Term
|
Definition
short duration-
unpleasant sensory & emotional experience associated w?actual or potential tissue damage or described in terms of such damage |
|
|
Term
|
Definition
| pain that persists beyond the time of expected healing |
|
|
Term
|
Definition
| pain related to tumor recurrence or treatment |
|
|
Term
| Mechanisms of pain transmission |
|
Definition
| pain signal transmission starts at the nociceptors (free nerve endings) that can sense many types of tissue injury |
|
|
Term
|
Definition
| Biochemicals including Leukotrienes, prostaglandins, & histamine |
|
|
Term
| 3 kinds of endogenous endorphins |
|
Definition
| enkephalins, dynorphins, B-endorphins |
|
|
Term
| interact in opiate receptors in the brain |
|
Definition
| endorphins & narcotic analgesics |
|
|
Term
| pain that cannot be described by nociceptors |
|
Definition
| neuropathic pain, pain modulated w/out nociception, sympathetically maintained pain, phantom limb pain |
|
|
Term
|
Definition
there is a correct amount of pain for a given injury
people become easily addicted to narcotics |
|
|
Term
|
Definition
pain is necessary b/c it builds character
the use of analgesics is evidence of weak character |
|
|
Term
| complexity of pain assessment |
|
Definition
pain is difficult to assess in young kids & elderly (dementia) patients b/c they often aren't able to express the extent of their discomfort
INadeuwate assessment techniquefoster undertreatment b/c PRN dosing is based on patients report of need for analgesics |
|
|
Term
| predictors of inadequate pain management |
|
Definition
| age, non-caucasian, low cognitive performance, multiple other meds |
|
|
Term
| Principles of effective pain assessment |
|
Definition
| Palliative/Provocative factors, Quality, Radiation, Severity, Temporal factors |
|
|
Term
|
Definition
| measure pain using self reportand/or behavioral observation tools, interpret behaviors cautiously, tailor assessment strategy to development level & situation, use caregivers report if patient is unwilling or unable, use physiologic measures only as adjuncts of self report & behavioral observation, assess pain at regular intervals PAIN AS A 5th VITAL SIGN |
|
|
Term
|
Definition
| heart rate, BP, RR, diaphoresis |
|
|
Term
|
Definition
| cry characteristics, facial expression, objective pain scale |
|
|
Term
|
Definition
faces pain rating scale, numerical rating scale,
descriptive rating scales, visual analogue scales |
|
|
Term
| principles of effective pain management |
|
Definition
| assess pain intensity & relief at regular intervals, respect patient preferences, eval the effectiveness of pain management & medication side effects & adjust regimen as needed. Suspect pain! Patient may not be able to report |
|
|
Term
| Nonpharmacological therapy |
|
Definition
| TENS, Psychological intervention:info on sensations to expect after procedures, relaxation training, controlled mental imagery, controlled attention or distraction, hypnosis, Biofeedback |
|
|
Term
|
Definition
eliminate underlying cause if possible
STEP1 +non-opioid+/-adjuvants
STEP2 weak opioids +non-opioids +/- adjuvants
STEP 3 strong opioids +non-opioids +/- adjuvants |
|
|
Term
|
Definition
| acetaminophen (Tylenol), NSAIDS, ASA |
|
|
Term
|
Definition
| analgesic & anti-pyretic effects lacks anti-inflammatory activity, treats mild-mod pain, =ASA |
|
|
Term
|
Definition
Analgesic, antipyretic, & anti-inflammatory effects
produce no tolerance or dependence
ceiling effect to analgesia (flat-dose response curve for pain) |
|
|
Term
nonsalicylates
NSAIDS & Cox 2 |
|
Definition
Non-selective NSAIDS (traditional) Ibuprofen, naproxen
Partially selective NSAIDS nabumetone, meloxicam
Selective Cox2 Inhibitors celecoxib |
|
|
Term
|
Definition
Acetylated ASA
nonacetylates salsalate, trisalicylate |
|
|
Term
|
Definition
a single full dose, most nonselective NSAIDs are more effective than full dose ASA or APAP
Some have >= analgesic effect of oral opioid combo
some patients respond better to 1 NSAIDs than another
Celecoxib single 100-200 mg dose is less effective than ibuprofen 400 mg or naprosyn 550mg |
|
|
Term
|
Definition
GI-dyspepsia, mucosal lesions, serious GI complications
Renal, hematological, Cardiovascular, Hepatic, CNS: high doses can cause sedation & decreased cognition in elderly |
|
|
Term
High risk patients
(consider gastroprotective therapy) |
|
Definition
| 60+y.o., prior PUD or GI Bleed, High dose or more toxic NSAIDs, concurrent corticosteriod, biphosphate, or SSRi use, anticoagulant use or coagulopathy, antiplatelet use (ASA, clopidogrel), chronic illness (CV disease) |
|
|
Term
|
Definition
| due to direct or topical irruption of gastric epithelium or systemic inhibition of endogenous GI mucosal prostaglandins synthesis |
|
|
Term
|
Definition
| toxicity is related to NSAID effects on renal prostaglandins that help to increase renal blood flow & maintain renal function |
|
|
Term
|
Definition
more pronounced in patients w/pre-existing renal disease
intersitial nephritis, hyperkalemia, hyponatremia & papillary necorsis have also been reported w/various NSAIDs |
|
|
Term
| risk factors of Nephrotoxicity |
|
Definition
| old age, CHF, renal insufficiency, ascites, volume depletion, diuretic therapy |
|
|
Term
|
Definition
| may prolong bleeding times due to anti-platelet effects |
|
|
Term
|
Definition
ASA inhibits platelet aggregation for the lifetime of the platelet (7-10 days)
other non-selective NSAIDs affect platelet aggregation to a lesser degree & only when the drug is "on board" |
|
|
Term
|
Definition
| do not affect iNR but do increase bleeding risk when used w/anticoagulants |
|
|
Term
|
Definition
| may increase CV risk, potential varies between NSAID subtypes |
|
|
Term
|
Definition
| selective Inhibition of COX-2 may decrease endothelial production of prostacyclin, which may vasoconstrictor, platelet aggregation, & throbosis |
|
|
Term
|
Definition
| Risk usually increases w/higher doses longer duration, & degree of COX-2 selectivity |
|
|
Term
|
Definition
| highest w/celecoxib>meloxicam>etodolac>NAPROXEN is the lowest |
|
|
Term
| NSAIDs inhibit ASA Antiplatelt effect |
|
Definition
| take non-enteric coated ASA 1 hr before Ibuprofen or naproxen )so it can bind to platelets 1st) |
|
|
Term
|
Definition
| NSAIDs may increase Blood pressure |
|
|
Term
|
Definition
| overall incidence is <0.1% with >300 hospitalizations/year |
|
|
Term
|
Definition
no clear link between chemical structures & risk
Histological type of injury varies within/between chemical classes
No consistent mechanism for liver injury from NSAIDs |
|
|
Term
|
Definition
help to protect GI mucosa
diclofenac/misoprostol (Arthotec)
lansoprazole/naproxen (Prevacid NapraPAC) |
|
|
Term
ASA Acetylated salicylate
indications: |
|
Definition
| mild to moderate pain, prevention of MI, CVA |
|
|
Term
ASA Acetylated salicylate
MOA |
|
Definition
Analgesic: inhibits PG synthesis, prevents formation of TxA2
Antipyretic: inhibition of hypothalamic heat-regulating center |
|
|
Term
ASA Acetylated salicylate
doses: |
|
Definition
| 325-650 mg q 4hrs (max 5400 mg/day) |
|
|
Term
ASA Acetylated salicylate
Adverse effects: |
|
Definition
| platelet inhibiton (for life of platelet), ASA sensitivity (asthma, bronchospasm, angioedema, urticaria) related to COX-1 inhibition, which decreases PG E2 production, increase leukotriene production and increases histamine release (not a TRUE allergy but can be significant), Reye's syndrome |
|
|
Term
|
Definition
| APAP, NSAIDs, Salicylates |
|
|
Term
|
Definition
analgesic
adverse effect-respiratory depression, mitosis, reduced gastric motility, sedation, euphoria, dysphoria, psychotomimetic effect |
|
|
Term
| Common major effects of Opioids |
|
Definition
| Drowsiness, N&V, constipation (does NOT wane, remains constant), pruritis |
|
|
Term
| Severe major effects of Opioids |
|
Definition
Decreased respiratory rate
greater concern w/COPD, cor pulmonale, decrease respiratory reserve, pre-existing resp. depression, general anesthetics, phenothiazines, barbituates, TCA's, CNS depressants |
|
|
Term
Opioid & receptor activity
Agonist |
|
Definition
| maximal biologic response through binding to the opioid receptor |
|
|
Term
Opioid & receptor activity
partial agonists |
|
Definition
| submaximal response at the receptor even at high doses |
|
|
Term
Opioid & receptor activity
agonist/antagonists |
|
Definition
divergent activities at different receptors (mixed)
-analgesic ceiling
-ceiling effect on respiratory depression
-lower abuse potential
-can precipitate w/drawl in patients who are dependent on full agonist (use to be on agonist & now switched) |
|
|
Term
Opioid & receptor activity
Antagonist |
|
Definition
| reverse or inhibit the effects of agonists by preventing receptor access |
|
|
Term
|
Definition
severity & type of pain
duration of expected treatment
duration of action necessary
route of administration
pt adherence/ability to self dose
allergies or intolerance
concomitant meds
cost |
|
|
Term
Opioid withdrawl symptoms
minor |
|
Definition
Rhinorrhea
lacrimation
excessive yawning
mild irritability or restlessness
mild N&V |
|
|
Term
Opioid withdrawl symptoms
Moderate |
|
Definition
increasing restlessness or irritability
tremors
ab craoms
anxiety
persisitent N&V
increased HR, BP, hot or cold flashes, fever |
|
|
Term
opioid intolerance & allergy management
pseudoallergy |
|
Definition
flushing itching, sweating, mild hypotension
OPTIONS- non opioid (NSAID, APAP), avoid commonly associated opioids (codeine, morphine, meperidine), use more potent Opioids that release less histamine, if needed use diphenhydramine |
|
|
Term
opioid intolerance & allergy management
true allergy |
|
Definition
nonopioid analgesic (NSAID, APAP)
opioid in a different chemical class w/close monitoring |
|
|
Term
|
Definition
| caffeine, hydroxyzine, corticosteriod |
|
|
Term
|
Definition
dose 65-200 mg
may enhance analgesic effect of APAP, ASA, or ibuprofen |
|
|
Term
|
Definition
Anti-histamine dose 25-50 mg
may add to analgesic effect of opioids in post operative & cancer pain while reducing the incidence of N&V |
|
|
Term
|
Definition
| can produce analgesia in some patient w/inflammatory diseases or tumor infiltration of nerves |
|
|
Term
| 4 types of persistent pain |
|
Definition
pain persisting beyond the normal healing time for a disease or injury
pain related to chronic degenerative disease or neurologic condition
pain that emerges or persists w/out an identifiable cause
cancer pain |
|
|
Term
| signs or symptoms of persistent pain |
|
Definition
| DEPRESSION, ANXIETY, SLEEP DISTURBANCES, frustration, anger, low self esteem, low involvement in social activities, financial stresses & conners, decreased libido, work issues, inactivity, altered family dynamics, frequent use of meds, legal issues, increase # of Dr visists |
|
|
Term
|
Definition
increase tolerance for physical activity
decrease suffering & pain
decrease reliance on the health care system
decrease reliance on meds
return to work or function in society
develop appropriate strategies for self-management |
|
|
Term
|
Definition
simultaneously address the various components of the problem
taper use of inappropriate meeds while initiation appropriate therapy
provide education about chronic pain, correct misconceptions
focus on increase function & physical activity
establish a time frame for achieving specific goals
remind your patient & yourself that chronic pain isn't the same as acute pain
emphasize the mulitfactorial nature of chronic pain & avoid the distinction between physical & psychological causes |
|
|
Term
persistent pain treatment options
nonpharmacologic |
|
Definition
|
|
Term
persistent pain treatment options
pahrmacologic |
|
Definition
non-opioids (APAP, NSAIDs good for bone pain)
tramadol, opioids, adjuvant analgesics (TCAs, AED, SNRI, SSRIs) |
|
|
Term
|
Definition
titrate dose w/scheduled regular release products
use regular release products prn for breakthrough pain
consider sustained release when adequate dose is established
3guidelines chronic Opioid noncancer pain=suggest assessing for substance abuse, get informed consent, & use Opioid contract |
|
|
Term
|
Definition
antidepressant, anticholinergic effects (antiSLUD)
sedative onset 2wks |
|
|
Term
|
Definition
|
|
Term
|
Definition
| potent inhibitor of NE, 5-HT reuptake,antidepressant indicated for DM neuropathy & chronic MS pain & OA pain |
|
|
Term
|
Definition
| antidepressant, increase 5-HT in CNS, less effective, less sedative than TCAs |
|
|
Term
|
Definition
pain in #1 reason patents seek medical advice
accurate assessment is 1st step in adequate pain management
selection of med should be based on type, severity, & individual patient characteristics
dose titration or change of med is indicated if pain management is unsatisfactory
monitoring of analgesic therapy efficacy is essential for adequate pain management |
|
|
Term
| Rheumatiod arthritis (RA) |
|
Definition
Chronic autoimmune disorder
most common systemic inflammatory disease characterized by symmetrical joint involvement |
|
|
Term
| RA extra-articular involvement may include: |
|
Definition
Rheumatiod nodules
vasculitis
eye inflammation
neurologic dysfunction
cardiopulmonary disease
lymphadenopathy
splenomegaly |
|
|
Term
|
Definition
affects 1-2% adults
3x more females, no racial predilections
genetic predisposition & exposure to unknown environmental factors may be needed for expression |
|
|
Term
|
Definition
chronic inflammation of synovial tissue-proliferation-pannus (inflammed, proliferating synovium) which invades cartilage/bone surface-erosions of bone/cartilage-destruction of joint
*factors that initiate the inflammatory process are unknown & joint damage as soon as 2 years post onset of RA |
|
|
Term
| clinical presentation of RA |
|
Definition
insidious onset over several weeks to months
prodromal sx:fatigue, weakness, low-grade fever, loss of appetite, joint pain
stiffness & muscle aches may proceed joint swelling
joint involvement usually symmetrical, involving small joints of hands, wrists & feet
most patients disease wax & wanes in spite of treatment-resulting in progressive joint destruction, deformity, disability, & even premature death |
|
|
Term
functional classes of RA
Class I |
|
Definition
| capable of all activities w/out handicap |
|
|
Term
functional classes of RA
Class II |
|
Definition
| able to conduct normal activities despite handicap of discomfort or limited mobility of one or more joints |
|
|
Term
functional classes of RA
class III |
|
Definition
| functional capacity only adequate to perform a few of the normal duties of usual occupation |
|
|
Term
functional classes of RA
Class IV |
|
Definition
| confined to bed or wheelchair, capable of little or no self-care |
|
|
Term
|
Definition
prevent or control joint damage
prevent loss of function
decrease pain & inflammation of joints |
|
|
Term
complete remission of RA is not frequently achieved
treatment goals than become |
|
Definition
control disease activity
decrease pain
maintain daily function
maximize quality of life
adequately educate the patient about their disease & its treatment |
|
|
Term
|
Definition
rest
OT/PT
Patient ed
use of assistive devices
weight reduction
surgery
patient support group |
|
|
Term
|
Definition
| NSAIDS, DMARDs, Methotrexate (MTX), Leflunomide (Arava), Minocycline (Minocin), Hydroxychloroquine (plaquenil), Sulfasalazine (Azulfidine) |
|
|
Term
|
Definition
often initial drug therapy for RA
given at full anti-inflammatory doses
decrease joint inflammation & pain
improve joint function
does NOT prevent joint destruction or slow disease progression, should not be used solo
AE-GI, CV, hepatotoxicty & renal toxicity, antiplatelet effects (ASA & nonselective NSAIDS)
*patients w/RA 2x likely to have serious complications from NSAIDs than w/OA
Nonselective NSAID alternatives: nonacetylated salicylate, COX2I, NSAID+gastroprotective agent (PPI or Misoprostil) |
|
|
Term
| Disease-modifying Antirheumatic Drugs (DMARDs) |
|
Definition
Often selected as initial therapy especially in patients whose RA is more active or severe
appropriate to use in ALL RA patients
recommended to start w/in 3 mos of dx in patients who continue to have signs, sx, or disease progression despite adequate treatment w/NSAIDs
also w/patients not currently being treated but have signs, sx, or disease progression, in order to prevent or delay further joint damage
DMARDs can reduce or prevent joint damage & preserve joint integrity & function
DMARD choice depends on relative efficacy, convenience of administration, monitoring, cost, time to benefit |
|
|
Term
|
Definition
| effective slows disease progression, low toxicity, & cheap |
|
|
Term
|
Definition
| folic acid antagonist, may affect immune funciton |
|
|
Term
|
Definition
| stomatitis, N/D, alopecia, elevated LFTs, low risk of liver toxicity, thrombocytopenia, leukopenia, rare pulmonary & lymphoproliferative toxicity |
|
|
Term
|
Definition
| do not use in pregnant or nursing women |
|
|
Term
|
Definition
| LFT monitoring in necessary, also CBC, caffeine>180mg/day may decrease effectiveness of MTX for RA |
|
|
Term
|
Definition
alternative to MTX, for patients who don't tolerate or respond to MTX
as effective as MTX at reducing disease activity & progression |
|
|
Term
|
Definition
| inhibits pyrimidine synthesis, resulting in antiproliferative & antiimflammatory effects |
|
|
Term
|
Definition
| elevated liver enzymes, hepatotoxicity, rare reports of severe infection, pancytopenia, agranulocytosis, & thrombocytopenia, may interact w/Warfarin increasing INR |
|
|
Term
|
Definition
| liver disease, viral hepatitis, severe immunodeficiency, obstructive biliary disease, inadequate birth control, & treatment w/rifampin (increase Leflunomide (Arava) levels) |
|
|
Term
|
Definition
ALT, platelet, WBC, & HmG or Hct monitored
Baseline, monthly for 6mos, then eve 6-8 weeks there after |
|
|
Term
|
Definition
| recommended for mild disease, early in disease (<6 months) w/low disease activity w/out poor prognostic features |
|
|
Term
|
Definition
unclear
thought to have antimicrobial anti-inflammatory, immunomodulatory & chondroprotective effects, thought to be a potent inhibitor of metalloproteinases (important mediators in RA joint damage) |
|
|
Term
|
Definition
| photosensitivity, GI upset, pseudomotor cerebri (benign intracranial HTN), abnormal pigmentation, vertigo, rare severe drug interaction (lupus like reaction) |
|
|
Term
Minocycline (Minocin)
note |
|
Definition
do not use in children <8, pregnant or nursing women 2ndary permanent tooth discoloration
Drug interactions: antacids, OCs, anticoagulants |
|
|
Term
| Hydroxychloroquine (Plaquenil) |
|
Definition
often chosen as an initial treatment, esp patients w/ less active or milder disease
treatment w/Hydroxychloroquine (Plaquenil) alone does not slow disease progression, but early treatment still has an impact on long term patient outcome |
|
|
Term
Hydroxychloroquine (Plaquenil)
MOA |
|
Definition
| Inhibits locomotion of neutrophils & chemotaxis of eosinophils:impairs complement-dependent antigen-antibody reactions |
|
|
Term
Hydroxychloroquine (Plaquenil)
AE |
|
Definition
Rash, diarrhea, abdominal cramps infrequently
increased risk of retinal toxicity if the dose exceeds 6gm/kg |
|
|
Term
Hydroxychloroquine (Plaquenil)
notes |
|
Definition
NO lab monitoring is necessary
periodic ophthalmic exams are necessary for early detection of reversible retinal toxicity |
|
|
Term
| Sulfasalazine (Azulfidine) |
|
Definition
| helps slow disease progression in patients w/RA & may work more quickly than hydroxychloroquine |
|
|
Term
Sulfasalazine (Azulfidine)
MOA |
|
Definition
| a pro-drug cleaved by bacteria in colon to metabolites thought to have anti-RA activity, however the exact mechanism is unknown |
|
|
Term
Sulfasalazine (Azulfidine)
AE |
|
Definition
Nausea, abdominal discomfort
Mostly occur in the 1st few months, can lessen by starting w/low dose & increase dose gradually |
|
|
Term
Sulfasalazine (Azulfidine)
Notes |
|
Definition
| periodic monitoring for Leukopenia is recommended; tell patients they may notice yellow/orange color of urine and/or skin |
|
|
Term
Sulfasalazine (Azulfidine)
Notes |
|
Definition
| periodic monitoring for Leukopenia is recommended; tell patients they may notice yellow/orange color of urine and/or skin |
|
|
Term
TNF-alpha Inhibitor
Biologic Agent |
|
Definition
|
|
Term
|
Definition
anti-inflammatory & immunosuppressive effects
used in RA bridging therapy, continuous low-dose therapy, short-term high dose bursts control flares
Local steroid injections are also effective, but the effects are temporary |
|
|
Term
|
Definition
| HTN, hyperglycemia, cataracts, skin fragility, fluid retention, weight gain, osteoporosis |
|
|
Term
| corticosteroid & osteoporosis risk |
|
Definition
a major concern w/the use of systemic steroids is the increased risk of developing osteoporosis
patients w/RA have an increased risk of osteoporosis that is independent of the risk due to steroids
recommend that patients taking steroids get 1,500 mg of elemental calcium per day (from diet & supplements) & 400-800 IU of Vit D per day
other options that should be considered are raloxifene (Evista) & antiresportive agents such as the biphosphonates (fosamax) |
|
|
Term
|
Definition
single DMARD is often inadequate to control symptoms or prevent disease progression
role of combo DMARD therapy continues to evolve
combo DMARD therapy can be used, consultation w/a rheumatologist is recommended
controversy remains about how to approach combo DMARD therapy |
|
|
Term
|
Definition
to prevent joint damage, early accurate diagnosis is key
corticosteroid are effective, but it is important to take precautions to prevent significant AE that can occur w/long term use
NSAIDs aren't effective in slowing disease progression, so shouldn't be monotherapy
DMARDs do slow disease progression& should be started w/in 3 oaths of dx in most patients |
|
|
Term
| typical nonbiological DMARDs therapy |
|
Definition
Methotrexate or leflunomide (all patients)
Minocyclince or hydroxychloroquine (mild disease)
Sulfasalazine (mild to moderate disease) |
|
|
Term
| typical biologic DMARDs treatment |
|
Definition
Anti-TNF alpha agents:etanercept, infliximab, adalimumab, adalimumab, golimumab
T-cell inhibitor (abatacept)
B-cell inhibitor (rituximab) |
|
|
Term
|
Definition
most common joint disease
ranks 2nd to CV diseases as a cause of severe, chronic disability |
|
|
Term
|
Definition
affects approximately 50% over 65 & almost 100% over 75
after 45 women are more commonly affected
Hip:women >men, Knee:women=men |
|
|
Term
|
Definition
| multifactorial, including obesity, occupation, participation in sports, history of joint trauma, genetic predisposition |
|
|
Term
|
Definition
chondrocyte fails to maintain the balance between cartilage formation & destruction
leads to loss of cartilage in the joint, local inflammation, pathological changes in underlying bone, & further damage to cartilage triggered by affected bone |
|
|
Term
| OA clinical presentation & course |
|
Definition
OA pain is worse w/use, relieved by rest
brief am stiffness & "gelling" of joints after rest are common
bony enlargement, crepitus on motion & limited joint motion can also develop
As OA progresses pain occurs w/minimal activity or at rest |
|
|
Term
|
Definition
| based on symptoms, physical exam, radiography |
|
|
Term
|
Definition
educate the patient
relieve pain & stiffness
maintain or improve joint mobility
limit functional impairment
maintain or improve QOL |
|
|
Term
|
Definition
patine ed
strengthening & ROM exercises(PT)
use of assistive devices (OT)
joint protection
weight loss as necessary
surgery |
|
|
Term
|
Definition
use in conjunction w/non-pharm therapy
current meeds don't change the course of the disease, use for symptom management |
|
|
Term
|
Definition
1st line therapy for mild to moderate pain
up to 4gm.day, reduce dose by 50-75% for renal or hepatic failure or EToH abuse |
|
|
Term
Acetaminophen for OA
advantages |
|
Definition
effective for mild to moderate pain
low risk for AE |
|
|
Term
Acetaminophen for OA
disadvantages |
|
Definition
not effective for pain associated w/inflammation
use w/caution for patient w/hepatic dysfunction |
|
|
Term
|
Definition
mild to moderate pain, no response to APAP & desire to avoid systems therapy or adjunct
capsaicin applied to symptomatic joint bid-qid |
|
|
Term
OA topical capsaicin
advantages |
|
Definition
| avoids systemic side effects |
|
|
Term
OA topical capsaicin
disadvantages |
|
Definition
| local irritation (burning sensation), delayed response (up to 2wks), non-adherence |
|
|
Term
OA topical capsaicin
MOA & Note |
|
Definition
releases & depletes substance P from afferent nociceptive nerve fibers
topical NSAIDs:ibuprofen (compounded); diclofenac gel solution, or patch recommended by AAOS for patients w/increased GI risk |
|
|
Term
| OA Glucosamine sulfate +/- Chondroitin |
|
Definition
500 mg po tid (eval effect after 8-12 wks)
consider for symptom improvement before initiation of NSAIDs: mixed trial results, try 8-12 wks & DC if no improvement |
|
|
Term
OA Glucosamine sulfate +/- Chondroitin
disadvantages |
|
Definition
| potential for allergic reaction in patients w/shellfish allergy, may cause GI upset & nausea |
|
|
Term
|
Definition
moderate to severe pain, no response to APAP
advantage-effective for moderate to severe pain |
|
|
Term
OA nonselective NSAIDs
disadvantages |
|
Definition
GI S/E, renal dysfunction
precautions:
Warfarin increase risk of bleeding (NSAIDs do NOT change INR)
Diuretics, ACE-I, ARB. decrease the effect
Lithium increases Li levels
INdomethacin: long term use in hip OA may be associated w/accelerated joint destruction in the setting, avoid! |
|
|
Term
|
Definition
moderate to sever pain, no response to APAP, alternative to nonselcetive NSAIDs due to AE or drug interaction
500-750 mg bid, Choline magnesium trisalicylate 500-750 mg tid |
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Term
OA NONsalicylates
advantages |
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Definition
effective for moderate to severe pain
less risk of GI toxicity compared to NSAIDs
do not affect platelet aggregation |
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Term
OA NONsalicylates
disadvantages |
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Definition
potential for GI adverse effects, renal disfunction
use w/caution for patients w/renal failure, CHF, HTN |
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Term
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Definition
moderate to severe pain, no response to APAP, AE or high risk of AE w/nonselective NSAIDs: consider patients w/high GI & low CV risk
Celecoxib 100 mg bid or 200 mg qd |
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Term
OA COX 2 inhibitor
advantages |
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Definition
effective for moderate to severe pain
less risk of GI toxicity compared to NSAIDs
do not affect the platelet aggregation |
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Term
OA COX 2 Inhibitor
disadvantages |
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Definition
potential for GI AE, renal dysfunction
use w/caution for patients w/renal failure, CHF, HTN
Celecoxib CI w/allergy to sulfa-containing products
possible increased risk of CV events, do NOT exceed 200 mg/day
drug interactions: Warfarin may increase INR, ACE-I, ARBS, diuretics, lithium |
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Term
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Definition
moderate to severe pain, no response, AE or CI to APAP, NSAIDs, & COX 2 I
50-100 mg q4-6hr (max 400 mg/day: >75yo 300mg/day) |
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Term
| OA tramadol disadvantages |
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Definition
sedation, confusion, urinary incontinence, seizures
Adjust the dose to q12hrs for CrCl<30 ml/min (max 200 mg/day) |
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Term
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Definition
| moderate to severe pain, no response, AE or CI to APAP, NSAIDs, COX2 I, & tramadol |
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Term
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Definition
constipation, seadtion, confusion
Propoxyphene NOT recommended due to lack of efficacy & potential for AE
Meperdine NOT recommended due to normeperidine accumulation in the elderly |
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Term
| OA intraarticular Glucocorticoids |
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Definition
adjunctive therapy
various doses methylprednisolone 4-80 mg based on side of joint q1-5weeks |
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Term
OA intraarticular Glucocorticoids
advantages/disadvantages |
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Definition
ad-effective for knee OA
disad-not studied in hip OA |
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Term
| OA intraarticular Hyaluronic acid |
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Definition
moderate to severe pain, no response, AE or CI to APAP, NSAIDs, & COX 2I, not a candidate for intraarticular glucosteroids or surgery
Hyalgan 20 mg intra-articualr qweek x 5, synivisc 16mg intra-articular qweek x 3, Supartz 25mg intra-articular qweek x 5 |
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Term
OA intraarticular hyaluroinc acid
Advantages/disadvantages |
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Definition
ad- duration of relief may last up to 6months
disad- delayed onset of action, not approved for hip OA, some clinical trial results similar to placebo, use w/caution w/allergies to avian products, feathers, or egg products |
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Term
OA alternative therapy
Duloxetine (Cymbalta) |
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Definition
Consider if analgesics aren't sufficient & theres current depression
now indicated for chronic musculoskeletal pain 2ndary low back pain & OA
start 30 mg/day x 1week to decrease nausea, don't exceed 60 mg/day for pain (higher doses do not improve efficacy but increase S/E) |
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Term
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Definition
OA is most common joint disease
treatment should always include nonpharm
pharm therapy should be selected based on severity of joint pain & patient characteristics |
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Term
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Definition
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