Therapeutics Exam 1 Questions With All Complete And Verified Solutions Graded A+.

Risk factors of Osteoarthritis (OA) - correct answer Older age Obesity Occupation, sports, and trauma Genetic factors clinical presentation of OA - correct answer Symptoms of pain localized to affected joints, joint stiffness, limited range of motion, and crepitus (crackling or grating sound) Physical examination of joints (hand, knee, hip, spine, foot) Laboratory tests Erythrocyte sedimentation rate (ESR) less than 20mm/hr Rheumatoid factor negative Evaluation of synovial fluid (WBC less than 2000 cells/mm3) Radiographic findings Goals of OA therapy - correct answer Educate patient, family, and caregiver Relieve pain and stiffness Maintain or improve joint mobility Limit functional impairment Maintain or improve quality of life Avoid toxic effects of therapy Weight loss, if appropriate Comprehensive management plan for OA may include educational, behavioral, psychosocial, and physical interventions as well as topical, oral, and intra-articular medications. nonpharmacologic therapy for OA - correct answer strongly recommended: Physical and/or occupational therapy Exercise (any type) Weight loss, if overweight or obese Self-efficacy and self-management programs Tai Chi (balancing/fall prevention) Goals of pharmacologic treatment of OA - correct answer Targeted at pain relief (long term) Utilized in older individuals with other medical conditions (hypertension, cardiovascular disease, gastrointestinal bleeding risk, chronic kidney disease) Patient-centered approach to long-term drug treatment beginning treatments with least systemic exposure or toxicity Specific drug therapy recommendations depend on which joint is affected, response to previous trials of medication (symptom control/adverse effects), and patient comorbidities. OA treatment in patients with risk factors for gastrointestinal toxicity with NSAIDs - correct answer Adverse effects include nausea, dyspepsia, anorexia, abdominal pain, flatulence, diarrhea Gastric and duodenal mucosal bleeding that leads to ulcerations Monitoring: complete blood cell count (CBC) to check for bleeding, this is done yearly. Risk factors for GI toxicity include being older than 65, high dose NSAID therapy, concurrent use of aspirin or anticoagulants, and concurrent use of corticosteroids. OA treatment in patients with risk factors for renal toxicity with NSAIDs - correct answer NSAID use is not recommended with CrCl less than 30 Monitoring: serum creatinine at baseline and within 3-7 days of drug initiation yearly Risk factors include being older than 65 and concomitant disease states such as renal failure, heart failure, and cirrhosis. Also, the concurrent use of medications: diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), aminoglycosides, and cyclosporine. OA treatment in patients with risk factors for cardiovascular toxicity with NSAIDs - correct answer Increased risk of heart attack or stroke Monitoring: check blood pressure each time the patient comes into the office Risk factors include pre-existing cardiovascular disease or risk factors for cardiovascular disease, duration of NSAID use and likely high doses increases risk, and potentially higher risk based on degree of COX-2 selectivity. Drug interactions with potentially serious interaction with NSAIDs - correct answer Warfarin: NSAIDs can displace from protein binding and reduce platelet aggregation and induce GI bleeding Diuretics: NSAIDs reduce natriuretic effects Antihypertensives: NSAIDs may cause sodium retention Lithium: reduced lithium clearance Methotrexate: reduced renal elimination of methotrexate Agents that increase bleeding risk Formulate a follow-up plan to monitor and evaluate pharmacologic treatment of a patient with osteoarthritis - correct answer Evaluate the patient to see if their pain levels have improved Determine if any additional/concurrent therapies should be implemented Collect, assess, plan, implement, and follow up Maximum Doses: Acetaminophen - correct answer 4 grams per day Maximum dose of Topical diclofenac - correct answer 32 grams total per day Upper extremities: 8 grams per joint per day Lower extremities: 16 grams per joint per day maximum dose of tramadol: - correct answer 300-400 mg per day Renal impairment: 200 mg per day in q12 hour intervals Hepatic impairment: 50 mg q12 hours Elderly: 300 mg max per day Acetaminophen OA therapeutic use - correct answer CR for knee, hip, and/or hand OA Dosing: 325 to 650 mg every 4 to 6 hours or 1 g three to four times daily; scheduled dosing is really important FDA max is 4 grams daily Adverse effects: Considered one of the safest analgesics Hepatotoxicity: monitor liver function tests because an overdose can be serious and fatal. Majority of overdoses are unintentional. Dosing precautions: Use caution in chronic alcohol users (more than 3 drinks per day) or liver disease, avoid use or consider lower max dose.