Osteoarthritis-Individualization of therapy

Kaleem Mohammed, Rph, PhD
Osteoarthritis (OA) is a progressive degenerative disease of weight-bearing joints and the leading cause of disability, pain and stiffness in elderly.

Current management of OA includes weight management, exercise, nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol, intra-articular corticosteroid injections, opiates and topical medications.

Gastrointestinal adverse effects with traditional NSAIDs and cardiovascular adverse effects associated with selective cyclooxygenase-2 (COX-2) inhibitors call for more effort to find a better NSAID with no or minimal adverse effects.

Renal function should be monitored in the elderly on NSAIDs. Tramadol can be used in chronic kidney disease patients

(GFR <30 ml/min: dose q 12 h; maximum tramadol dose 100 mg/day in advanced CKD)

In addition, prophylactic medications like omeprazole and ranitidine can be used to reduce risk of gastrointestinal ulceration, perforation and bleeding is recommended in patients > 60 years of age

References:

1. Pain management in patients with chronic kidney disease NDT Plus. 2009 Apr; 2(2): 111–118.

2. National Guideline Clearinghouse: Guideline Summary: American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of osteoarthritis of the knee, 2nd edition. (Summary of a guideline from American Academy of Orthopaedic Surgeons.) NGC website. Published 1996. Revised May 18, 2013.

3. National Institute for Health and Care Excellence: Osteoarthritis: care and management in adults. NICE guideline CG177. NICE website. Published February 2014.

Comments

Mounjaro, Is it a game changer for weight loss and diabetes?

MOUNJARO™ ( Tirzepatide) was approved for medical use in the United States in May 2022 WEIGHT LOSS: (Not approved by FDA for weight loss) Eli Lilly and Company is finalizing an application to the U.S. Food and Drug Administration for fast-track approval to sell tirzepatide for chronic weight management. MOUNJARO™ is a glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist indicated in adults for type 2 diabetes mellitus management. CONTRAINDICATIONS Personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2 Known serious all to tirzepatide or any of the excipients in MOUNJARO ...

Thyroid health- Quality of Life

Let's get a TSH blood test for our family and friends Normal serum TSH ranges are higher in the people age 70 to 80 years ; based on this, higher serum TSH goals may be needed as a patient ages. The American Thyroid Association (ATA) suggests raising the target serum TSH to 4-6 m IU/L for 70 years-old and up The thyroid is a small, butterfly-shaped hormone-producing gland located at the front of the neck. The thyroid gland secretes two main hormones: thyroxine (T-4) and triiodothyronine (T-3). These hormones regulate energy levels, metabolism of fats, proteins and carbohydrates, body temperature, heart rate. Hypothyroidism happens when the underactive thyroid gland doesn't make enough hormones. Hypothyroidism affects up to 10% of the general population (5% undiagnosed) . A n autoimmune disease called Hashimoto's diseas e where our body makes antibodies that attack healthy thyroid tissues is the most common cause of hypothyroidism in soc...

Vaccines, XBB.1.5 variant and antibody evasion

Corona virus XBB and XBB.1 were first identified in India in mid-August and quickly became predominant in India. The spike protein of the predominant XBB subvariant has 14 mutations in addition to those found in BA.2, including 5 in the N-terminal domain (NTD) and 9 in the receptor-binding domain (RBD), whereas XBB.1 has an additional G252V mutation. Single and combination therapies with monoclonal antibodies have received emergency use authorization for COVID-19. Using COVID-19 pseudovirus, which enables the study of the SARS-CoV-2 virus in cell culture, XBB, and XBB.1 subvariants were found to have far greater antibody resistance than earlier variants. XBB sublineages are completely resistant to bebtelovimab, leaving us with no authorized antibody for treatment use. The combination of mAbs known as Evusheld that is authorized for the prevention of COVID-19 is also completely inactive against the new subvariants. This poses a serious problem for millions of im...

Real Time Pharmacology

Search This Blog