ILE X: OA/Iron def

What disease state occurs due to cartilage degradation, bone remodeling, and synovial inflammation, leading to chronic pain?

Osteoarthritis

What stage of osteoarthritis is most represented by pain on movement, joint stiffness, mild crepitus, mild changes in range of motion, minimal radiographic changes, and is often monoarticular?

Early Disease

What stage of osteoarthritis is most represented by pain on movement and rest, swelling/heat/inflammation at joint, significant crepitus, radiographic changes (joint space narrowing), osteophytes, abnormal joint alignment, and effusions?

Late Disease

What patient population is more likely to experience osteoarthritis when they are older than 50?

Women

What patient population is more likely to experience osteoarthritis when they are younger than 50?

Men

What two non-pharm recommendations are considered strong for ALL osteoarthritis types (hand, knee, hip)?

Exercise, Self Management Programs

What three non-pharm recommendations are considered strong for only knee and hip OA?

Weight loss, tai chi, cane

What non-pharm recommendation is strongly recommended AGAINST for knee and hip OA?

Transcutaneous electrical nerve stimulation (TENS)

What pharmacologic recommendation is considered strong for ALL types of OA?

Oral NSAIDs

What pharmacologic recommendation is only considered strong for knee OA?

Topical NSAIDs

What pharmacologic recommendation is considered strong for knee and hip OA?

Intraarticular glucocorticoid injection

What type of intraarticular glucocorticoid injection is strongly recommended AGAINST for hip OA and conditionally against for knee?

Hyaluranic Acid

What three pharmacologic interventions are strongly recommended AGAINST for ALL OA types?

Biologics, Methotrexate, Hydroxychloroquine

What types of OA are platelet rich plasma and stem cell injections strongly recommended AGAINST for pharmacologic treatment interventions?

Knee and Hip

What topical NSAID inhibits COX-2 enzymes in tissues near the site of application and is associated with few serious adverse effects, but may cause mild skin reactions?

Diclofenac Gel

What is the brand name for the OA treatment intervention that recommends avoiding contact with eyes or open wounds and washing hands after application?

Voltaren

What OA medication class reduces pain, inflammation, and fever by preventing synthesis of tissue prostaglandins and related prostanoids?

Oral NSAIDs

Which oral NSAID has the most COX-2 selectivity (and therefore the least potential for GI effects) in the following list?

Ibuprofen

Naproxen

Diclofenac

Celecoxib

Celecoxib

In which two patient populations may oral NSAIDs not be the best option for OA treatment?

CKD, HF

Which oral NSAID is most related to causing photosensitivity and, therefore, should be used with caution in patients with a history of skin cancer?

Ibuprofen

Which oral NSAID is most related to causing hepatotoxicity within 4-6 months of initiation?

Diclofenac

Which OA medication acts within the central nervous system by inhibiting the synthesis of prostaglandins?

Acetaminophen

In which two patient populations should acetaminophen be used with caution due to the associated risks?

Liver Disease, Alcoholism

What is the maximum recommended dose of acetaminophen?

4 g/day

What OA medication is analgesic with affinity for mu-opioid receptor, as well as weak inhibition of the reuptake of norepinephrine and serotonin and, therefore, may be helpful in patients who cannot take NSAIDs?

Tramadol

What OA medication class may be useful for those who don't experience relief with topical therapy, oral NSAIDs, acetaminophen, or intra-articular injections OR patients with underlying conditions that cannot use other first line agents?

Opioids

What OA medication is a centrally acting dual-reuptake inhibitor of both serotonin and norepinephrine, but has a risk of serotonin syndrome, especially when used with other medications that can cause it?

Duloxetine

What OA medication is isolated from hot peppers and releases and ultimately depletes substance P from afferent nociceptive nerve fibers, but must be used regularly to be effective?

Capsaicin

How long may it take for capsaicin to take effect?

2 weeks

In which two types of OA is capsaicin NOT recommended?

Hand, Hip

What medications may cause iron deficiency anemia?

PPIs, NSAIDs

What is the standard treatment recommendation for patients diagnosed with iron deficiency anemia?

elemental iron QD or QOD and treat for 3 months AFTER iron deficiency has been corrected

How long AFTER iron deficiency has been corrected should patients be treated with elemental iron?

3 months

When should elemental iron be taken in order to have better absorption?

Empty Stomach

When should reticulocyte count be expected to rise after initiation of iron treatment?

4-10 days

When should hemoglobin be expected to increase after initiation of iron treatment?

2 weeks

When is complete recovery expected after initiation of iron and, therefore, indicates a follow-up to check CBC with the patient's PCP?

2-3 weeks

What does iron bind to in the body, allowing myoglobins to deliver and store in muscles and provides cytochrome oxidase with the ability to generate ATP?

Oxygen

What are the following signs/symptoms most related to?

Pallor

Palpitations

Shortness of breath

Easy fatiguability

Anemia

What are the following signs/symptoms most related to?

Koilonychia (concave nails)

Hair loss

Pica

Glossitis

Esophageal webs

Iron Deficiency

In what type of PUD are patients more likely to get iron deficiency anemia?

H. pylori

How are Hg/Hct, MCV, and MCHC in microcytic anemia?

Low

What lab value is sometimes elevated until iron therapy in IDA, but may be a dilutionary effect?

Platelets

Which iron study may be increased in patients with IDA, related to the body's signal attempt in making more iron?

Total Iron Binding Capacity (TIBC)

Which iron study lab values may be deceased in patients with IDA?

Serum Ferritin, Iron, Transferrin Saturation

Which IDA treatment intervention may increase concentration after takin iron, but decreases absorption and is considered controversial?

Hepcidin

Which controversial IDA treatment intervention has shown no difference in the absorption of iron?

Vitamin C

Approximately how much elemental iron is provided by 324 mg Ferrous Fumarate?

107 mg

Approximately how much elemental iron is provided by 324 mg Ferrous Sulfate?

65 mg

Approximately how much elemental iron is provided by 325 mg Ferrous Gluconate?

39 mg

What iron formulation is higher in cost but possibly has less metallic taste?

Polysaccharide-iron complex (PIC)

What two patient factors are considered contraindications to oral iron therapy?

Celiac Disease, Bariatric Surgery

What are four common adverse effects from iron supplementation?

Stomach irritation, Constipation, Nausea, Dark Stools

What iron supplementation adverse effect is considered harmless and an important counseling point for patients to differentiate from melena?

Dark Stools

In patients with high risk for recurrence of IDA, what treatment duration is typically recommended?

Lifelong

How do antacids, PPIs, TEA, coffee, and dairy products affect the efficacy of iron supplementation and, therefore, requires patient counseling?

Decreases Absorption

When should iron supplementation be administered in relation to PPI and H2RAs?

2 Hours Before or 4 Hours After

What treatment intervention may be considered when iron supplementation does not work or is not an option?

IV therapy

What form of iron administration should NEVER be performed due to extreme painfulness and the ability to tattoo the patient?

IM therapy

Iron limits absorption of some drugs such as _

Levothyroxine