1. Common drug usage in orthopedic practice (for extern) Department of Orthopaedic Surgery Faculty of Medicine Siriraj Hospital Mahidol University

5. Pharmacologic management Anesthetic approach Physical medicine & rehabilitation Psychosocial Treatment Electrical stimulation

6. WHO 4-steps treatment of pain

11. Effect of NSAID to COX 1&2

12. COX-1 and COX-2

13. Prostaglandins Arachidonic acid Conventional NSAIDs Prostaglandins Impaired platelet function  Inflammation, pain, and fever กลไกการออกฤทธิ์ของ NSAIDs COX-2 COX-1 Thromboxane Gastrointestinal toxicity COX; 2 Isoforms X X

14. Prostaglandins Arachidonic acid COX II inhibitors Prostaglandins Impaired platelet function กลไกการออกฤทธิ์ของ NSAIDs COX-2 COX-1 Thromboxane Gastrointestinal toxicity COX; 2 Isoforms X  Inflammation, pain, and fever

35. Drug usage in OA

38. GLUCOSAMINE SULFATE CH 2 OH NH 3 +  – O —  S —  O – + H 3 N OH O O  = HO CH 2 OH OH OH HO OH O Cl – Na + O Na + Cl –

46. World Health Organization (WHO) Osteoporosis Guidelines WHO, Guidelines for Preclinical Evaluation and Clinical Trials in Osteoporosis , 1998. T-Score Mean Lumbar Spine BMD: Decades 3 to 9 of a Woman’s Life Adapted from AACE Guidelines. Endocr Pract. 2001;7:293-312. Bone Mineral Density Values 1.4 1.3 1.2 1.1 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 20 30 40 50 60 70 80 Age BMD Mean –2 SD Consider preventive intervention Consider therapeutic intervention

47. DEXA scan: Hip T-Score

51. Thank you for your attention