Question

OSTEOARTHRITIS

G.P., a 66-year-old, right-handed white man, seeks treatment for swelling and decreased range of motion in the third finger of his right hand. 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. 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 third DIP joint. 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. He is concerned that he will continue to lose movement in the finger that is already affected, as well as the fingers of his left hand. His medical history is remarkable for hypertension and three episodes of gout.

2. What drug therapy would you prescribe, and why?

3. How would you monitor in terms of efficacy and adverse effects? Specifically, what laboratory tests would you order for G.P.?

5. If the above occurred, what would be the choice for second-line therapy, and why?

6. Discuss specific patient education based on your first-line therapy choices.

8. What dietary and lifestyle changes would you recommend for this patient?

10. Write your prescription for this patient.

Answer 1

2.DRUG THERAPY:

Combination of celecoxib and amlodipine besylate for treatment of patient with osteoarthritis and hypertension.(patient have past medical history of hypertension)

It is given because combination of this drug lowered day time systolic blood pressure by at least 50% of the reduction in blood pressure achieved in patient treated with amlodipine besylate.

3. SIDE EFFECTS:

• Cardiovascular thrombotic event .

• GI bleeding

• Ulceration and perforation

• Hepatotoxicity

• Increase angina or myocardial infraction

MONITOR :

• Assessment the patient condition.

• Watch patient GI bleeding occur or not.

• Patient with peptic ulcer greater risk for serious GI bleeding.

• Blood pressure is monitoring during this drug administration.

5. SECOND LINE THERAPY :

• NSAIDS with proton pump inhibitor.

• COX-2 Selective opioids.

• Topical capsacin

6. PATIENT EDUCATION ABOUT FIRST LINE THERAPY:

NSAIDS are often considered to be the preferred first line drug treatment for osteoarthritis . They have shown efficacy similar and Superior paracetamol .It is superior for rest pain and overall pain .

8. DIETARY MANAGEMENT:

TAKE----

• Oily fish- Contain lot of omega -3 fatty acids,have anti- inflammatory properties.

• Oils

• Dark leafy greens

• Broccoli

• Garlic

• Nuts

AVOID---

• Sugar-- sugar rich carbohydrates such as processed cakes,cookies, may change body's immune response to disease .

• Salt

• Fried food

• White flour

LIFESTYLE MODIFICATION---

• Education about medication used.

• Use assistive device, support and brace .

• Access strengthening exercise.

• Aerobic fitness.

• Weight loss.

10.WRITE PRESCRIPTION :

• Drug combination of celecoxib and amlodipine.

• Use assistive device .

• Doing aerobic fitness exercise.