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therapeutic management of OA
Terms in this set (35)
what type of pain is OA pain?
Nociceptive somatic bc it deals with the joint and bone
what are the risk factors of developing OA?
age esp > 50, levels off at 80
gender - women at higher risk
genetics - determines ~30% of the risk
what are the lifestyle factors in developing OA?
what parts of the body (specifically) does the disease OA encompass?
ligaments and bone
what was OA previously classified as ? and why is this not believed to be the case anymore?
- it was traditionally been classified as a noninflammatory disease
- it is now understood that it is characterized by synovitis which is an inflammation of the synovial membrane
what is stage 1 OA characterized by?
predictable, sharp pain usually brought on by mechanical insult that eventually limits high impact activities with relatively modest effect on function
what is stage 2 OA characterized by?
pain becomes more constant and starts to affect daily activities. there may be unpredictable episodes of stiffness
what is stage 3 OA characterized by?
constant dull/aching pain punctuated by episodes of often predictable, intense exhausting pain that results in severe limitations in function.
what are the symptoms of OA?
loss of rom
stiffness at the location of node development
what are the signs of OA?
bony swellings that form on hands
heberden's nodes - at the DIP (closest to the tips of the fingers/toes)
bouchard's nodes - at the pip - lower joints
what is absent in a PE when inspecting OA?
boggy synovitis seen in RA or the intense, hot inflammation of crystalline arthropathy
what would be found in a xray and indicate OA?
osteophyte formation, joint narrowing, subchondral sclerosis and cysts
osteophytes are the most specific radiographic marker for OA - it indicates relatively advanced disease
what are the three subscales the WOMAC index uses ?
physical function (what degree of difficulty with these physical activities)
what types of OA is the WOMAC index used to assess?
knee and/or hip OA
what are challenges associated with assessing pain?
subjective - cant draw labs to verify the pain
patients who deny pain
pt who refuse pain meds
cultural or religious diversities
patients with impaired communication (cognitive impariment=dementia patient, unconscious patient, peds=esp <7 YO)
patients with hx of misuse, addiction and abuse
what is gelling and why is this a symptom that can be used to distingusih between OA and RA?
gelling is stiffness after rest.
OA stiffness only lasts about 30 min in the morning
RA stiffness can last an hour or more in the morning
what is the primary symptom of the disease?
deep, achy joint pain exacerbated by extensive use
what is the number one nonpharm intervention for OA?
what are the therapeutic goals in OA?
educate the patient, caregivers, relatives
relieve pain and stiffness
maintain or improve joint mobility
to limit functional impairment
maintain or improve QOL
what are the 5 strongly recommended interventions from the article Dr. McPherson posted for hip and knee OA?
self efficacy and self management programs
what is capsaicin's MOA and what type of OA is used for?
depletes substance P
use for knee OA
what is the difference btw COX 1 and COX 2?
cox 1 = produces PG with beneficial effects such as regulation of blood flow to gastric mucosa and kidneys
cox 2 = produces PG that activate and sensitize nociceptors
what is the goal with NSAID therapy (in terms of the MOA)?
goal with cox2 inhibitor therapy is preserving pg-mediated gastroprotection (which occurs through the cox 1 enzyme) so we are only really wanting to target cox 2
if you are prescribing nsaid to a patient with hx of dyspepsia/abd pain and/or gi discomfort what preventive measures should u take?
nsaid + PPI, H2 blocker
if you are prescribing nsaid to a patient with hx of GI bleeding what preventive measures should u take?
avoid NSAIDs when GI bleeding is in hx
celecoxib +/- PPI/misoprostol
if you are prescribing nsaid to a patient with hx of CV complications (worsening HTN, MI) what preventive measures should u take?
avoid COX2 inhibitors/nonselective NSAIDs in patients at risk of CV events
avoid NSAIDs in patients with CHF
use NSAIDs with caution in patients with HTN
if you are prescribing nsaid to a patient with hx of hepatic complications what preventive measures should u take?
avoid NSAIDs in patients with cirrhosis due to potential hematologic and renal complications
if you are prescribing nsaid to a patient with hx of impaired renal function what preventive measures should u take?
avoid nsaids in patients with renal disease
use nsaids with caution when combined with meds that have the potential to decrease renal function (ACEi, beta blockers)
if you are prescribing nsaid to a patient with hx of respiratory (aspirin-exacerbated respiratory disease) what preventive measures should u take?
use nsaids and aspirin with caution in pt with asthma. esp pt with nasal polyps or recurrent sinusitis
if you are prescribing nsaid to a patient with hx of clotting problems contributing to significant bleeding what preventive measures should u take?
avoid nsaids in patients with platelet defects of thrombocytopenia
avoid nsaids with anticoagulants
if nsaids are necessary in patient with anticoagulant, expect an increase in INR
avoid low dose ASA if CV risk is low
if you are prescribing nsaid to a patient with prolonged pregnancy or lab what preventive measures should u take?
avoid nsaids toward the the end of pregnancy (6-8 weeks before term)
the rules dr mcpherson gave were to always consider topical diclofenac first. which types of OA is this best suited for and which types are not best suited for diclofenac?
always -> knee
sometimes --> hand
never --> hip. cannot reach to the site action because its deeper than other two types of oa
what are the agent related variables of tramadol?
lowers sz threshold
may cause serotonin syndrome, may cause hypoglycemia
what are examples of subjective indices of therapeutic effect?
subjective description of improve functional status
- sleeping better
- performing ADLs better
what are examples of objective indices of therapeutic effect?
objective assessment of improved functional status
- longer sleep
- able to walk further
- able to work/work longer
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