Module: Pharmacotherapy III Module Coordinator: Dr. Arwa M. Amin Mostafa Academic Level: Postgraduate, Master of Pharmacy in Clinical Pharmacy School: Dubai Pharmacy College Year of first presented in Class: 2018 This presentation is for Educational purpose. It has no commercial value.

3. • Osteoarthritis (OA) is a chronic and progressive
disease which happens due to articular
cartilage damage.
• OA affects primarily weight - bearing
diarthrodial (Synovial) joints.
• OA is the single most common cause of disability
in older adults.
Diarthrodial (Synovial) Joints

4. • Damage to cartilage increases activity of chondrocytes in attempt to repair
damage, leading to increased synthesis of matrix constituents.
• Normal balance between cartilage breakdown and re-synthesis is lost, with
increasing destruction and cartilage loss.

6. Video of OA pathophysiology and stages:
https://www.youtube.com/watch?v=BBqjltHNOrc

8. • Joints often affected by OA are:
• Knee
• Hand: Fingers, thumbs
• Foot: Toes
• Spine: Lumber
• Hip
• Shoulder

9. • Classification of OA:
• Primary OA appears with unknown cause.
• Secondary OA appears with known causes:
• Trauma, excessive load (obesity), metabolic or endocrine
disorders, and congenital factors.

12. Normal Knee Knee with OA OA Radiographs
• Degenerative Changes
• Osteophytes or bone spurs
• Joint space narrowing

13. ESR: Erythrocyte Sedimentation Rate

16. OA: Osteoarthritis, HTN: Hypertension, BPH: Benign Prostatic Hyperplasia

18. • Patient may be at risk of hepatotoxicity due to overdose of Acetaminophen
(daily dose > 4 g/day).
• Patient is Stage 3 CKD (Estimated GFR= 45 ml/min/1.73m2) and he may be at
risk of developing Acetaminophen nephrotoxicity.
• Un treated Hyperlipidemia: No anti-hyperlipidemic treatment in patient’s
medications’ list.
• Patient is taking Amitriptyline for sleep, however, Amitriptyline may lead to
urinary retention and worsen symptoms of BPH.

19. • Since Patient’s BG 248 mg/dl and HbA1C 8.1, patient’s T2DM is not
properly controlled which may increase patient’s risk of developing
diabetes associated complications such as cardiovascular diseases
(CVD), particularly that the patient suffers from hyperlipidemia and
hypertension.
• Although ADA* guidelines (2017) HbA1C goal (<7%) can be less
stringent in elderly (HbA1C < 8), optimized glucose control will help
to slow the progression of diabetic neuropathy and prevent T2DM
associated complications.
ADA: American Diabetes Association

27. OA treatment Goals:
(1) Educate patient, family members, and caregivers.
(2) Relieve pain and stiffness.
(3) Maintain or improve joint mobility.
(4) Limit functional impairment.
(5) Maintain or improve quality of life.

28. What are Non-Pharmacological treatments of OA which could be suggested
to treat Mr. Abernathy?
Non-Pharmacological Treatment of OA
• Educate patient: disease process and extent, prognosis, and treatment.
• Promote dietary counseling, exercise, and weight loss program (for
overweight patients).
• Participation in aquatic, aerobic and resistance exercise.

29. • Physical therapy — with heat or cold treatments and self management
program
• Helps maintain range of motion and reduce pain and need
for analgesics.

30. • Assistive and orthotic devices
• Canes, walkers, braces, heel cups, insoles can be used during
exercise or daily activities.

31. • Surgical procedures (eg. Osteotomy, Arthroplasty, Joint Fusion) are
indicated for functional disability and/or severe pain unresponsive to
conservative therapy.
Osteotomy
Arthroplasty
Joint Fusion

33. What are the feasible Pharmacological treatment options to treat Mr.
Abernathy OA?

35. Source: Osteoarthritis, Pharmacotherapy: A Pathophysiologic Approach, 10e, Citation: DiPiro JT, Talbert RL, Yee GC,
Matzke GR, Wells BG, Posey L. Pharmacotherapy: A Pathophysiologic Approach, 10e; 2017 Available at:
http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=133893029 Accessed:
February 14, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved

36. Source: Osteoarthritis, Pharmacotherapy: A Pathophysiologic Approach, 10e, Citation: DiPiro JT, Talbert RL, Yee GC,
Matzke GR, Wells BG, Posey L. Pharmacotherapy: A Pathophysiologic Approach, 10e; 2017 Available at:
http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=133893029 Accessed:
February 14, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved

37. Source: Osteoarthritis, Pharmacotherapy: A Pathophysiologic Approach, 10e, Citation: DiPiro JT, Talbert RL, Yee GC,
Matzke GR, Wells BG, Posey L. Pharmacotherapy: A Pathophysiologic Approach, 10e; 2017 Available at:
http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=133893029 Accessed:
February 14, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved

38. Source: Osteoarthritis, Pharmacotherapy: A Pathophysiologic Approach,
10e, Citation: DiPiro JT, Talbert RL, Yee GC, Matzke GR,
Wells BG, Posey L. Pharmacotherapy: A Pathophysiologic
Approach, 10e; 2017 Available at:
http://accesspharmacy.mhmedical.com/content.aspx?booki
d=1861&sectionid=133893029 Accessed: February 14, 2018
Copyright © 2018 McGraw-Hill Education. All rights
reserved

41. • Intra-articular injection of corticosteroids (Should be no more than once
every 3 months):
• Methylprednisolone (starting:10 – 20 mg)
• Triamcinolone (starting: 5 – 15 mg).
• Duloxetine is a preferred second-line medication in patients with both
neuropathic and musculoskeletal OA pain.
• The ADA* guidelines (2017) recommends Duloxetine to treat Diabetic
Neuropathy (DNP).
• Duloxetine recommended dose is 60 mg once daily.
• Caution: Amitriptyline should be discontinued before initiating
Duloxetine (Serious Drug interaction: increased risk of serotonin syndrome)
*ADA: American Diabetes Association