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Flashcards in Rheum- OA Deck (27)
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1
Q

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

A

Primary (idiopathic) OA

2
Q

What are the 4 possible causes of Secondary OA?

A
  • Rheumatoid or another inflammatory arthritis
  • Trauma
  • Metabolic or endocrine disorders
  • Congenital factors
3
Q

S/s of what?

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

Osteoarthritis

4
Q

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

A

Heberden’s nodes (distal joint)

Bouchard’s nodes (proximal joint)

5
Q

What is the primary objective of medication therapy for OA?

A

pain relief

6
Q

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

A
  • increased joint fluid
  • microfracture
  • periosteal irritation
  • damage to ligaments, synovium, or the meniscus
7
Q

What are the 3 non-pharmacologic options for OA?

A

Exercise

Weight loss

Education

8
Q

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

A

Acetaminophen

9
Q

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

A

Tramadol

Duloxitene

NSAIDs

Narcotics (in selected cases)

10
Q

Tx of OA:

Why is immobilization bad for joint health?

A

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

11
Q

Pharmacologic tx of OA:

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

A
  • misoprostol
  • proton pump inhibitor
  • H2 antagonist
  • COX-2-specific NSAID (coxib)
12
Q

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

A

Corticosteroid injections

Hyaluronic acid injections

13
Q

What 2 meds do you give if Acetaminophen fails?

A

Topical or oral NSAIDs (topical over knee, hands)

Topical Capsaicin

14
Q

OA treatment:

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

A

Ketoprofen

15
Q

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

A

Oral NSAIDs or Celecoxib (COX-2 inhibitor)

(only after careful risk assessment)

16
Q

Duloxetine is primarily effective as ____ therapy for OA

A

add-on

17
Q

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

A

Without underlying hepatic disease

18
Q

T/F: No NSAID has proven superior to another

A

True

19
Q

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

A

GI, Renal, and Cardiovascular events

20
Q

OA tx:

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

A

PPIs and misoprostol

21
Q

Treatment of OA:

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

A

Naproxen

(non-selective NSAID)

22
Q

Which 2 toxicities are reported for all NSAIDs?

A

Nephrotoxicity

Hepatotoxicity

23
Q

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

A
  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
Q

When are NSAIDs contraindicated?

A

renal impairment

25
Q

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

A
  1. Use the Nonacetylated salicylates (Choline salicylate and trisalicylate?)
  2. COX-2 Selective inhibitors
  3. Add Misoprostol or PPI
26
Q

RA is MC in which 2 regions?

A

Feet and hands

27
Q

OA is MC in what 4 regions?

A
  • neck
  • low back
  • hips
  • knees