Term
| What is the #1 cause of OA? |
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Definition
Obesity. Can also be occupational, Sports, trauma, or genetic
Age - major factor |
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Term
| What are the signature signs of OA of the knee? |
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Definition
Pain,grating with movement
Difficulty rising
May appear bow-legged |
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Term
| What are signature signs of OA of the hip? |
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Definition
Pain in groin, butt, inner thigh.
Referring pain in thigh, limping while walking
Instability, increase in falls |
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Term
| What are the goals of OA therapy? |
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Definition
Control pain
Maintain/improve function, QoL
Avoid AEs |
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Term
| What is the first line therapy for OA? |
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Definition
Nondrug - PT, diet, education
Drug - scheduled tylenol, topical capsaicin
No response - NSAIDS depending on person |
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Term
| What is used when a patient is at risk for an ulcer? |
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Definition
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Term
| What is necessary when starting an NSAID? |
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Definition
| Assess renal function, CrCl for pts over 65 or with comorbidities (diabetes). Measure BP in HTN. Celebrex affects the heart |
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Term
| When should NSAIDs be avoided? |
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Definition
| IF a patient is at both high GI risk and high CV risk |
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Term
| When should a patient take Naproxen + PPI? |
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Definition
| Low GI risk + high CV risk |
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Term
| What is the indication for surgery for OA? |
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Definition
- Debilitating pain, limitation in walking, sleeping
- Intolerance or ineffectiveness of medication
- Joint replacement + PT |
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Term
| What is the appropriate dosage of Tylenol? How should it be used? |
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Definition
325 mg q4-6h, max 3.25g/day OR 1000 mg TID OR 650 - 1300 mg TID max 3.9 g/day (longer acting)
Scheduled is more effective! Can use with tramadol, capsaicin, glucosamine
Liver toxicity with chronic high doses. Monitor AST/ALT at base, in 6 weeks, at 6 months
Decr GI, no CV but no AIF, affects liver |
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Term
| How should salicylates (Salsalate, Diflunisal, Choline) be used? |
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Definition
| for mild OA when APAP has failed. Lower incidence of GI and renal AEs, but low AIF effects. |
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Term
| Which NSAIDs are used for moderate to severe OA? |
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Definition
| Acetic acids, Propionic acids, Fenamate, Oxicams, COX2. |
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Term
| Is a GI AE warning on COX2 inhibitors still required? |
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Definition
| Yes! Just lower incidence. Also causes CV effects |
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Term
| What is the dose and maximum dose for Etodolac/Lodine? |
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Definition
800 - 1200 mg/day in divided doses, MAX 1200/day
300 bid - tid or 400 - 500 BID |
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Term
| What is the dose and maximum dose for Diclofenac/Voltaren? |
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Definition
| 50 mg BID-TID or 75mg BID; MAX 200mg/day |
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Term
| What is the dose and maximum dose for Nabumetone/Relafen? |
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Definition
| 500-1000mg QD-BID, MAX 2000mg/day |
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Term
| What is the dose and maximum dose for Piroxicam/Feldene? |
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Definition
| 10-20 mg QD, max 20 mg QD |
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Term
| What is the dose and maximum dose for Meloxicam/Mobic? |
|
Definition
| 7.5-15 mg QD, max 15 mg QD |
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Term
| What is the dose and maximum dose for Ibu/Motrin? |
|
Definition
| 800 mg TID - QID, MAX 3200 mg/day |
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Term
| What is the dose and maximum dose for Naproxen/Aleve? |
|
Definition
| 275 - 550 mg BID, max 1375 mg QD |
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Term
| What is the dose and maximum dose for Oxaprozin/Daypro? |
|
Definition
| 600 - 1200 mg QD, Max 1800 mg/day |
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Term
| What is the dose and maximum dose for Indomethacin? |
|
Definition
| 25 mg BID to TID, max 200 mg QD |
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Term
| What is the dose and maximum dose for Celebrex? |
|
Definition
100 BID or 200 QD, max 200 mg QD
Use 50% reduced dose for hepatic impairment, do not use in severe impairment |
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Term
| What monitoring takes place with NSAIDs? |
|
Definition
Major ADRs: GI, Renal, Hepatic, CV
Initial SCr, BUN, K, AST.ALT, BP
Chronic: Recheck in 1-2 mo, then 6 mo
Watch for signs of a bleed, gastric ulcers: previous PUD, over 75, high dose, on anti-coags, steroids, KCl, alcohol |
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Term
| How can GI complications be prevented? |
|
Definition
- COX2 agents
- NSAID + misoprostol or PPI
- Take with food or use enteric coating |
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Term
| How do NSAIDs affect renal function? |
|
Definition
acute renal insufficiency and nephropathy in patients who are older, use chronically in high doses, have HTN or diabetes.
increased SCr, diabetes, K+, BUN
Symptoms: edema, weight gain
Usually indomethacin, piroxicam |
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Term
| How does liver toxicity occur in NSAIDs? |
|
Definition
High doses or with other toxic agents
Monitor AST/ALT at base and in 6 weeks, then 6 months
Usually diclofenac and sulindac |
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Term
| What oral agents are preferred in patients with CV disease? |
|
Definition
| APAP, ASA, Tramadol, opioids |
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Term
| What are rarer AEs of NSAIDs? |
|
Definition
| Photosensitivity, angioedema, CNS, rash |
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Term
| What are drug interactions that can occur with NSAIDs? |
|
Definition
- ASA + IBU = block anti-platelet activity of ASA
- NSAID + anticoags = increase GI bleed risk
- NSAID + MTX = increase liver toxicity
- NSAID + diuretics = blocks effect of diuretics |
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Term
| What is the use of capsaicin? |
|
Definition
Alone or with other therapies. Apply TID to QID for 1-2 weeks before seeing full effect, not recommended for knee or hip.
Avoid on broken skin and mucous membranes. |
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Term
|
Definition
-Voltaren Gel - do not apply heat, used in hands and knees. 2-4 grams QID. 8 grams in upper, 16 grams in lower, body max of 32 grams/day.
- Pennsaid sln - only in OA of the knee, DMSO sln. 40 gtts QID
- Flector patches |
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Term
| How is the intraarticular hyaluronic acid injection used? |
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Definition
| In knee OA patients who have not responded to other therapy. Synvisc QW x3W or Synvisc one x1. Comes from the rooster! |
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Term
| What are steroid shots used for? |
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Definition
| Short term inflammation relief in the hip, knee, and shoulder. Gout relief. only 3-4x per year per joint, peak relief in 7-10 days, can last 4-8 weeks. Triamcinolone 5-20 mg or Dexamethasone 20-40 mg |
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Term
| How is Glucosamine/Chondroitin dosed and used? |
|
Definition
Repair of cartilage - 500 mg TID, does not cure. Sulfate is the better absorbed salt.
Chondroitin 1200 mg QD |
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Term
| What is the proper use of tramadol in OA? |
|
Definition
Can use with APAP to control pain or to keep NSAID dose low.
50mg q4-6h, 200 mg/day MAX. Reduce dose in age, CrCl < 30, hepatic damage. Major side effect: Sweats! also nausea, sedation, seizures w/ SSRIs |
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