Therapeutics - OA 2

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Author:
kyleannkelsey
ID:
281851
Filename:
Therapeutics - OA 2
Updated:
2014-09-01 18:30:05
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Therapeutics OA
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Therapeutics - OA 2
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  1. How would you counsel on topical Diclofenac for OA?
    Apply 4 x day
  2. What are the rubefacients?
    • Methyl salicylate
    • Trolamine salicylate
    • (Both are topical)
  3. When should you use Rubefacients?
    • Try if failed other topical therapies
    • Not too efficacious
  4. Which is better Diclofenac or Capsaicin?
    Diclofenac is more recommended but is much more expensive
  5. What SNRI is used in OA and is approved by the FDA for musculoskeletal pain?
    Duloxetine
  6. What is the dose of Duloxetine for OA?
    • 60 mg PO QD
    • No benefit from higher doses
  7. What are the AE of Duloxetine?
    N/V and constipation
  8. What are the precautions to using Glucosamine and Chondroitin for OA?
    • Glucosamine is a sulfate salt
    • Chondroitin is derived from shellfish (shellfish allergy)
  9. What corticosteroids are used for OA?
    • Triamcinolone hexacetonide
    • Methylprednisolone acetate
  10. What is the duration, peak effects and onset of symptom relief for Corticosteroids in the treatment of OA?
    • Duration: 4-8 weeks
    • Peak effect: 1 week
    • Onset of symptom relief: 24-72 hours
  11. What are the AE for Corticosteroids in the treatment of OA?
    • (Mainly local)
    • Joint infection
    • Osteonecrosis
    • Tendon rupture
    • Skin atrophy
  12. How should Corticosteroids be administered?
    Intraarticularly
  13. How can you reduce Tendon rupture with corticosteroid use in OA?
    Limit injections to 3-4 x per year
  14. How can you reduce Skin atrophy with corticosteroid use in OA?
    Limit injections to 3-4 x per year
  15. How is Hylauronic acid administered for OA?
    Intra-articular
  16. What type of OA is treated with Hyaluronic acid?
    Knee
  17. What patients should use Hyaluronic acid for OA?
    Knee patients that are refractory to other treatments
  18. What is the downside of Hyaluronic acid in the treatment of OA?
    • Expensive
    • Injected weekly for 3-5 weeks
    • No significant effects
  19. Is Hyaluronic acid well tolerated?
    Yes
  20. What patients should receive Opioid analgesics for OA?
    When all other therapies have been exhausted
  21. What should be given with Opioids?
    Some sort of anti-constipation therapy
  22. What Opioid is most used for OA?
    Tramadol
  23. What formulation of Opioid is recommended for OA?
    Low dose, sustained release
  24. In order of what should be tried first to last, list the OA therapies:
    • Non-pharmacologic
    • Oral pharmacologic
    • Intra-articular injections
    • Opioid analgesics
  25. All patients with OA should receive what therapy?
    Non-pharmacologic
  26. What is medication selection for OA based on?
    • Affected joints
    • Response to previous medications
    • Patient comorbidities
  27. What are the precautions for Celecoxib?
    Sulfa allergies
  28. What are the topical therapies for OA?
    Capsaicin, Diclofenac, Methylsalicylate and Trolamine salicylate
  29. What type of OA is best treated with topical therapies?
    Knee
  30. When should you use topical therapies for OA?
    • CI to NSAIDs
    • > 75 years
    • Failed on APAP
  31. How should you counsel use of topical Capsaicin for OA?
    • Apply 2-4 x day
    • Takes up to 2 weeks to work
    • Avoid eyes and mouth
    • Wash hands after applying
  32. What are the AE of Capsaicin?
    • Burning/stinging
    • Erythema
    • Coughing
  33. What is the brand name for Diclofenac?
    Voltaren or Pennsaid

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