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22 Cards in this Set
- Front
- Back
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What are the goals of therapy for OA?
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Relieve pain and stiffness
Maintain joint mobility Limit functional impairment Maintain/Improve QOL |
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What is first line therapy for OA?
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Acetaminophen
Could use Ibuprofen/Naproxen, but ideally you want to try acetaminophen first Tramadol is typically an add-on or used if acetaminophen and NSAIDs fail or if these are contraindicated. |
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What are some add-on therapies to acetaminophen?
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Capsaicin (Topical)
Methylsalicylate (Topical - Not best efficacy) Glucosamin/Chondoitin (Does actually show efficacy) |
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What are some important things to tell the patient about Capsaicin?
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Be careful not to touch eyes
Side effects are burning and irritation Takes about 2 weeks to begin working Use 2-4 times daily |
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What are some important things to tell the patient about Glucosamine/Chondroitin
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Be careful if you have a shellfish allergy
May take a while to begin working |
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How do you monitor for efficacy and toxicity in acetaminophen therapy?
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Efficacy - Pain
Toxicity - Hepatotoxicity |
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What do you want to counsel a patient on who is taking acetaminophen?
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Max dose = 4 g per day, 2 g per day if you drink alcohol
Limit to 3 alcoholic drinks Avoid other medications with acetaminophen in them Give 2-3 weeks to adequately assess effect. |
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What non-pharmacological treatment do you want to recommend someone with OA?
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Weight reduction
PT/OT - Heat/Cold Treatments, Exercise Program |
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If the patient isn't responding to acetaminophen, what would be your next option?
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Ibuprofen or Naproxen
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When starting an NSAID like Ibuprofen or Naproxen, what types of things are you concerned about?
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PUD/GI Intolerance
ASA/NSAID Allergy CHF, Renal and Hepatic Dysfunction History of Bleeding Pregnancy (Category C, D in 3rd trimester) Concomitant Medications (Lithium, Anti-coagulants, Anti-platelets, Anti-hypertensives) |
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What types of patients are at an increased risk for bleeding?
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Age > 65 yo
Comorbid conditions (CVD, Severe Illness Oral Glucocorticoids History of PUD/GI Bleed Anti-coagulant/Anti-platelet use |
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What types of patients are at an increased risk for renal toxicity?
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CHF
Severe Hepatic Disease Nephrotic Syndrome Advanced Age Concomitant Medications (Diuretics, ACE- Inhibitors, Cyclosporine, Aminoglycosides) |
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How do you want to monitor efficacy and toxicity a patient on NSAIDs?
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Efficacy - Pain relief
Toxicity Baseline labs (SCr, BUN, K) and in 1-2 weeks BP and in 1-2 weeks Edema, Weight Gain Nausea, Dyspepsia, Dark-tarry stools, abdominal pain |
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How would you counsel a patient taking an NSAID?
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Take with food
Side effects Give 2-3 weeks to see results |
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When would you want to give a PPI with an NSAID?
You could also use Celecoxib. When is Celecoxib not an option? |
If you concerned about a Gastric Bleed.
Sulfa allergies |
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How does monitoring of NSAID therapy change if the person is at risk for bleeding or renal toxicity?
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Efficacy - Pain relief
Toxicity Baseline (SCr, BUN, K) and 3-7 days later BP and 3-7 days later Edema/Weight Gain GI Bleed (CBC at baseline and yearly) Nausea, Dyspepsia, Abdominal Pain, Dark-tarry stools |
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Once acetaminophen and NSAIDs options have been exhausted, what other options do you want to consider
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Hyaluronic acid (if knees are involved)
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How do you monitor for a patient on Hyaluronic acid?
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Efficacy - Pain relief
Toxicity - Acute joint swelling, Local skin reactions |
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If the patient has OA in a spot other than their knees, what would you want to go with?
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Intraarticular CS Injection
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How would you monitor for Intraarticular CS Injection?
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Efficacy - Pain relief
Toxicity - Infection of the joint, Tendon rupture, Skin atrophy, Osteonecrosis Systemic side effects more rare because it is a local injection. |
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What patient education would you provide?
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Minimize activities for several days after injection
Can take up to 72 hours to see relief Limited to 3-4 injections per year You should see it wear off in 4-8 weeks |
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What dosing do we have to know?
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Acetaminophen (325 mg every 4-6 hours)
Ibuprofen (400 mg po tid) Naproxen (250 mg po bid) |
