory

Answer 1

True

Question 2

What are risk factors of OA

Answer 2

Age, Obesitsy (most preventable), Men younger than 45 or women older than 45, occupation, sports, history of joint injury

Question 3

What are signs of OA

Answer 3

Pain, Stiffness, crepitus, osteophytes, effusions

Question 4

T/F: Lab testing for inflammatory markers (ESR/CRP, CBC, and CMP) are good indicators for OA

Answer 4

False: Often inflammatory markers are normal in OA

Question 5

What is localized OA, generalized OA, erosive OA

Answer 5

1 to 2 sites affected, 3 or more sites affected, erosions present on Xray

Question 6

What are the non- pharmacological ways to treat OA, what is special about them

Answer 6

Education, Weight loss, Exercise/ Only treatment shown to delay the progression of OA

Question 7

What are the recommended medications for hand OA, what is preferred if greater than 75

Answer 7

Topical capsaicin, Topical NSAIDs, Oral NSAIDs, Tramadol/ Topical NSAIDs

Question 8

What are the recommended medications for Knee OA

Answer 8

Acetaminophen, Oral NSAIDs, Topical NSAIDs, Tramadol, Intrarticular corticosteroid injections

Question 9

What drugs are not recommended for knee OA

Answer 9

Chrondroitin sulfate, Glucosamine, Topical Capsaicin

Question 10

What is the MOA of acetaminophen, regular dose, lower max dose, monitoring parameters

Answer 10

Block COX in CNS lowering prostaglandin synthesis, 650-1000 every 4 to 6 hours, 2-3 grams, LFTs for chronic use

Question 11

T/F: Patients have many different individual responses to NSAIDs, ibuprofen may not work but Naproxen will

Answer 11

True

Question 12

What NSAID is an acetylated salicyclate

Answer 12

Aspirin

Question 13

What NSAIDs are acetic acids

Answer 13

Etodolac, Diclofenac, Indomethacin, Nabumetone

Question 14

What NSAIDs are propionic acids

Answer 14

Ibuprofen, Naproxen, Oxaprozin

Question 15

What NSAIDs are oxicams

Answer 15

Piroxicam and Meloxicam (more COX 2 selective)

Question 16

What NSAIDs are Coxibs, what must be considered about it

Answer 16

Celecoxib (Celebrex), cant be used in those with a SULFA allergy

Question 17

What are the pertinent adverese effects of NSAIDs

Answer 17

GI (take with food), Asthma exacerbations, Cardiovascular (HTN, stroke, MI), Coagulation issues, Renal toxicty

Question 18

What should be monitored if a patient is taking NSAIDs

Answer 18

Blood pressure, CBCs, sCR, and LFTs

Question 19

When should patients not be given NSAIDs

Answer 19

CKD Stage 4 or 5

Question 20

What is the recommendation for a patient with a history of GI ulcer but NO bleed within the past year, GI bleed within one year

Answer 20

Cox-2 inhibitor in combination OR a nonselective NSAID with a PPI, Cox-2 inhibitor with a PPI

Question 21

T/F: If a patient is on a low dose aspirin for cardioprotection use a nonselective NSAID other than ibuprofen in combination with PPI

Answer 21

True

Question 22

T/F: If a person has Aspirin hypersensivity all NSAIDSs should be avoided

Answer 22

True

Question 23

What NSAIDS are known for displacing warfarin

Answer 23

Salisalates

Question 24

What must be considered when using Celecoxib

Answer 24

Metabolized by CYP450 2C9 so inhibition of 2C9 increases celecoxib, inhibits 2D6 causing an incrase in drugs metabolized by 2D6

Question 25

What happens when NSAIDs are mixed with furosemide, ACE inhibitors

Answer 25

Lower diuretic effects, lower natriuertic effect and anti-HTN leading to renal dysfunction and severe HTN

Question 26

T/F: Patients using topical NSAIDs should be cautious about the same side effect profiles due to possible systemic circulation

Answer 26

True

Question 27

What is the MOA of capsaicin, what is the tip about it

Answer 27

Depletes substance P from afferent nerves, medication should not be stopped until a few weeks have passed

Question 28

Which meds for OA work quickly (1-2 days) but doesn’t last long, how often can it be used

Answer 28

Corticosteroid injections (Triamcinolone and Methylprednisolone), only 3 times a year (every 3 months at least)

Question 29

What are hyaluronic acid products indicated for, how often are the used, what is a key counseling point

Answer 29

Knee OA only and fail CSI, every 6 months, AVOID strenuous activity for 48 hours after injection

Question 30

What is the MOA of tramadol , what patients should avoid tramadol

Answer 30

acts on mu-opiod receptios and inhibits the reuptake of norepinephrine and seotonin/ Age greater than 65, CrCl less than 30, liver impairment

Question 31

What drug-drug interactions does Tramadol have

Answer 31

TCAs and cyclobenzaprine (lower seizure threshold), duloxetine (serotonin syndrome)

Question 32

T/F: Narcotics (hydro Odom’s oxcodone morphine)can be used for chronic pain but must be at lowest dose with ONE prescriber

Answer 32

True

Question 33

What SNRI is indicated for pain due to OC

Answer 33

Duloxetine

Question 34

What OTCs do patients like to use but the guidelines advise against due to know evidence to say they work

Answer 34

Glucosamine

Question 35

What are the COX-1 inhibiting NSAIDs (less mucus secretion and bicarbonate)

Answer 35

Aspirin, naproxen, indomethacin,piroxicam

Question 36

What are the COX-2 inhibiting NSAIDs (increase risk of stroke and MI)

Answer 36

Etodolac, Diclofenac, celecoxib, Meloxicam

Question 37

What is the nonselective NSAID

Answer 37

Ibuprofen