Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm Finger > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Common disease that is often silent until

A

fractures occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Screening recommended for

A

women >65

men >70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

drugs known to affect BMD

A
  • Oral steroids
  • UFH
  • Levothyroxine
  • TZDs
  • PPIs
  • SSRIs
  • Aromatase inhibitors/GnRH agonists
  • Opioids
  • Phenytoin/CBZ
  • Calcineurin inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

glucocorticoid-induced osteoporosis causes BMD to drop the fastest when?

A

in the first 3-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Step to manage pts on meds w/ potentially (-) skeletal effects

A
  • asses fx risk
  • TLC (tobacco, ETOH, Ca, VitD, exercise)
  • consider meds w/ less skeletal impact
  • review ongoing need for meds
  • follow standard tx guidelines
  • reassess BMD / fx risk
  • identify pts w/ high risk for fx
  • reinforce adherence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Osteoporosis dx

A

measure BMD by DEXA of hip & spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Z-score

A

pts BMD to expected BMD for pt age & sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T-score

A

pts BMD compare to “young normal” adult of same score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal BMD

A

T-score of -1.0 and above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Osteopenia

A

T-score btwn -1.0 & -2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Osteoporosis

A

T-score >-2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

FRAX

A

gives a basis for tx decisions in pts wi/ osteopenia (better than T-score alone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

clinical RF for osteoporosis

A 
age
gender
hx of fx (personal or parental)
BMI
PO steroid use
secondary ostepporosis
smoking & ETOH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what does FRAX score give?

A

10 yr probability of hip fx & 10 yr probability of major ostepporotic fx (spine, forearm, hip, shoulder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

FRAX scores needing pharm tx

A

10 yr hip fx risk of 3% & 10 yr major osteoporotic fx risk of >20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prevention of osteoporosis

A
  • adequate dietary intake of Ca & Vit D
  • regular weight-bearing exercise
  • smoking cessation
  • prevention of falls
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how much Ca should adults consume?

A

1000-1200mg

dietary&raquo_space;>supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How much vit D should adults consume?

A

<70 yrs: 600 IU/day

>70yrs: 800 IU/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how long to wait to check 25-hydroxyvitamin D levels after starting tx?

A

at least 6 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

anti-resorptive agents

A

“bone protectors”

  • Ca/VitD
  • estrogen
  • SERMs
  • Bisphosphonates
  • Anti-RANK Ligand Antibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

anabolic agents

A

“bone builders”

-PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

single dose of Ca

A

should not exceed 600mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

is Vit D needed for Ca absorption?

A

YAS

24
Q

common Ca side effect?

A

constipation

25
Q

Ca citrate

A

less GI intolerance c/t CaCO3

can be taken w/ or w/o food

26
Q

HRT

A

Estrogen +/- progestin product

27
Q

Women w/ intact uterus

A

should take estrogen AND progestin (decrease risk of endometrial CA)

28
Q

Women w/o uterus

A

Estrogen alone

29
Q

is HRT 1st line tx?

A

NO

increased risk of breast CA, VTE, CVA, +/-CAD

30
Q

SERMs

A

Selective Estrogen Receptor Modulator

Raloxifene** & Tamoxifen

31
Q

SERM MOA

A

estrogen-like effects on bone & anti-estrogen effects on uterus/breast

32
Q

SERM ADRs

A

hot flashes
leg cramps
increase VTE risk

33
Q

Bisphosphonates

A

Alendronate, Risedronate, Zoledronic Acid

34
Q

Bis. MOA

A

Osteoclasts resorb bone impregnated w/ bis. > bis. released & inhibits enzyme > inhibits protein prenylation > promotes apoptosis > REDUCED BONE RESORPTION

35
Q

how are bis. absorbed best?

A

on an empty stomach w/ lots of water and STAY UPRIGHT

36
Q

Bis. indications

A

prevention AND tx of osteoporosis

also used for hypercalcemia ass w/ malignancy & Paget’s dz

37
Q

what decreases bis. absorption?

A

Ca, Fe, TTC, LT4, FQ (from the 1st pharm lecture!)

38
Q

how to monitor biz. action?

A

assess BMD w/ DEXA at 1 yr then q2yrs after

39
Q

reason for poor adherence to bis:

A
  • persistent unexplained decreased BMD
  • new fx
  • high rates of bone turnover after >1yr of tx
40
Q

Bis. NOT recommended in pts w/ eGFR

A

35mL

41
Q

Pts w/ Vit D /Ca deficiency should..

A

correct depletion before use

Vit D should be at least >30ng/mL

42
Q

DO NOT use Bis. in pts who

A
  • have impaired swallowing
  • can’t sit up for at least 30-60 mins post taking
  • pregnancy/lactation
43
Q

Bis. ADRs?

A
  • GI sx (Esophagitis***) (PO)
  • transient flu-like febrile illness (IV)
  • ocular effects possible (IV»)
  • osteonecrosis of the jaw
  • atypical femur fx
44
Q

Atypical femur fx:

A
  • subtrochanteric
  • transverse w/o splintering
  • bilat. fx NOT uncommon
  • no trauma
  • premonitory sx (groin/thigh pain before fx)
45
Q

when to stop bis. in pt with LOW risk

A

after 3-5 yrs

46
Q

Anti-RANK Ligand Antibodies

A

Denosumab

47
Q

Anti-RANK Ligand Ab MOA

A

prevent maturation of preosteoclast > osteoclasts

decreased bone remodeling and increased BMD

48
Q

Anti-RANK Ligand Ab ADRs

A
  • fatigue
  • hypocalcemia
  • osteonecrosis of the jaw
  • atypical fx
49
Q

PTH/PTHrP Analogs

A

Teriparatide & Abaloparatide

both are daily SQ injections

50
Q

PTH MOA

A

stimulate osteoblast function to form bone

51
Q

how long do you use PTH?

A

for up to 2 yrs in the pts lifetime

THEN YOU MUST STOP

52
Q

PTH BBW:

A

associated w/ increased osteosarcoma (do not use in high risk pts)

53
Q

PTH ADRs?

A

Nausea, HA, dizziness, arthralgias, hypercalcemia/hypercalciuria

54
Q

Sclerostin Inhibitors?

A

Romosozumab

55
Q

Romosozumab MOA?

A

stimulates osteoblasts to decrease bone & resorption; increases BMD

56
Q

Romosozumab BBW:

A

do not use in women w/ CVA or AMI in last yr

Pharm Finger (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions