Question

G.P., a 66-year-old, right-handed white man, seeks treatment for swelling and decreased range of motion in the right knee. He tells you he retired at age 65 after 40 years of assembly-line work. He reports that his physical activity has decreased and his weight has increased 20 pounds since retiring. His hobbies include woodworking and playing cards and playing with his two grandchildren. He denies tobacco use and alcohol use. Although he describes several years of joint pain that gradually worsened, his activities were not limited until approximately 6 months ago, when he noted an insidious onset of swelling in the right knee. Over the years, he has sporadically taken acetaminophen, aspirin, and ibuprofen to control the pain. He reports that none of the drugs provided better relief than the others. His medical history is remarkable for hypertension and three episodes of gout. Diagnosis: Osteoarthritis 1. List specific goals of treatment for G.P. 2. What drug therapy would you prescribe, and why? 3. What are the parameters for monitoring success of the therapy? 4. Discuss specific patient education based on the prescribed therapy. 5. List one or two adverse reactions for the selected agent that would cause you to change therapy. 6. What would be the choice for second-line therapy? 7. What over-the-counter and/or alternative medications would be appropriate for G.P.? 8. What lifestyle changes should be recommended for G.P.? 9. Describe one or two drug–drug or drug–food interactions for the selected agent.

Answer 1

Goals to reduce pain and swelling. To control the blood pressure in normal range.The best choice of drug is Methotrexate because it is the the only drug having lesser cardiovascular complications. It does not affect the blood pressure.parameters are full blood count,kidney function test,liver function test,ESR,C reactive protein and rheumatoid factor.The usual dose is 12-15 mg / week.The dose should not excced 30 mg in week.It cause complications to kidney and liver hence can go for next choice of treatment.Hydroxychloroquine is the next choice is a antimalarial drug but used in treatment of arthritis. Over the counter medications should be always avoid.Alternative medications can be use.Performing exercise to reduce weight. Low salt,low fat and low caloric diet is the dietary modifications.regular follow up of treatment.amoxycillin-Methotrexate interactions this antibiotic is penicillin which cause retention of Methotrexate in the body does not allow to get out of body remains in kidney for longer time cause serious kidney complications.Already it has a liver complication further intake of alcohol will increase the liver complications. Taking caffeine also decrease the effect of drug.