Osteoarthritis Day 2

Question 1

What are the renal effects of NSAIDs?

Answer 1

actue renal insufficiency (constriction of afferent arteriole)
tubulointerstitial nephropathy
hyperkalemia
renal papillary necrosis
worsened by medications that decrease renal blood flow (ACEI, ARB, Diuretics)

Question 2

WHat do you need to caution with NSAIDs?

Answer 2

caution in asthma pts with ASA allergy

Celecoxib has sulfer in it (sulfa allergy)

Question 3

What do you need to monitor in NSAIDs?

Answer 3

pain management, renal function, bleeding

Question 4

What is the MOA of tramadol?

Answer 4

Mu receptor agonist, it inhibits signal transmission, inhibits NE and serotonin reuptake

Question 5

When is tramadol useful?

Answer 5

moderate to severe OA

Question 6

What is the dose of tramadol?

Answer 6

50-100 mg every 6 hours up tp 400 mg/day

max 200 mg/day in CrCl <30

Question 7

What are the adverse effects of Tramadol?

Answer 7

N/V, constipation
Headache
Dizziness, solmnolance

Question 8

What is the dosing of Triamcinolone?

Answer 8

10-20 mg 3-4 injections/year

Question 9

What is the dosing of Methylprednisolone?

Answer 9

20-40 mg 3-4 injections/ year

Question 10

What is the efficacy of corticosteroids?

Answer 10

initial relief in 24-72 hours
peak is 7-10 days
lasts 4-8 weeks

Question 11

What are the systemic adverse effects of corticosteroids?

Answer 11

hyperglycemia, edema, elevated BP, Dyspepsia, adrenal suppression

Question 12

What are the local adverse effects of corticosteroids?

Answer 12

joint infection, osteonecrosis, tendon rupture, skin atropy

Question 13

What is the MOA of Hyaluronic Acid?

Answer 13

component of synovial fluid. may reduce inflammation

Question 14

When is Hyaluronic acid injected?

Answer 14

injected once weekly for 3-5 weeks

Question 15

What is the adverse effects of Hyaluronic Acid?

Answer 15

joint swelling, increased pain, stiffness, skin reactions

Question 16

What is the last line agent for moderate to severe OA?

Answer 16

Opioids

Question 17

What are common opioids?

Answer 17

oxycodone, morphine, hydromorphone, fentanyl

Question 18

What are adverse effects of opioids?

Answer 18

constipation, nausea, dizziness, solmnance, respiratory depression

Question 19

What is the MOA of duloxetine?

Answer 19

SNRI

pain relief through blockade of central pain transmitter

Question 20

What is the dose of Duloxetine?

Answer 20

30 mg daily for 1 week then 60 mg daily

Question 21

What are common adverse effects of duloxetine?

Answer 21

nausea, dry mouth, constipation, anorexia, fatigue, somnolence, dizziness
RARE- SJS, liver failure

Question 22

How long can duloxetine take to work?

Answer 22

several weeks

Question 23

What is the MOA of Glucosamine and Chondroitin?

Answer 23

shifts cartilage metabolism

stimuates proteoglycan synthesis

Question 24

Where is Glucosaminefound and what does it do?

Answer 24

found in cartilage matrix and synovial fluid. It decreases joint spacing narrowing

Question 25

Where is Chondroitin and what does it do?

Answer 25

found in proteoglycans and helps cartilage resist compression

Question 26

What is the dosing of Glucosamine?

Answer 26

1500 mg daily

Question 27

What is the dosing of Chondroitin?

Answer 27

800-1200 mg daily

Question 28

How long with it take for Glucosamine and Chondroitin to take effect?

Answer 28

4-8 weeks

Question 29

When do patients use the option of surgery?

Answer 29

patient have functional disiability and/or severe pain unresponsive to other therapy

Question 30

What are the benefits of total joint arthroplasty?

Answer 30

may restore prior activity level and QOL

Question 31

What are the risks of total joint arthroplasty?

Answer 31

thrombosis, infection, dislocation of joint, anestheisa risk

Question 32

What are the contraindications of total joint arthroplasty?

Answer 32

long rehabilitation, anticoagulation, duration of prosthesis

Question 33

What are other surgical options?

Answer 33

joint fussion for small painful joints | osteotomy to correct misalignment

Question 34

What is recommended with Knee OA?

Answer 34

``` APAP Oral NSAIDs Topical NSAID above age 75 Tramadol Intraarticular corticosteroids ```

Question 35

What is not recommended with Knee OA?

Answer 35

Glucosamine Chondroitin Topical Capasian

Question 36

What is recommended for hand OA?

Answer 36

Topical capasian Topical NSAIDs above the age of 75 oral NSAID Tramadol

Question 37

What is not recommended for hand OA?

Answer 37

Intraarticular injections | Opioid anagesics

Question 38

What is recommended for hip OA?

Answer 38

APAP Oral NSAIDs Tramadol Intraarticular corticosteroids

Question 39

What is not recommended for hip OA?

Answer 39

Glucosamine | Chondroitin

Question 40

What do you monitor in Osteoarthritis?

Answer 40

joint pain function, range of motion, radiographs, quality of life, adverse effects of therapy