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44 Cards in this Set

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What is the definition of osteoarthritis?
failure of a movable synovial-lined joint due to thinning of joint surface, weakening and splitting of cartilage
What are the 2 classifications of osteoarthritis?
• Primary: no predisposing factor present
• Secondary: due to another cause (ex. trauma, congenital, metabolic, rheumatoid arthritis)
What are risk factors for osteoarthritis?
• Age (#1)
• Females
• Obesity
• Occupation
• Physical trauma
• Race (Hispanic & Blacks > Whites)
What are signs and symptoms of osteoarthritis?
• boney enlargement
• crepitus on motion
• limited joint movement
• pain (early: pain is localized; late: pain is at rest)
• radiographic evidence (ex. moderate narrowing of joint space; deformity)
• stiffness (esp. in the morning)
What are treatment goals for patients with osteoarthritis?
• reduce pain
• maintain or improve joint motion
• minimize decline
• non-pharmacological
What is the DOC for osteoarthritis?
Tylenol (Acetominophen)
What is the MOA of Tylenol?
inhibits the synthesis of prostaglandins in the CNS & peripherally blocks pain impulse generated
What is the starting and max dose for Tylenol for patients with osteoarthritis?
• starting dose: 500 mg PO BID
• max dose: 4 grams per day (2 gms PO BID)
How do you dose adjust Tylenol for patients with renal or hepatic impairment or a history of alcohol abuse?
• reduce dose by 50-75%

* reduce dose more for hepatic impairment
What are advantages and disadvantages for acetominophen?
• Advantages: effective for mild to moderate pain
• Disadvantages: not effective for pain associated w/ inflammation; must monitor INR with high doses
True/False: Celebrex can be used in the treatment for acute MI because of its anti-platelet effects
• COX2 inhibitors (like Celebrex) have no effect on platelets
• The correct answer is: False
What is the dosing for Celebrex for acute pain and for chronic pain of osteoarthritis?
• Acute pain: 400 mg PO
• Chronic pain for osteoarthritis: 200 mg PO BID
What is the MOA and uses of Tramadol (Ultram)?
• MOA: binds to Mu receptors in the CNS causing inhibition of ascending pain pathways
• used for moderate to severe pain
What is the dosing for Tramadol (Ultram)?
• 50-100 mg Q6-8hrs PRN
• Max: 400 mg/day ; age > 75, 300 mg/day
What are side effects of Tramadol (Ultram)?
SUCS

• sedation
• urinary incontinence
• confusion
• seizures
What class of drugs can be used for moderate to severe pain in osteoarthritis?
opiods (codeine, morphine)
What are the 2 most common intrarticular glucocorticoids?
• Triamcinolone (Kenalog 40)
• Methylprednisilone-Long acting (Depo-Medrol)
Intrarticular glucocorticoids are most effective in what joint?
knee
True/False: Intrarticular glucocorticoids are good for only short-term relief
The correct answer is: True
What are topical agents that can be used to treat osteoarthritis?
• Aspirin creamm
• Capsaicin
• Ibuprofen (topical form)
• Methylsalicilate (Ben-Gay)
List 2 examples of Intrarticular Hyaluronic Acid and their dosages
• Hyalgan 20 mg IA (1 shot every week for 5 weeks)
• Synvisc 25 mg IA (1 shot every week for 3 weeks)

* used for moderate to severe pain
What is an herbal product used to treat osteoarthritis?
Glucosamine/Chondritin
What are adverse effects of Glucosamine/Chondritin?
• GI upset
• hyperglycemia
What is the usual dose of Glucosamine/Chondritin?
500 mg PO TID
What is Rheumatoid Arthritis?
• chronic systemic inflammatory disorder characterized by symmetrical joint involvement
• results in cartilage destruction and erosion, as well as joint deformity
What is the pathogenesis of rheumatoid arthritis?
• hyperplasia and hypertrophy of synovial lining
• cytokines contribute to inflammatory process
How do patients with rheumatoid arthritis clincally present?
• Subjective: prodrome, morning stiffness, myalgias, symmetric joint involvement

• Objective: joint deformities (hand, wrist, feet, ankles, knees)
What are lab findings in patients with rheumatoid arthritis?
• can have anemia of chronic disease
• increased ESR
• positive rheumatic factor
What are diagnostic criteria for rheumatoid arthritis?
• morning stiffness > 1 hr
• arthritis in 3 or more joints
• positive rheumatic factor
• symmetric arthritis
What are classes of drugs that are used for rheumatoid arthritis?
• NSAIDS
• DMARDS (Disease-modifying antirheumatic drugs)
• corticosteroids
What drug class is used as 1st line treatment for rheumatoid arthritis?
NSAIDS (Aspirin is gold standard)
What is the max dose of aspirin for a patient with rheumatoid arthritis?
5 gms per day
What drug can be given for prevention of NSAID ulcers?
• Misoprostol (Cytotec)
• a PG-E analogue
What is dosage and adverse effects of Misoprostol (Cytotec)?
• Dose: 100-200 mcg QID
• ADE: diarrhea
True/False: DMARDs have a slow onset of action
• DMARDs have a slow onset of action and should be initiated quickly upon diagnosis
• The correct answer is: True
List examples of DMARDs
• 1st line agents
- Methotraxate
- Gold
- Hydroxychloroquine (Plaquinel)

• 2nd line agents (SAP)
- Sulfasalazine
- Azathioprine (Imuran)
- Penicillamine
What is the dosing for Azathiorprine (Imuran)?
50 mg BID
Which of the DMARDs is an anti-metabolite?
Methotrexate
What are contraindications, adverse effects, and dosing of Methotrexate?
• CI: pregnancy, chronic liver disease
• ADE: anemia, GI, increased LFTs
• Dose: 7.5 mg PO per week OR 2.5 mg sub-q (M,W,F)
What are contraindications and adverse effects of gold?
• CI: renal disease, blood dyscrasias
• ADE: metallic taste, dermatologic effects
What is the name of the oral and IM forms of gold? what are their dosages?
• Oral: Auranofin 3 mg BID
• IM: Aurothioglucose (Solganol) 25 mg per week
What are adverse effects and dosage for Hydroxycholorquine (Plaqeunil)?
• AE: GI, night blindness
• Dose: 200-400 mg/day
What are adverse effects of corticosteroids?
• cataracts
• gastritis
• hyperglycemia
• infections
• osteoporosis
Give an example of a topical anesthetic used to treat pain from rheumatoid arthritis
Lidocaine patch (Lidoderm)