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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?
  1. A. Increase dose of acetaminophen
  2. B. Switch to NSAIDS
  3. C. Switch to NSAIDS and PPI
  4. D. Switch to topical NSAIDS and PPI
Answer
Ans: B
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
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