1. Determine whether the patient's symptoms are consistent with OA. Review the medical history to determine whether other rheumatologic diseases may be involved.
2. Assess symptoms to determine if pain warrants additional attention. Does the pain affect quality of life or interfere with activities of daily living?
3. Evaluate symptoms to determine what nonpharma-cologic interventions can be recommended and whether pharmacologic treatment is warranted.
4. Obtain a thorough history of previous drug use, including prescription drugs, over-the-counter drugs, and dietary supplements. Determine whether any of these treat ments have been effective. Ask the patient about the dose and frequency of previous pharmacologic agents to determine if an adequate trial was given.
5. Educate the patient about appropriate use of nonpharmacologic treatments for OA.
6. Formulate a drug therapy plan, taking into consideration the patient's medical history, concomitant medications, and previous use of medications.
7. Develop a plan to monitor the patient's response to therapy.
8. Evaluate for the presence of adverse drug reactions, drug hypersensitivity, and drug interactions.
9. Document whether the patient has had improvements in quality-of-life measures, such as improved functioning, increased ability to perform activities of daily living, and improved well-being.
10. Emphasize the value of adherence to medication regimens and lifestyle modifications. Facilitate adherence by implementing medication regimens and lifestyle plans that are simple and consistent with the patient's lifestyle.
11. Educate the patient about OA, lifestyle modifications, and medications:
• How will lifestyle modifications affect the disease?
• What are the expectations of treatment?
• When and how should medications be taken?
• What adverse effects are most common, do they decrease during therapy, and what are the warning signs of more severe complications?
• What prescription and over-the-counter medications should be avoided to prevent drug-drug, drug-food, or drug-disease interactions?
• What options are available if the current regimen fails?
• Evaluate serum creatinine, complete blood count, and serum transaminases at baseline and at every 6 to 12 months in patients treated with oral NSAIDs or acetaminophen.
• Perform stool guaiac in patients taking oral NSAIDs when clinically indicated.
• Monitor for drug interactions, including alcohol, at every visit.
Abbreviations Introduced in This Chapter
ACR APS COX DJD MMP NSAID OA
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