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

Answer the following questions. Include two references, cited in APA style.

List specific goals of treatment for G.P.

What drug therapy would you prescribe, and why?

What are the parameters for monitoring success of the therapy?

Discuss specific patient education based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause you to change therapy.

What would be the choice for second-line therapy?

What over-the-counter and/or alternative medications would be appropriate for G.P.?

What lifestyle changes should be recommended for G.P.?

Describe one or two drug–drug or drug–food interactions for the selected agent.

Answer 1

• List specific goals of treatment for G.P.

  • To reduce the swelling and to improve the joint function.
  • To increase physical activity.
  • To reduce weight and to maintain a normal body weight.
  • To manage the condition of osteoarthritis, hypertension, and prevention of further episode of gout.

  What drug therapy would you prescribe, and why?

  • Acetaminophen may be prescribed initially, but the long-term use may cause liver damage.
  • NSAIDs effective for reduction of pain and inflammation, but may produce the side effects of GI problems.
  • Cymbalta is an antidepressant used to treat chronic pain.
  • Corticosteroids which inject directly into the joints.

  What are the parameters for monitoring the success of the therapy?

  • Relieve of pain.
  • Reduction of swelling.
  • Improved joint function.
  • Increased physical activity.

  Discuss specific patient education based on the prescribed therapy.

  • Educate about the control of blood pressure because the NSAIDs may lead to hypertension.
  • Educate about side effects of Gastrointestinal symptoms.
  • Educate about the toxicity of liver and kidney if it overuses.

  List one or two adverse reactions for the selected agent that would cause you to change therapy.

  Adverse effects of NSAIDs:

  • Stomach upset
  • Cramping.
  • Ulcer
  • Bleeding.

  What would be the choice for second-line therapy?

  • Physical therapy includes exercises, walking.
  • Use of knee braces to support the knee.
  • Apply local application for relieving of pain.
  • Apply heat and cold packs for pain reduction and swelling.

  What over-the-counter and/or alternative medications would be appropriate for G.P.?

  • Ginger
  • Green tea
  • Avacado
  • Soybeans
  • Massage therapy
  • Ayurvedic herbal medicine.
  • Chinese herbal preparations.

  What lifestyle changes should be recommended for G.P.?

  • Increase exercise within the limit and increased physical activity.
  • Intake of antioxidant diets such as fruits and vegetables.
  • Reduce weight to prevent additional pressure on the joint.

  Describe one or two drug-drug or drug-food interactions for the selected agent.

  • Use of ibuprofen with methotrexate results in kidney toxicity.
  • Consumption of alcohol with the NSAIDs may produce a headache, stomach bleeding, and liver damage.