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Flashcards in Rheum- OA Deck (27)
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1

Is primary (idiopathic) OA or secondary OA more common?

Primary (idiopathic) OA

2

What are the 4 possible causes of Secondary OA?

•Rheumatoid or another inflammatory arthritis

•Trauma

•Metabolic or endocrine disorders

•Congenital factors

3

S/s of what?

  • Joint pain/tenderness
  • Decreased ROM
  •  Weakness
  • Joint instability
  • Disability
     

Osteoarthritis

4

What is the name of the 2 classic physical exam findings of OA?

Heberden's nodes (distal joint)

Bouchard's nodes (proximal joint)

5

What is the primary objective of medication therapy for OA?

pain relief

6

Pain from OA may result from distention of the synovial capsule caused by what 4 things?

  • increased joint fluid
  • microfracture
  • periosteal irritation
  • damage to ligaments, synovium, or the meniscus

7

What are the 3 non-pharmacologic options for OA?

Exercise

Weight loss

Education

8

What med is used initially for pain relief in knee and hip OA?

Acetaminophen

9

Other than Acetaminophen, what other 4 simple analgesics can be used in OA?

Tramadol

Duloxitene

NSAIDs

Narcotics (in selected cases)

10

Tx of OA:

Why is immobilization bad for joint health?

Movement allows nutrients to flow into the cartilage whereas immobilization reduces nutrient supply

11

Pharmacologic tx of OA:

Nonselective NSAIDs for patients at low risk for GI complications; Otherwise, consider addition of what 4 meds? 

  • misoprostol
  • proton pump inhibitor
  • H2 antagonist
  • COX-2-specific NSAID (coxib)

12

Which two intra-articular injections are alternative first line tx for both knee and hip in OA?

Corticosteroid injections

Hyaluronic acid injections

13

What 2 meds do you give if Acetaminophen fails?

Topical or oral NSAIDs (topical over knee, hands)

Topical Capsaicin 

14

OA treatment:

If Acetominophen fails, What medication is recommended for patients older than 75 to decrease the risks of systemic toxicity?

Ketoprofen 

15

What 2 meds should you give patients w/ OA if Acetaminophen, topical NSAIDs, Topical Capsaicin and Ketoprofen all fail?

Oral NSAIDs or Celecoxib (COX-2 inhibitor)

(only after careful risk assessment)

16

Duloxetine is primarily effective as ____ therapy for OA

add-on

17

Although Acetaminophen may be modestly less effective than NSAIDs in the tx of OA, a trial is favored in all patients without underlying _____ disease in the tx of knee and hip OA

Without underlying hepatic disease

18

T/F: No NSAID has proven superior to another

True

19

NSAIDs pose a higher risk for what 3 adverse events in comparison to Acetaminophen

GI, Renal, and Cardiovascular events

20

OA tx:

Which 2 meds significantly reduce the occurance of GI adverse events in those taking NSAIDs

PPIs and misoprostol

21

Treatment of OA:

What is the NSAID of choice in patients with high cardiovascular risk?

Naproxen

(non-selective NSAID)

22

Which 2 toxicities are reported for all NSAIDs?

Nephrotoxicity 

Hepatotoxicity

23

What are the top 3 ADEs of NSAIDs and how do you monitor?

1. Ulcers or bleeding- monitor w/ CBC
2. liver failure (rare)- monitor w/ hepatic transaminase levels

3. Renal insufficiency, renal failure, hyperkalemia - monitor w/ SrCr

24

When are NSAIDs contraindicated?

renal impairment

25

What are 3 ways you can reduce risk of GI toxicity associated w/ NSAIDs?

1. Use the Nonacetylated salicylates (Choline salicylate and trisalicylate?)

2. COX-2 Selective inhibitors

3. Add Misoprostol or PPI

26

RA is MC in which 2 regions?

Feet and hands

 

27

OA is MC in what 4 regions?

  • neck
  • low back 
  • hips 
  • knees