NSG 533 Advanced Pharmacology Bone
and Joint Disorders (chapters 57,59 &
60) Questions with Detailed Solutions
2024-2025.
What is the typical presentation of Osteoarthritis and the overall goals of therapy?
- Answer: Patients are usually more than 50 years old. May be asymptomatic to
severe joint pain and stiffness. Joint involvement is asymmetric. Inflammation is
absent or mild. Cardinal s/s are use-related joint pain (deep and aching), joint
stiffness (abates with motion, recurs with rest), weight bearing joints unstable,
joint stiffness lasts fewer than 30 minutes. One or more joints can be involved but
most common are distal finger joints, proximal finger joints, first carpometacarpal
1|Page
,joint, knees, hips, cervicolumbar spine, and joint of the great toe. Examination of
the joint may reveal tenderness, crepitus, muscle atrophy, and limited ROM.
Osteoarthritis (OA) treatment goals - Answer: Educate the patient and caregivers
o Relieve pain o Maintain or restore mobility o Minimize functional impairment
and associated adverse outcomes (like falls) o Preserve joint integrity o Improve
quality of life
Osteoarthritis (OA) - Answer: progressive, degenerative joint disease with loss of
articular cartilage and hypertrophy of bone (formation of osteophytes, or bone
spurs) at articular surfaces
Provide a stepwise approach to the treatment of osteoarthritis, including non-
pharmacological interventions (figure 58-2). - Answer: 1) non pharm, 2) pharm
(Tylenol APAP/nsaids + glucosamine), then 3) injections, opioids, surgery *If
NSAIDS are contraindicated, then utilize glucocorticoid injections
What is meant by adequate dose / duration and ATC dosing when determining
APAPs effectiveness - Answer: APAP: *first line therapy for mild to moderate
osteoarthritis* Apap should be tried initially at an adequate dose and duration
before considering an NSAID* Insufficient acetaminophen dose or duration are
common reasons for inadequte response. APAP should be given on a PRN basis in
divided doses up to 4 g daily. Single doses should not exceed 1 g. Trial for 4 to 6
weeks. Use 2.5g max for pts who consume 2 to 3 alcoholic beverages/daily.
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, Consider alternative medications if pain not managed/presence of severe pain
and/or inflammation.
When should NSAIDs be introduced - Answer: NSAIDS are a first line therapy for
patients with moderate to severe OA or alternative therapy APAP when APAP fails
to provide an acceptable analgesic response or if there is an inflammatory
component. All systemic NSAIDS are associated with adverse GI, renal, hepatic,
cardiovascular, CNS, hypertensive effects.. particularly in older individuals.
Inhibition of the cox-1 enzyme is thought to be responsible primarily for the
adverse effects on the gastric mucosa, kidney, and platelets. Cox-2 inhibitors
(Celebrex) are preferred for patients at high risk for GI complications
Practice question: Understand when you would use Acetaminophen versus an
NSAID or an NSAID instead of Acetaminophen - Answer: NSAIDs work best on
inflammatory pain or pain mediated by prostaglandins (RA, menstrual and post-
surgical pain) and bony metastasis. NSAIDs come with increased GIB risk and renal
impairment. APAP is a good first line for mild to moderate pain and considered the
first line in low back pain and osteoarthritis. APAP hepatotoxicity has occurred in
those with liver injury or chronic drinkers. (pg 576)*
Who would benefit from COXib? - Answer: Coxib or cox 2 inhibitors are preferred
for patients at risk for GI complications, especially when using with a PPI.
OTC products for osteoarthritis - Answer: APAP (topical and oral), ibuprofen,
naproxen, aspirin), diclofenac gel
3|Page
and Joint Disorders (chapters 57,59 &
60) Questions with Detailed Solutions
2024-2025.
What is the typical presentation of Osteoarthritis and the overall goals of therapy?
- Answer: Patients are usually more than 50 years old. May be asymptomatic to
severe joint pain and stiffness. Joint involvement is asymmetric. Inflammation is
absent or mild. Cardinal s/s are use-related joint pain (deep and aching), joint
stiffness (abates with motion, recurs with rest), weight bearing joints unstable,
joint stiffness lasts fewer than 30 minutes. One or more joints can be involved but
most common are distal finger joints, proximal finger joints, first carpometacarpal
1|Page
,joint, knees, hips, cervicolumbar spine, and joint of the great toe. Examination of
the joint may reveal tenderness, crepitus, muscle atrophy, and limited ROM.
Osteoarthritis (OA) treatment goals - Answer: Educate the patient and caregivers
o Relieve pain o Maintain or restore mobility o Minimize functional impairment
and associated adverse outcomes (like falls) o Preserve joint integrity o Improve
quality of life
Osteoarthritis (OA) - Answer: progressive, degenerative joint disease with loss of
articular cartilage and hypertrophy of bone (formation of osteophytes, or bone
spurs) at articular surfaces
Provide a stepwise approach to the treatment of osteoarthritis, including non-
pharmacological interventions (figure 58-2). - Answer: 1) non pharm, 2) pharm
(Tylenol APAP/nsaids + glucosamine), then 3) injections, opioids, surgery *If
NSAIDS are contraindicated, then utilize glucocorticoid injections
What is meant by adequate dose / duration and ATC dosing when determining
APAPs effectiveness - Answer: APAP: *first line therapy for mild to moderate
osteoarthritis* Apap should be tried initially at an adequate dose and duration
before considering an NSAID* Insufficient acetaminophen dose or duration are
common reasons for inadequte response. APAP should be given on a PRN basis in
divided doses up to 4 g daily. Single doses should not exceed 1 g. Trial for 4 to 6
weeks. Use 2.5g max for pts who consume 2 to 3 alcoholic beverages/daily.
2|Page
, Consider alternative medications if pain not managed/presence of severe pain
and/or inflammation.
When should NSAIDs be introduced - Answer: NSAIDS are a first line therapy for
patients with moderate to severe OA or alternative therapy APAP when APAP fails
to provide an acceptable analgesic response or if there is an inflammatory
component. All systemic NSAIDS are associated with adverse GI, renal, hepatic,
cardiovascular, CNS, hypertensive effects.. particularly in older individuals.
Inhibition of the cox-1 enzyme is thought to be responsible primarily for the
adverse effects on the gastric mucosa, kidney, and platelets. Cox-2 inhibitors
(Celebrex) are preferred for patients at high risk for GI complications
Practice question: Understand when you would use Acetaminophen versus an
NSAID or an NSAID instead of Acetaminophen - Answer: NSAIDs work best on
inflammatory pain or pain mediated by prostaglandins (RA, menstrual and post-
surgical pain) and bony metastasis. NSAIDs come with increased GIB risk and renal
impairment. APAP is a good first line for mild to moderate pain and considered the
first line in low back pain and osteoarthritis. APAP hepatotoxicity has occurred in
those with liver injury or chronic drinkers. (pg 576)*
Who would benefit from COXib? - Answer: Coxib or cox 2 inhibitors are preferred
for patients at risk for GI complications, especially when using with a PPI.
OTC products for osteoarthritis - Answer: APAP (topical and oral), ibuprofen,
naproxen, aspirin), diclofenac gel
3|Page
