Osteoarthritis Treatments Quiz
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Questions and Answers

Which of the following is NOT a topical treatment for osteoarthritis?

  • Diclofenac gel
  • Menthol
  • Capsaicin cream
  • Ibuprofen gel (correct)

What is the maximum daily dose of Diclofenac gel that can be applied to a single joint?

  • 16g (correct)
  • 8g
  • 20g
  • 12g

What is the mechanism of action of capsaicin cream?

  • Inhibits prostaglandin synthesis
  • Depletes substance P (correct)
  • Inhibits COX-2 enzymes
  • Increases local blood flow

What is the maximum recommended daily dose of acetaminophen?

<p>4g (A)</p> Signup and view all the answers

Which of the following is a potential adverse effect of Diclofenac gel?

<p>Pruritus (D)</p> Signup and view all the answers

Which of the following is NOT a recommended treatment for osteoarthritis?

<p>Antibiotics (C)</p> Signup and view all the answers

What is the recommended frequency of application for Diclofenac topical solution (Pennsaid) for knee osteoarthritis?

<p>Four times daily (B)</p> Signup and view all the answers

What is the mechanism of action of NSAIDs in the treatment of osteoarthritis?

<p>They inhibit the synthesis of prostaglandins (B)</p> Signup and view all the answers

Which of the following are potential risks associated with COX-2 inhibitors?

<p>Increased risk of cardiovascular disease (A), Increased cost of therapy (B), Same effects on renal function as NSAIDs (D)</p> Signup and view all the answers

What is the recommended duration for a trial of NSAIDs for pain?

<p>1-2 weeks (B)</p> Signup and view all the answers

Which of the following patients are at greatest risk for nephrotoxicity from NSAIDs?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is NOT a combination product that includes an NSAID?

<p>Celebrex (D)</p> Signup and view all the answers

What is the recommended frequency of monitoring serum creatinine (SCr) in patients taking NSAIDs?

<p>Every 3 months (A)</p> Signup and view all the answers

Which of the following agents is NOT an NSAID?

<p>Celebrex (D)</p> Signup and view all the answers

What is the recommended dose of Celebrex for osteoarthritis?

<p>100-200 mg orally daily or twice daily (D)</p> Signup and view all the answers

Which of the following is NOT a factor that increases the risk of adverse effects from NSAIDs?

<p>History of asthma (C)</p> Signup and view all the answers

What is the maximum daily dose of acetaminophen recommended for patients with osteoarthritis?

<p>3000 mg (D)</p> Signup and view all the answers

What is the recommended treatment for osteoarthritis?

<p>All of the above (D)</p> Signup and view all the answers

What is a potential adverse effect of NSAIDs?

<p>All of the above (D)</p> Signup and view all the answers

What is a possible way to reduce the risk of GI complications associated with NSAIDs like Mobic?

<p>All of the above (D)</p> Signup and view all the answers

What is the recommended starting dose for tramadol?

<p>25-50 mg every 4-6 hours (A)</p> Signup and view all the answers

What is the maximum recommended daily dose of tramadol?

<p>300 mg (B)</p> Signup and view all the answers

What is the recommended duration of treatment with Glucosamine/Chondroitin?

<p>3 months (A)</p> Signup and view all the answers

Which of the following is NOT a common adverse effect of tramadol?

<p>Gastrointestinal bleeding (B)</p> Signup and view all the answers

Which of the following is an appropriate treatment option for osteoarthritis, according to the provided text?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is considered a disease-modifying osteoarthritis drug (DMOAD)?

<p>None of the above (D)</p> Signup and view all the answers

Which of the following is NOT a potential adverse effect of glucosamine/chondroitin?

<p>Dizziness (C)</p> Signup and view all the answers

What is the primary mechanism of action of hyaluronate injections?

<p>Increase joint viscosity (A)</p> Signup and view all the answers

Which of the following is NOT a symptom of osteoarthritis in the knee?

<p>Red, swollen area around the knee (B)</p> Signup and view all the answers

Which of the following is a non-drug therapy option for osteoarthritis?

<p>Exercise and physical therapy (D)</p> Signup and view all the answers

What is the patient's name in the given case study?

<p>JD (D)</p> Signup and view all the answers

Which of the patient's conditions is a risk factor for osteoarthritis?

<p>Overweight (D)</p> Signup and view all the answers

What is NOT a goal of therapy for the patient's osteoarthritis?

<p>Increasing the patient's weight (C)</p> Signup and view all the answers

What is a common concern related to osteoarthritis treatment for the patient?

<p>She cannot afford treatment. (D)</p> Signup and view all the answers

What is the most likely reason the patient's right hand pain is worse after she does housework and uses the computer?

<p>She is using her right hand more. (D)</p> Signup and view all the answers

What type of therapy could be recommended for the patient's hand osteoarthritis?

<p>Topical creams and oral medications (B)</p> Signup and view all the answers

What are the clinical manifestations of osteoarthritis?

<p>Joint pain, morning stiffness, crepitus, and inflammation (A)</p> Signup and view all the answers

What is a common risk factor for osteoarthritis?

<p>Obesity (A)</p> Signup and view all the answers

Which of these joints is most commonly affected by osteoarthritis?

<p>Hip (C)</p> Signup and view all the answers

Which of the following statements accurately describes the pathophysiology of osteoarthritis?

<p>Degeneration of cartilage and bone within the joint, leading to pain and stiffness (B)</p> Signup and view all the answers

What is the most common joint-related disease in patients over 75 years old?

<p>Osteoarthritis (A)</p> Signup and view all the answers

What is the typical progression of osteoarthritis?

<p>Progressive joint pain and stiffness, with eventual disability (C)</p> Signup and view all the answers

A 55-year-old woman presents with joint pain and stiffness in her hands and knees. She also notes a crunching sound in her knees when she walks. What might these symptoms be indicative of?

<p>Osteoarthritis (B)</p> Signup and view all the answers

Which of the following is NOT a common risk factor for osteoarthritis?

<p>Regular exercise (B)</p> Signup and view all the answers

Flashcards

Osteoarthritis

A degenerative joint disease characterized by cartilage and bone destruction.

Incidence of Osteoarthritis

Osteoarthritis is more common in older adults, especially females over 75.

Joint Involvement

Commonly affects distal interphalangeal joints, hips, and knees.

Risk Factors

Factors include age, obesity, gender, trauma, and heredity.

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Clinical Manifestations

Symptoms include joint pain, morning stiffness, and inflammation.

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Herberden’s Nodes

Bony growths on the distal joints of fingers, indicative of OA.

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Bouchard’s Nodes

Bony growths on the proximal joints of fingers, related to OA.

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No Systemic Symptoms

Osteoarthritis usually does not cause systemic symptoms like fever.

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Joint Pain Symptoms

Common signs include tenderness, crackling sound, and swelling.

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Knee Osteoarthritis

A degenerative joint disease affecting the knee, causing pain and stiffness.

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Non-Drug Therapy

Treatments for osteoarthritis that do not involve medications.

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Drug Therapy for OA

Medications used for treating osteoarthritis pain, including topical and oral agents.

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JD's Profile

68-year-old female with joint pain, obesity, and diabetes in therapy.

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Goals of Therapy

To relieve pain and maintain joint function and strength.

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Hand Osteoarthritis

A type of osteoarthritis that affects the joints of the hands, leading to pain.

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Muscle Weakness

Reduced strength in leg muscles, often associated with knee pain.

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Mobic

A brand name for meloxicam, a NSAID used for pain relief.

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NSAIDs

Nonsteroidal anti-inflammatory drugs used to reduce inflammation and pain.

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PUD

Peptic Ulcer Disease, a history of stomach ulcers affecting treatment choice.

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GI complications

Potential gastrointestinal problems like ulcers or bleeding from NSAID use.

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Tylenol

Acetaminophen, a common over-the-counter pain reliever.

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Naproxen analgesic dose

Naproxen 220 mg every 8-12 hours.

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Naproxen anti-inflammatory dose

Naproxen 440 mg every 8-12 hours.

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NSAID adverse effects

Common risks include GI upset, ulcers, and renal dysfunction.

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Greatest risk for nephrotoxicity

Patients with CHF, HTN, renal dysfunction, or dehydration.

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Greatest risk for cardiovascular AEs

Patients with CHF and cardiovascular disease (CVD).

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Monitoring NSAIDs

Check blood pressure, weight gain, and SCr every 3 months.

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COX-2 Inhibitors benefits

Lower incidence of GI bleeding compared to traditional NSAIDs.

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Combination NSAID products

Examples include Vimovo®: naproxen + esomeprazole, Arthrotec®: diclofenac + misoprostol.

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Non-Pharmacologic Therapy

Treatment options for osteoarthritis not involving drugs, including support, education, and exercise.

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Topical Therapy

Local treatment applied directly to the skin to relieve pain.

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Capsaicin Cream

Topical treatment that depletes substance P to relieve pain; applied 2-4 times daily.

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Diclofenac Gel

Topical NSAID that inhibits COX-2; applied to joints four times a day.

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Acetaminophen (Tylenol)

Pain reliever that inhibits prostaglandin synthesis; max dose 4g per day.

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Hepatotoxicity Risk

Potential liver damage from acetaminophen, especially in heavy drinkers and those with liver disease.

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NSAIDs Response Variability

No universal response to NSAIDs; patients may need a different one if the first doesn’t work.

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Injection Therapy

Involves injecting medication directly into the joint, such as corticosteroids.

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Opioid Analgesics

Medications used as needed for breakthrough pain with dose management.

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Tramadol (Ultram®)

An opioid analgesic with a dose of 25-50 mg every 4-6 hours, max 200-300 mg/day.

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Duloxetine (Cymbalta®)

An adjunct medication for pain; starts at 30 mg/day, max 60 mg.

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Glucosamine/Chondroitin

OTC supplements that stimulate proteoglycan synthesis; doses of 500 mg and 400 mg respectively.

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Intra-Articular Corticosteroid Injections

Used for isolated joint pain, administered every 4-6 months with peak relief in 7-10 days.

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Hyaluronate Injections (Synvisc)

Temporary increase in joint viscosity; injected weekly for 3-5 weeks.

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Monitoring Parameters for OA

Evaluate pain, disability, joint function, and medication side effects regularly.

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Future Treatments for OA

Alternative therapies include acupuncture and stem cell therapy, targeting joint structures.

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Study Notes

Osteoarthritis

  • Overview of osteoarthritis (OA) is presented, including the course, key features and management strategies
  • Patient scenarios were given to illustrate the typical patient presentations in a pharmacy setting

Pathology

  • OA is characterized by degenerative changes in the cartilage and associated bone.
  • This results in increased destruction of cartilage and subsequent proliferation of cartilage and bone.

Etiology and Risk Factors

  • Risk factors associated with osteoarthritis include:
    • Genetic predisposition
    • Joint misalignment
    • Age
    • Gender (more common in females)
    • Race
    • Hormonal status
    • Joint trauma
    • Overuse/sports
    • Obesity
    • Joint immobilization
    • Muscle weakness
    • Repetitive stress
    • Major joint trauma
    • Heredity

Incidence

  • OA is observed more commonly in older patients.
  • It's the most common joint-related disease, affecting almost 85% of patients over 75 years old.
  • The severity of the disease increases with age.
  • More common in females.

Joint Involvement

  • Distal interphalangeal joint.
  • Hips.
  • Knees.

Clinical Manifestations

  • Joint pain.
  • Morning stiffness.
  • Crepitus.
  • Inflammation.
  • Muscle atrophy.
  • Asymmetric joint involvement.
  • No systemic symptoms
  • Instability of weight-bearing joints.
  • Herberden's nodes.
  • Bouchard's nodes.
  • Symptom examples from a patient perspective:
    • Pain when waking up.
    • Tenderness/soreness after activity.
    • Pain even when not active.
    • Difficulty with daily tasks (e.g., getting up from a chair, going up and down stairs).
    • Cracking/grating sounds/feelings with movement.
    • Redness and swelling around joints
    • Inability to perform activities due to stiffness and pain.
      • Reduced muscle strength -Reduced coordination due to pain or stiffness -Overweight -Peptic ulcer disease -Hypertension -Diabetes

Goals of Therapy

  • Relief of pain and discomfort.
  • Maintenance of joint function and strength.

Treatment of OA

  • Non-drug therapy.
  • Drug therapy (based on hand, knee, or hip):
    • Topical therapy
    • Oral agents
    • Supplements
    • Injectables

Treatment of OA (continued)

  • Non-pharmacological therapy:
    • Psychological support
    • Education
    • Rest
    • Physical activity/exercise
    • Heat/Ice
    • Physical Therapy
    • Occupational Therapy
    • Weight Loss

Medications for OA

  • NSAIDs:

    • Mechanism of action (MOA): Inhibition of COX-1 and COX-2 enzymes.
    • Dosing: Analgesic vs anti-inflammatory dose.
    • Patient response varies.
    • Adverse effects: GI upset, ulcers, bleeding, renal dysfunction, increased blood pressure, risk of stroke, MI and death

  • Possible patient at risk of nephrotoxicity and cardiovascular issues

  • COX-2 inhibitors:

    • Lower incidence of GI bleeding

  • Combination products

    • NSAID + PPI
    • NSAID + misoprostol
    • NSAID + H2 antagonist

  • Guidelines for NSAID use in OA:

    • Avoid NSAIDs if possible for patients at high CV risk.

  • Opioid Analgesics:

    • Used for breakthrough pain
    • Start low and increase dosage gradually.
    • Adverse effects: nausea, somnolence, constipation, dizziness

  • Tramadol:

    • MOA: affinity for μ-receptor
    • Dose: 25-50 mg every 4-6 hours, titrating to 200-300 mg per day.
    • Adverse effects: nausea, vomiting, dizziness, constipation

  • Duloxetine:

    • Adjunct medication
    • Dose: 30mg/day for 1 week increasing gradually to 60mg daily.
    • Avoid with tramadol
    • Adverse effects: gastrointestinal issues

  • OTC Supplements:

    • Glucosamine/chondroitin:
      • MOA: stimulates proteoglycan synthesis.
      • Dose: 500mg PO TID of glucosamine and 400mg PO TID of chondroitin.
      • Slow onset (4 weeks), 3 month trial.
      • Adverse effects: gas, bloating cramping and nausea

  • Intra-articular corticosteroid injections:

    • Used for isolated joints.
    • Not more than every 4-6 months.
    • Can be painful.
    • Peak pain relief in 7-10 days

  • Hyaluronate injections (e.g., Synvisc™):

    • Temporary increase in viscosity
    • Injected weekly for 3-5 weeks.
    • Maximum benefit in 8-12 weeks.
    • Used for patients who do not tolerate other treatments or not suitable for surgery.
    • Only local adverse effects (minor swelling).

  • Joint Replacement Surgery:

    • Relieves pain at rest, restores joint function, and lasts 10-15 years.
    • Newer materials last longer.

Monitoring Parameters

  • Pain (at rest).
  • Joint stability and function
  • Risk of falling
  • Degree of disability.
  • Weight.
  • Adverse drug reactions.
  • Compliance with non-drug measures.
  • Range of motion
  • X-rays
  • Quality of life (QOL) issues.

Future/Alternative Treatments

  • Acupuncture.
  • Strategies for targets: cartilage, synovial membrane and subchondral bone.
  • Disease-modifying osteoarthritis drugs (DMOADs).
  • Stem cell therapy.

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