Chapter 62 Osteoarthritis Q&A (1 of 26) Sample Questions
1. 2. A 60-year-old female presents with a three-month history of difficult ambulating secondary-to-left knee pain. Pain worsens with activity and improves upon rest. She has been using extra-strength Acetaminophen (500 mg tablets) with minimal relief. You saw her in the clinic two months ago where the following investigations were performed: CBC, chemistry panel, renal function, ESR: all normal, X-ray left knee: asymmetrical joint-space narrowing, subchondral osteosclerosis consistent with osteoarthritis. At the time, you recommended Acetaminophen 1 g four times daily, and scheduled a follow-up dated today. Today, she reports only minimal improvement in pain and mobility. Aside from her knee symptoms, she has no other complaints. No history of reflux or ulcers. Non-smoker; no alcohol. What is the appropriate medication to relieve her arthritic pain?
- A. Increase dose of acetaminophen
- B. Switch to NSAIDS
- C. Switch to NSAIDS and PPI
- D. Switch to topical NSAIDS and PPI
Tips: Patient has no risk factors so she can be switched to NSAIDS.
Assess risk for adverse GI events.
Low or No risk factors use low dose NSAIDs
Moderate 1-2 risk factors. use low dose NSAID + gastroprotection or low dose cox2 inh.
High. Multiple risk factors, previous ulcer, concomitant use of anticoagulants corticosteroids or low dose ASA. No NSAIDS. use cox2 inh + gastro protection.
what is the most important factor to initiating PPI in patient using NSAIDs? Age >65 yo