Case Study: G.P., a 66-year-old, right-handed white man, seeks treatment for swelling and decreased range of motion in the right knee. He tells you he retired at age 65 after 40 years of assembly-line work. He reports that his physical activity has decreased and his weight has increased 20 pounds since retiring. His hobbies include woodworking and playing cards and playing with his two grandchildren. He denies tobacco use and alcohol use. Although he describes several years of joint pain that gradually worsened, his activities were not limited until approximately 6 months ago, when he noted an insidious onset of swelling in the right knee. Over the years, he has sporadically taken acetaminophen, aspirin, and ibuprofen to control the pain. He reports that none of the drugs provided better relief than the others. His medical history is remarkable for hypertension and three episodes of gout.
Diagnosis: Osteoarthritis
1. List specific goals of treatment for G.P.
2. What drug therapy would you prescribe, and why?
3. What are the parameters for monitoring success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for G.P.?
8. What lifestyle changes should be recommended for G.P.?
9. Describe one or two drug–drug or drug–food interactions for the selected agent.
