OSTEOARTHRITIS - PowerPoint Presentation

Slide1

OSTEOARTHRITIS

SCENARIO

:

Here is a 55 yrs old female patient hospitalized for 10 days .

CHIEF COMPLAINTS :

Pain in left knee since 15 days .

Swelling B/L lower limb since 8 days .

HISTORY OF PRESENT ILLNESS :

Patient complains of pain in left knee which is gradually progressive, throbbing type aggravates on moving and relieves on taking rest.

PAST MEDICAL HISTORY :

k/c/o Type 2 DM since 1 month.

PAST MEDICATION HISTORY :

Tab Metformin 500mg 1-0-1

PERSONAL HISTORY :

Menopause – 3 years back LABORATORY INVESTIGATIONS : GRBS at the time of admission is 239 mg/dL

CBC

TEST VALUE

NORMAL

RANGE

WBC

16,500 cumm

4000-11000

cumm

Haemoglobin

9.5 g/dl

11-14 g/dl

Neutrophils

82

40-60

MCH

24.8 g/dl

32-36 g/dl

MCHC

28.3

g/dl

32-36 g/dl

ESR

90 mm/hr

< 20 mm/hr

SOAP Note :

Subjective : Here is a 55 years old female patient complaining of pain in left knee and swelling of lower limb .Objective : WBC is increased to 16,500 cumm which is due to infection or inflammation . Hb decreased to 9.5 g/dl which implies anaemia MCH is decreased to 24.8 g/dl which indicates hypochromia MCHC is decreased to 28.8 g/dl which also indicates hypochromia

ESR is increased to 90 mm/hr which is due to inflammation.

GRBS increased to 239 mg/

dL

which suggests diabetes mellitus.

Antibiotic sensitivity testing :- (pus samples)

Organism – Methicillin resistant Staphylococcus aureus. Sensitive to Erythromycin, Tetracycline, Cloxacillin, Amoxiclav, ceferoxime.Diagnosis : OsteoarthritisAssessment : Pain in knee : Due to osteoclast activity release of vasoactive peptide and matrix metalloproteinase, neovascularisation increased permeability of the adjacent cartilage, which leads to cartilage degradation and eventually cartilage loss resulting in pain

.

Swelling : Due to release of inflammatory mediators synovitis occurs which causes swelling.

Osteoarthritis : Due to progressive deterioration and loss of articular cartilage.

PROBLEM

GOALS OF TREATMENTDRUGS & MOADOSAGEOsteoarthritis

Relieve pain and stiffness

Improve joint mobility

Limit functional impairment

Acetaminophen :- they inhibit PG synthesis which causes algesia.

NSAIDS :- Diclofenac inhibits

PG synthesis where PG’s are mediators of pain

325mg TID

100-150mg/day

Plan :

TRADE NAMEGENERIC NAME

DOSAGE

1

2

3

4

5

6

7

8

9

10

Inj.Contramol

Tramadol

100ml 1-0-1

Y

Y

Y

Y

Y

Y

Y

Y

T.Neusaid

Aceclofenac

+

paracetamol

1-0-1

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

T.Rabsure

Rabeprazole

40mg

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

T.Phlogam

Trypsin , brome lain, rutoside trihydrate

1-1-1

Y

Y

Y

Y

Y

Y

Y

Y

Y

T.Neuromine

Merobalamine

0-1-0

Y

Y

Y

Y

Y

Y

Y

Y

Y

T.Zifi

turbo

Linezolide

1-0-1

Y

Y

Y

Y

Y

Y

Y

Y

Y

T. Melmet

Metformine

500mg

Y

Y

Y

Y

Y

Syp.Heam

up

Ferrous sulphate

5ml

Y

Y

Inj.Tazomac

Pipercillin

4g

Y

Y

DISCHARGE DRUGS :

T. ReboronT. Melmet SR 500mg DRUG INTERACTIONS : Tramadol + linezolide – Major interaction Nausea , sweating , increased heart rate , serotonin syndromePATIENT COUNSELLING:While using Metformin might feel a little irritation in GIT Weight control

Reduce protein in diet

Rabeprazole should be taken before food