Term
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Definition
| disease of localized joints associated with deterioration of cartilage & 2ndary changes in underlying bone; causes pain & impairs fcn; leads to joint pain, stiffness, swelling; most common arthritic disorder; prevalence increases with age; more common in men <45 yrs old but more common in women >45 yrs old |
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Term
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Definition
| cartilage water content increases --> changes glycosaminoglycans leading to loss of proteoglycans, reducing proteoglycans aggregates; Result: destruction of cartilage, structural changes in bone; Consequences: pain, decreased functioning & mobility |
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Term
| Clinical Presentation of OA |
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Definition
| PAIN: dull, aching, with joint activity; joint stiffness (in AM, lasts 30 min); inflammation (localized to affected joint); Rest relieves pain, movement relieves stiffness; Heberden's nodes - bony enlargements of DIP & PIP joints; Loss of range of motion; Joint tenderness; crepitus; Affects knees, hip, DIP, PIP, lumbar vertebrae |
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Term
| Risk Factors for Developing OA |
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Definition
| obesity; repetitive joint stress, overuse; trauma to joint, loss of ligament integrity, damage to meniscus; Age (>50 yrs); family hx; Usually does not occur in pts w/ osteoporosis |
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Term
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Definition
| relieve pain & joint stiffness; maintain and/or improve joint mobility; limit functional impairment; minimize ADRs of therapy; Maintain or improve pts quality of life; Educate pt, family, caregivers |
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Term
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Definition
| Patient education; Social support services; Weight loss; Aerobic & muscle strengthening exercises; Heat/cold therapy; Weight loss; Physical therapy; Provide assistive ambulatory devices (canes, crutches); Occupational therapy; Surgery - severe pain refractory to convetional therapy |
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Term
| acetaminophen (APAP, Tylenol) |
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Definition
| 1st line analgesic; Tx of mild-moderate pain of OA; MoA: acts in CNS, inhibits prostaglandin synthesis; Dose: 325-650 mg q4-6 hrs or 1000 mg 3-4x/day, MAX = 4 g/day; Take on scheduled basis (NOT PRN); Avoid if chronic EtOH abuse (MAX = 2.5 g/day); D-D interactions: warfarin (monitor INR); Monitor: LFTs, renal fcn |
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Term
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Definition
| MoA: inhibits prostaglandin synthesis; Dose: 325-650 mg q4-6 hrs, MAX = 3.6 g/day; ADRs: GI upset (Take w/ food, or EC), tinnitus (sign of toxicity); Precautions: anticoagulant tx, GI bleed, liver dx; Monitor: CBC, LFTs |
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Term
| NSAIDs - ibuprofen [Advil, Motrin], naproxen [Aleve, Naprosyn], nabumetone [Relafen], diclofenac [Voltaren], meloxicam [Mobic] |
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Definition
| MoA: inhibit prostaglandin synthesis thru inhibition of COX-1 & COX-2; ADRs: GI effects (nausea, dyspepsia, abd pain), duodenal & gastric ulceration (Take with food to minimize); Precautions: renal dx, GERD, PUD, HF; D-D ix: anticoagulants, ASA, other similar drugs, ACE-Is, ARBs, Li; Monitor: CBC, LFTs, renal fcn |
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Term
| Risk Factors for GI events 2ndary to NSAIDs |
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Definition
| age >65 yrs; comorbidities; oral glucocorticoids; history of PUD; hx of upper GI bleed; Pt on Anticoagulants; Length of time on drug, high doses |
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Term
| naproxen [Aleve, Naprosyn] |
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Definition
| 250-500 mg BID; MAX = 1500 mg/day |
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Term
| ibuprofen [Advil, Motrin] |
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Definition
| 400 mg TID - 800 mg QID; MAX = 4 g/day |
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Term
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Definition
| 50 mg BID-TID/day; MAX = 200 mg/day |
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Term
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Definition
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Term
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Definition
| 500 - 1,000 mg qdaily-BID |
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Term
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Definition
| 100 mg BID - 200 mg daily; MoA: inhibits COX-2 enzyme only; Tx: moderate-severe pain, less GI toxicity does not afect platelet aggregation; Monitor: CBC, renal fcn, liver fcn, BP; Concern regarding CVD; Caution: sulfa allergy |
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Term
| Strategies to prevent GI bleeds when using NSAIDs |
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Definition
| take w/ food; use COX-2 inhibitor or more COX-2 selective NSAID (meloxicam, nabumetone, etodolac); Monitor CBC yearly; Use NSAID in combo w/ GI protective med (PPI, misoprostol) |
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Term
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Definition
| derived from hot peppers; MoA: inhibits release of substance P in periphery, decreases transmission of painful stimuli; ADRs: burning, stinging, erythema at site; Dose: Take 2-4 wks for max benefit, take regularly (Apply 2-4 times/daily) |
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Term
| glucocorticoids - methylprednisolone acetate (Medrol), triamcinolone hexacetonide |
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Definition
| intraarticular injection; effective for knee OA, local inflammation or joint effusion, SHORT TERM; Use infrequently (4-6 month intervals, no more than 3-4 injections/yr); Administer physician's office; short term pain relief, use as adjunct |
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Term
| intraarticular hyaluronic acid |
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Definition
| intraarticular injection; for moderate-severe pain w/ ADR or C/I to APAP, NSAIDs, & COX-2 inhibitors or unable to use glucocorticoids; MoA: provides lubrication & shock absorbency in joint, anti-inflammatory; Regimen: 20 mg weekly x 5 wks, 16 mg weekly x 3 wks, 30 mg weekly x 3 wks; Pain relief occurs slowly, lasts up to 6 months; Indication: OA of knee only; HIGH COST; ADRs: pain @ injection site, transient joint pain, swelling |
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Term
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Definition
| centrally acting analgesic, opioid-like; Dose: 50-100 mg q4-6 hrs, MAX = 400 mg/day, if >75 years old = 300 mg/day; ADRs: sedation, confusion, urinary incontinence, constipation; Dose adjusted to q12 hrs dosing if CrCl < 30 mL/min; abuse potential; Tx: moderate-severe pain if no response to APAP, NSAIDs, COX-2 inhibitors |
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Term
| narcotic/analgesic combos - propoxyphene/APAP (Darvocet), hydrocodone/APAP (Vicodin, Lortab) |
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Definition
| Tx: moderate-severe pain if no response/ADR/CI to APAP, NSAIDs, COX-2 inhibitors & tramadol; ADRs: constipation, dizziness, sedation, confusion; Avoid in elderly; Use low doses |
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Term
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Definition
| MoA: rebuild cartilage that is damaged, decrease cartilage loss, relieves OA sx, may slow dx progression, improves pain sx & functionality; Dose: 1500mg/1200 mg/day TID; ADRs: increases INR, GI upset, nausea; NOT FDA regulated |
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