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Osteoarthritis
n/a
103
Pharmacology
Graduate
03/26/2012

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Cards

Term
What is osteoarthritis?
Definition
Failure of the movable, synovial-lined joint
Term
In what gender OA is more common?
Definition
Women
Term
What pecent of women <45 has OA?
Definition
2%
Term
What percent of women betweem 45 and 64 y.o.has OA?
Definition
30%
Term
What perceent of women >65 y.o. has OA?
Definition
68%
Term
What kind of OA women are more likely to have?
Definition
Women are more prone to inflammatory OA of proximal and distal joints of hands
Term
How does race influence distribution of OA?
Definition
Knee OA is 2X as likely in black women than white
Chinese, East Indian, Native American have lower incidence of hip OA than Caucasian
Term
True/False
Older women are twice as likely as men to have OA of knee and hands
Definition
True
Term
What are risk factors for OA?
Definition
Age, Female sex,Race,Genetic factors
Major joint trauma,Repetitive stress
Obesity,
Congenital/develop-mental defects
Prior inflammatory joint disease,
Metabolic/endocrine disorders
Term
What is a role of chondrocytes in OA?
Definition
Produce collagen and PG as well as playing a role in degradation
Undergo active cell division and are active metabolically leading to thickened cartilage and compensated, stable OA
Term
What is going on in early OA?
Definition
the cartilage is thicker than normal
Extra-cellular matrix is damaged and water content increased
Primary changes begin in the cartilage with a change in the arrangement and size of the collagen fibers
Term
What is going on later in OA?
Definition
, joint surface thins, cartilage softens, integrity of the surface is breached, vertical clefts develop
Areas of repair develop but function is inferior
Bone growth occurs altering the contour of the joint and reducing mobility
Osteophyte – new bone growth at the joint margin away from the area of destruction
Synovitis leads to thickening of the joint capsule
Periarticular muscle wasting is common
Term
What are clinical finding for OA?
Definition
Pain – deep ache, localized to the joint, aggravated by joint use, relieved by rest
Nocturnal pain is seen in advanced OA of the hip
Stiffening after inactivity
Joint motion limitation
Crepitus – grating or crackling with motion
Term
True/False
People with OA complain about joint ache during weather change.
Definition
True (due to the change in barimetric pressue)
Term
What joints are more commonly affected by OA?
Definition
DIP (Heberden’s nodes)
PIP (Bouchard’s nodes)
First carpometacarpal
Knees
Hips
Cervical and lumbar spine
First MTP joints (big toe)
Term
What joints are less commonly affected?
Definition
Shoulder
Elbow
MCP (finger base)
Term
What are the sources of pain in OA?
Definition
Cartilage contains few nerve endings
Pain can result from:
Osteophyte growth with stretching of the periosteum
Microfractures
Synovitis
Damage to ligaments and meniscus
Term
What is first line in the treatment of OA?
Definition
Nonpharmacological therapy
Term
What is a role of the meds in OA?
Definition
Medications do not alter disease course, but are used to treat symptoms
Term
What are the goals for treatment of OA?
Definition
Relieve pain and stiffness
Maintain or improve joint mobility
Limit functional impairment
Maintain or improve quality of life
Term
What is a key in nondrug therapy of OA?
Definition
Muscle stregthening
Term
On what side should be crutch used in OA?
Definition
On opposite site
Term
What is a first line agent for treatment of mild to moderate symptms of OA?
Definition
Acetaminophen
Term
What is a typical dose of acetameinophen for OA?
Definition
325-1000 mg four times a day
Term
What is a max dose of APAP for OA?
Definition
Maximum of 4 grams daily
Term
What is a major advantage of acetaminophen?
Definition
Lack of GI toxicity
Term
Acetamenophen is safest drug for patients with renal disease
True/False
Definition
True
Term
What is a big concern with acetamenophen?
Definition
Potentially fatal hepatotoxicity in ovedse.
Term
Caution should be exercised when using acetamenophen in liver disease and alcohol abuse.
True/False
Definition
True
Term
What kind of activity acetamenopen does not have?
Definition
antiinflamatory
Term
What qualities does aspirin have?
Definition
anti-inflamatory
analgesic
antipyretic
platelets inhibition
Term
At what dose ASA has anti-inflamatory effect?
Definition
3.6 g daily
Term
For what kind of pain ASA can be used for?
Definition
mild to moderate
Term
What is a mechanism for antipyretic effect of ASA?
Definition
Heat dissipation through vasodilation
Term
Cardioprotective effect of ASA is due to what?
Definition
Platelet inhibition
Decreased aggregation from inhibition of thromboxane synthesis
Irreversible inhibition, therefore 8 days required for normal platelet function
Term
How should be plain ASA be taken?
Definition
with foodor milk to min GI SEs
Term
Enteric coated ASA should be separated from antacids and milk
Definition
True
Term
What are SE of ASA?
Definition
GI (from mild to peptic ulcers),Decreased platelet aggregation increases bleeding risk
CNS – tinnitis and vertigo
Intolerance
Reye’s Syndrome – children
Allergy
Term
Dyspepsia can't predict GI bleed.
True/False
Definition
True
Term
NSAIDs exibit antiinflamatory effect at higher doses.
True/False
Definition
True
Term
NSAIDs exibit analgesic effect at higher doses.
True/False
Definition
False (at lower)
Term
What is a MOA of NSAIDs?
Definition
Mechanism is based on blockade of prostaglandin synthesis through inhibition of cyclooxygenase (COX-1 and COX-2)
Term
What toxicities do NSAIDs have?
Definition
Gastrointestinal
Renal
Cardiovascular
Hematological
CNS
Term
What percent of pts will have dyspepsia, heartburn and pain while taking NSAIDs?
Definition
20-30%
Term
What kind of GI SE another 20-30% ofpts will have?
Definition
mucosal erythema, erosions, peptic ulceration (endoscopy)
Term
What will increase risk of GI SE with NSAIDs?
Definition
age, history of peptic ulcer or bleeding, systemic glucocorticosteroids, increasing NSAID dose
Term
How one can reduce GI irritation with NSAIDs?
Definition
Take with food or antacids to reduce irritation
Term
What kind of products can't be taken with food or antacids?
Definition
enteric coated products
Term
What can be use for treatment/prophylaxis against ulceration?
Definition
Proton pump inhibitors (PPIs) -omeprazole (Prilosec)
Prostaglandin analogs –misoprostol/diclofenac (Arthrotec)
H2 blockers -famotidine (Pepcid), ranitidine (Zantac)
Antacids -calcium carbonate (Tums)
Sucralfate (Carafate)
Term
What i a SE of prostaglandin analogs misoprostol/diclofenac (Arthrotec)?
Definition
Diarrhea, cramping (unsafe in women)
Term
What drugs are often used with NSAIDs to prevent ulceration?
Definition
PPIs - omeprazole (Prolosec)
Term
What doses of H2 blockers -famotidine (Pepcid), ranitidine (Zantac) should be used for GI prophylaxis?
Definition
Higher doses
Term
What drugs have less degree of evidence long term for GI prophylaxis?
Definition
Antacids -calcium carbonate (Tums)
Sucralfate (Carafate)
not used in combo
Term
What blood tests should be done while taking NSAIDs?
Definition
BUN, creatinine
Term
In what condition prostaglandins are especially important?
Definition
Prostaglandins are especially important for renal function in patients with volume overload or diminished cardiac output
Term
What is an average BP increase on NSAIDs?
Definition
5 mmHg
Term
NSAIDs should be used in caution in what group of pts?
Definition
in patients with congestive heart failure (CHF), liver disease with ascites, compromised renal function, or concomitant diuretic use
Term
Neprotic syndrme is directly relate to previous renal problems
True/False
Definition
False, it s a rare SE, due to direct irritation of the nephrons, reversible on D/C
Term
NSAIDs can lead to CV events,thrombotic events, myocardial infarction, and stroke, which can be fatal.
Definition
True
Term
What will increase risk of CV, thrombosis, MI, stroke with NSAIDs?
Definition
prolonged use, CV disease or factors for CV disease
Term
What is CI contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery ?
Definition
Tradename
Term
What drugs are linked to increased risk of CV events?
Definition
Ibuprofen, Diclofenac
Term
What drug is safer in CV risk?
Definition
Naproxen
Term
When pt should take ASA while on therapy with NSAIDs?
Definition
1 hour before NSAIDs
Term
What patients population at increased risk for GI AEs?
Definition
elderly
Term
Hematological SE of NSAIDs are due to what?
Definition
Inhibition of COX-1 causes reduced platelet adhesiveness and prolonged bleeding time
Rarely -thrombocytopenia and bone marrow toxicity
Term
What CNS SE do NSAIDs HAVE?
Definition
Cognitive dysfunction, confusion, somnolence, dizziness, behavioral changes, headache
Term
What is respiratory SE of NSAIDs?
Definition
Asthma exacerbation
Term
What is dermatological SE of NSAIDs?
Definition
Rash
Term
What factors increae risk of GI renal SE?
Definition
Moderate to high dose (Naproxen, Ibuprofen, diclofenac)and increased age
Term
NSAIDs decrease antihypertensive effect of which drugs?
Definition
ACE inhibitors, beta blockers, diuretics
Term
NSAIDs + warfarin = ?
Definition
increased bleeding risk
Term
bisphosphonates + NSAIDs =?
Definition
increased risk of GI irritation
Term
What is effect of salicylates on NSAIDs?
Definition
decreased NSAIDs effect
Term
Phenytoin/Lithium + NSAIDs = ?
Definition
increased level of phenytoin/lithium
Term
Methotrexate + NSAIDs = ?
Definition
increased toxicity of methotrexate
Term
What pts can't take celecoxib?
Definition
allergics to sulfa drugs
Term
What SEs are similar for nonselective NSAIDs and COX-2 inhibitors?
Definition
Sodium retention and decreased glomerular filtration
Term
When we target COX-2 we interfere with?
Definition
platelet aggregation, vasodilation, antiproliferative effects
Naproxen and diclofenac have bad outcomes
Term
When we target COX-1 we interfere with?
Definition
platelet aggregation, vasoconstriction, smooth muscle proliferation
Term
True/False
Combo (naproxen + PPI) is effective as celecoxib in pts with GI risk?
Definition
True
Term
Celecoxib risk increases with which dose?
Definition
> 200 mg/d
Term
How ibuprofen should be dosed when ASA is used for cardioprotection?
Definition
Dose ibuprofen 8 hours before or 30 minutes after immediate-release ASA
Term
When ASA is used for cardioprotection what should be used for pain management?
Definition
non-NSAIDs
Term
What is most COX-2 selective agent?
Definition
Etodolac (Lodine)
Term
What are some characteristics of Non-acetylated Salicylates?
Definition
Less GI irritation than ASA
Less effective than ASA at inhibiting COX
Smaller effect on platelet aggregation than ASA Potential benefit in asthma, bleeding risk, renal dysfunction
Term
What agents are Non-acetylated Salicylates?
Definition
Salsalate
Diflunisal
Choline salicylate
Choline magnesium salicylate
Term
What opioids can be used for OA?
Definition
Tramadol (Ultram®)
Codeine w/ APAP
Propoxyphene
Term
What opioid is not a first line agent?
Definition
Propoxyphene
Term
What are SE o opioids?
Definition
nausea, vomiting, dizziness, constipation, tolerance, dependence, respiratory depression
Term
What is glucosamine?
Definition
Endogenous substance made from glucose and used in biosynthesis of proteoglycans and glycosaminoglycans, the building blocks of cartilage
Term
What is simptomatic improvement with glucosamine similar to?
Definition
ibuprofen
Term
true/false
Glucosamine is C/I in pts with diabetes
Definition
False
caution
Term
What dose of glucosamine is used for OA?
Definition
1500 mg QD (or divided BID-TID)
Term
What are SE of glucosamine?
Definition
GI distubbances
Term
What is chondroitin?
Definition
Mucopolysaccharide found in most mammalian cartilaginous tissues
Term
What is daily dose of chondroitin?
Definition
800-2400 mg daily
Term
What classes of agents chondroitin may interact with?
Definition
anticoagulants and antiplatelets: INR will increase
Term
True/false
one should start combo (glucosamine+chondroitin) since the beginning
Definition
False
A pt should start with one product for a month and see if there is any improvement.
Term
What drugs glucosamine may interact with?
Definition
doxorubicin, etoposide
Term
What are indications for orthopedic referral in OA?
Definition
Severe OA that has failed to respond to medications
Progressive limitation in ADLs
Term
What are indications for total hip replaement?
Definition
Radiographic evidence of joint damage
Moderate to severe persistent pain or disability
Not substantially relieved by an extended course of therapy
Term
What agents have evidence in OA disease progression and inflamation?
Definition
Doxicycline and minocycline
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