RT Book, Section A1 Buys, Lucinda M. A1 Wiedenfeld, Sara A. A2 DiPiro, Joseph T. A2 Talbert, Robert L. A2 Yee, Gary C. A2 Matzke, Gary R. A2 Wells, Barbara G. A2 Posey, L. Michael SR Print(0) ID 1148578789 T1 Osteoarthritis T2 Pharmacotherapy: A Pathophysiologic Approach, 10e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9781259587481 LK accesspharmacy.mhmedical.com/content.aspx?aid=1148578789 RD 2024/03/29 AB Patient Care Process for the Management of OsteoarthritisCollectPatient characteristics (e.g., age, weight, height, race, sex, pregnant)Patient history (past medical, family, social, and alcohol use)Symptom information: type and location of pain; duration; effect of motion and rest; range of motion and limitations on activities; instabilityCurrent and past medications, including nonprescription agents and dietary supplements, and medications' relief of symptomsObjective data (see Box 90-1)Physical examination; appearance of jointsRadiologic evaluation—changes in joints; subchondral bone sclerosis; effusions (see Box 90-3)Body mass index (presence of overweight or obesity)Presence of renal or hepatic diseaseAssessDistribution and severity of joint involvementImpact of symptoms on patients' daily activities, interference with occupational functioning, health-related quality of lifeEffects of pre-existing renal or hepatic disease on choice of medication selection and dosePlan*Patient education about disease, prognosis, treatment options, application and use of topical productsNonpharmacologic therapy (see Table 90-1)—weight loss (if overweight or obese), exercise, surgery (for severe pain or functional disability)Drug therapy regimen including specific analgesics, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Figures 90-4 and 90-5 and Tables 90-2 and 90-3)Monitoring parameters including efficacy (e.g., symptom relief), safety (medication-specific adverse effects) (see Table 90-3)Self-monitoring of symptoms, exercise, and weight—where and how to record resultsReferrals to other providers when appropriate (e.g., physician, orthopedic surgeon, physical therapist)Consider joint replacement if patient has severe pain or significant functional impairment, or drug therapy is ineffective or poorly tolerated.Implement*Provide patient education regarding all elements of treatment plan Use motivational interviewing and coaching strategies to maximize adherence. This is particularly important for nonpharmacologic interventions. Schedule follow-up monthly until symptoms controlled to assess efficacy of drug therapy regimen and assess adherence to nonpharmacologic interventions.Follow-up: Monitor and EvaluateAssess symptom relief, effectiveness of weight loss and exercise programsPresence of adverse effects (see Table 90-3), including cardiovascular and renal effects of NSAIDs, hepatic effects of acetaminophen and glycemic effects of intraarticular corticosteroids.Closely monitor proper use of opioids in all patients, including dependence, addiction, tolerance, hyperalgesia, and diversion (see text).Patient adherence to treatment plan using multiple sources of information*Collaborate with patient, caregivers, and other health professionals