Question

1.         Duloxetine was approved for pain relief in osteoarthritis in 2010. Find a study that supports this approval and comment on how convincing you find it to be.

2.         A 55 yo female patient with severe osteoarthritis of the knee is dispensed a prescription for 50 tabs of hydrocodone 7.5 mg/acetaminophen 325 mg to be used as 1 or 2 tabs every 6 hours as needed. After two weeks, the patient is back for the same prescription, and once again in another two weeks.

a. What could be the reasons for the frequent prescriptions?

b. What actions would you take with the patient and prescriber at this point? Explain your reasoning.

3.         a. Would you recommend glucosamine to your OA patients? Explain why.

            b. Would you recommend vitamin D supplements? What evidence is there?

4.         Evaluate the efficacy and safety of ONE of the following dietary supplements or alternative treatments for osteoarthritis: MSM, SAMe, turmeric, or acupuncture.  

                                   

Answer 1

Q NO,1:- Answer ;- Duloxetine is an approved pain relief in osteoarthritis since 2010 . However the majority of RCTs evaluating analgesic efficacy utilize reductions in pain intensity as their primary outcome measure. Visual analog scale,numerical rating scales,as well as verbal rating scales have all been demonstrated as being valid and reliable measures of pain. In addition to its interference on daily functions BPI-I .The sub scale is composed of four questions which ask the subject to rate their pain on a 0 to 10 likert scale . Pain score also showed a statistically significant difference in favor of duloxetine 60/120 mg/day and also Responder analyses were conducted in all three duloxetine trials.that show moderate to substantial improvement in their pain severity.

Q NO.2:- A:- The usage of duloxetine to a 55 year old female patient can cause sleepiness or may affect the patients ability , nausea , dry mouth , constipation etc . Once prescribed to an old patient it may cause liver damage , abnormal bleeding and some severe skin reactions. Besides this the contineous use of this drug for twice a day may cause serious repercussions to an old female patient and also effects to the fetus when the mother takes the drug. It may cause greater risk for falls due to blood pressure changes and may cause headache , weakness , confusion, etc.

B;- At this point I may advise to the patient that you should follow a proper prescription and may take dosages as advised by your doctor that might be of 30 mg /day for two weeks of minimum dosage so that the patient could be relieved as well as the chances of side effects could be neutralized.

Q NO.3.A :- Glucosamine supplement may ease the patients joint pain , and is worth to use as pain reliever for mild to moderate knee osteoarthritis and it may work for other joints too that is why we prefer to use glucosamine for an OA patient.

B :- While study results have been mixed , in general to suggest that vitamin D may be protective in OA.Vitamin D promotes calcium absorption by the body to enable bone growth and repair.

Q NO. 4:- The efficacy and safety of Turmeric patient to an OA Patient have been used for treating arthritis symptoms to elucidate the efficacy of curcuma for alleviating the symptoms of arthritis . Although turmeric belongs to the zingiberaceae family , that contains different bioactive components , mainly curcuma and demethoxycurcumin used as an alternative medicine for osteoarthritis.Thus turmeric preparations and curcumin were considered to be safe and does not exceed 1200 mg / day .