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Ortho Tx 2
Orthopedics
| Question | Answer |
|---|---|
| Tx of choice: acute gout | NSAIDs (indomethacin, celecoxib) |
| Acute gout: other tx | colchicine (esp for prophylaxis); c’steroids (oral, IV, intra-art) for pt who cannot take NSAIDs; |
| Gout tx: never: | start a drug to tx elevated uric acid in midst of acute attack; don’t stop prophylactic tx (if already on it) during acute; tx arthritis first, then hyperuricemia (not both at once) |
| Indications for gout prophylaxis: | 2 or more attacks/yr; erosive dz on plain film; uric acid nephropathy/ nephrolithiasis; chronic polyarticular gout |
| gout prophylaxis: Pharmacology: | colchicine; uricosurics (probenecid); xanthine oxidase inhibitors (allopurinol, Uloric) |
| Enteropathic arthritis: Tx | NSAIDs (indomethacin: AS); DMARDs for chronic / refractory; Abx if nec; Ct guided intra-art injections; PT & lifestyle mod |
| Psoriatic arthritis: Tx | Pts have 2 chronic dz; NSAIDs (or combo NSAIDS & sulfasalazine); Physical therapy; Methotrexate in refractory |
| OA tx that are not effective | wedged insole (esp not for severe); unloader brace; some thermal (diathermy, infrared) |
| OA tx: patellar taping | for P-F compartment, for medial pull of patella only; combo w/VMO exercise |
| Useful thermal tx OA | US (only modality to increase hip temp); microwave (deeper) |
| OA alt tx: | glucosamine / chondroitin (safe, won’t slow progression); doxycycline, vit C,D; acupuncture? |
| Tx: fish oil (re: arthritis) | evidence for RA (not OA) |
| OA: surg tx | wedge osteotomy okay; Arthro debridement no (except for torn meniscus); microfx (not LT cure); Carticel; OATS; joint replacement |
| Gono arthritis: Tx: | hospitalize pt; ceftriaxone 1gm (IM or IV) q 24 hours until clinical improvement; po cefixime or cefpodoxime > 1 wk |
| Nongono arthritis gram pos Rx: | Nafcillin or cefazolin (vanc for MRSA) |
| Nongono arthritis: gram neg | esp Enterobacteriaceae; IVDU; & neutropenic (also pseudomonas) ; ceftazidime or genta; IV 2wks & po 4 wks |
| TB arthritis: Tx | same as for pulmonary dz: multiple agents for at least 9 months |
| Lyme arthrtitis: Tx | oral doxycycline or amox x 1-2 mo; or IV ceftriaxone for 2-4 wks |
| Fungal arthritis: Tx | Ampho B (IV +/- intra-art) |
| Infxs arthritis: prosthetic joint: Tx | aggressive debridement (early), removal of prosthesis (late), and prolonged Abx tx |
| Fibromyalgia: Tx | multifaceted; Self-care/ pt ed (exercise, yoga, support grp); CBT; Sleep improvement |
| Fibromyalgia: Tx: antidepressants | TCA; SSRIs (fluoxetine, paroxetine); SNRIs (duloxetine / milnacipran) |
| Fibromyalgia: Tx: analgesics: | tramadol, gabapentin, pregabalin |
| Fibromyalgia: Tx: muscle relaxers: | cyclobenzaprine |
| Fibromyalgia: Tx (genl) | NSAIDS, prednisone not helpful; combination therapy best |
| Nonspecific NSAIDs: Side effects: | HTN, GI, altered renal function, MI (ibuprofen and diclofenac) |
| Rheumatoid Arthritis: Rx: | DMARDs, steroids |
| Joint & Soft Tissue Injections/ Aspirations: CI | Intra-tendinous injections (future rupture likely); drug allergies; steroids are immunosuppressive |
| Joint & Soft Tissue Injections/ Aspirations: Side effects | Tendon rupture, Infection, Hypopigmentation, Fat atrophy, Steroid flare; caution in diabetics |
Created by:
Abarnard
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