Question

PJ is an 80 -year-old man who presents to your clinic due to OA in his right hand. Past medical history is significant for dyslipidemia treated with rosuvastatin 20gm daily and hypertension with lisinopril 5mg daily. Which of the following medications should be considered a first-line treatment for this patient?

A. Hydrocodone
B. PO Prednisone
C. PONSAID
D. Oxycodone
E. Topical NSAID

Answer 1

The first-line treatment for PJ's osteoarthritis in his hand would be a Topical NSAID due to its targeted pain relief and reduced systemic side effects, over other pain medications that carry a higher risk of serious side effects and addiction for an elderly patient with multiple medical conditions.

Step-by-step explanation:

PJ is an 80-year-old man presenting with osteoarthritis (OA) in his right hand. When considering first-line treatment for OA, acetaminophen is often prescribed initially due to its low risk of serious side effects. Topical non-steroidal anti-inflammatory drugs (NSAIDs) are also a good option, since they can provide targeted pain relief with a reduced risk of systemic side effects, which is particularly important for older adults or those with other health conditions like history of dyslipidemia and hypertension.

Topical NSAIDs are preferred over oral NSAIDs to minimize systemic exposure and potential side effects, especially gastrointestinal issues. Stronger pain medications such as hydrocodone and oxycodone, both opioids, are generally reserved for when other treatments have failed and should be used with caution due to the risk of addiction and other serious side effects. Therefore, for PJ, option E, a Topical NSAID, would be an appropriate first-line treatment to consider.