DJD Pharm
NSAIDs vs Tylenol- which can you take regularly but is more toxic in large doses?
Tylenol
What three medications/medication classes are used for treatment of acute gout flares?
NSAIDs, colchicine, corticosteroids
Demonstrate isometric, concentric, and eccentric contraction for the room
Isometric- muscle is contracted and held in one position
Concentric- muscle shortents
Eccentric- muscle lengthens (but still resists lengthening)
__________ is responsible for 64% of septic arthritis. 26% is streptococci. In older adults, IV drug users, and immunosuppressed patients ______ _______ _______ may be seen.
Staphylococcus; gram negative bacilli
Heberden's nodes are at the ______ and Bouchard's nodes are at the ______
DIP; PIP
What should you do if a patient has asymptomatic hyperuricemia?
Nothing <3
Hyaluronic acid is approved as a _________ _________ and described as "visco-supplementation." What do studies show about efficacy?
medical device; small but clinically irrelevant benefit over placebo
What is the mechanism of action of colchicine? When is it typically used?
Strain refers to a _______ or _____, while sprain refers to _______ or _______
Muscle or tendon; ligament or joint capsule
What symptoms are present in septic arthritis and absent in absent in osteomyelitis? Why?
erythema/warmth/swelling; the infection is too deep
What are the two surgical options for DJD?
arthroplasty (joint replacement) and arthrodesis (joint fusion)
What joint is most commonly affected in gout and what is the name for it? Pseudogout?
Gout- first MTP; podagra
Pseudogout- knee
What are the three potential adverse effects of corticosteroid injections?
What is the mechanism of action of allopurinol? How is it dosed? What is the most feared side effect?
xanthine oxidase inhibitor; dose based on renal function; Stevens-Johnson syndrome
Which conditions (2) fall under the category of inflammatory tendonopathy? Which falls under degenerative tendonopathy?
Inflammatory- tendonitis and tenosynovitis
Degerative- tendonosis
What are the three potential etiologies of septic arthritis?
1. hematogenous spread (bacteremia)
2. Direct inoculation into joint
3. Spread from adjacent tissues
What four x-ray views are important for evaluation of suspected knee arthritis? Describe the most important one
AP, lateral, sunrise... ROSENBERG- PA, weight bearing, knees slightly flexed
Psuedogout is often found incidentally and results from deposition of CPPD crystals in a joint. This results in _______________ of affected joints
chondrocalcinosis
What are the two mechanisms of action of topical capsaicin?
1. topical counter-irritant (gate-control theory)
2. Depletes substance P from sensory neurons
What is the MOA of Probenecid? What is a contraindication?
Uricosuric- inhibits reabsorption of uric acid at proximal tubule so more uric acid is excreted in the urine
Contraindicated with h/o nephrolithiasis
Grade I- fivers are stretched and lax, but not torn
Grade II- some fibers torn, but still intact overall
Grade III- Rupture (complete tear)
What is the gold standard for diagnosis of septic arthritis? What are the four things that should be ordered on it?
Synovial fluid analysis; gram stain, cell count, crystal analysis, and culture
What are three key X-ray findings in DJD?
osteophytes, subchondral sclerosis, and joint space narrowing
punched-out lesions in later disease; diagnostic if erosions are next to soft tissue top
What two steroids are most commonly used for corticosteroid injections? What potency are they?
Which medication is reserved for patients with severe gout with topi or nephropathy? What is its MOA?
Pegloticase (Krystexxa); gout flares, anaphylaxis
In terms of function, tendons are _______ while ligaments are ______. What does that mean for assessment of each?
contractile; inert
tendons can be evaluated with ROM while ligaments must be evaluated with the provider physically pulling on it
Should osteomyelitis wounds be cultured? Why/why not? What is the study of choice for diagnosis?
no, non-specific and contaminated. MRI is study of choice
What are the three goals/uses of x-rays in DJD?
confirm diagnosis, track disease progression, and aid in education of the patient
Describe the synovial fluid analysis findings in gout vs pseudo gout
Gout- negatively birefringent needle-like monosodium urate crystals
Pseudogout- Mildly positive birefringent rhomboid CPPD crystals