OP, Menopause and Testosterone Use Flashcards by Jessica Weaver

risk factors for OP

inc age
causacian, asian
FHx
female
low weight
smoking
3+ drinks a day
dec Ca and Vit D intake
no exercise

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diseases that inc risk for OP

DM
hyperthyroidism
eating disorders
hypogonadism
menopause
RA
autoimmune

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drugs that inc OP risk

PPI
aromatase-i
depo provera
GnRH ags
steroids

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T score interpretations

-1 and up = normal
-2.5 to -1 = osteopenic
-2.5 or less = OP

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what is a FRAX score

risk of OP fracture in next 10 years

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how much Ca should patients receive a day total

1000-1200 mg a day

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what are the Ca supplement options? What are the pearls of each?

Ca carb = 40% elem Ca, acid gut needed, needs to be with food

Ca citrate = 21% elem Ca, doesn’t care about gut acidity

both can cause constipation

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patients on a PPI should take calcium _____

citrate
calcium carbonate needs acidic gut

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Ca doses above ______________ should be divided BID

500-600mg

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vitamin D normal level

> 30

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what are the vit D supplementation options and doses for deficiency (<30)

D2: 50,000 IU q week
D3: 5000-7000IU daily

x8-12 weeks then switch to QD MD

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what are the tx criteria for OP

T score </= -2.5
T score -2.5 to -1 plus FRAX 20%+ OR 3%+ risk hip fx in next 10 years

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first line for OP

bisphosphonates

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why must hypocalcemia be corrected before OP tx

most OP drugs decrease bone resorption/Ca release from bones to inc MBD, so if a patient is already hypocalcemic, OP meds will worsen it to build bone strength

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denosumab
brand
MOA
use
CI

Prolia
binds RANK ligand to prevent binding and therefore osteoclast stimulation
use in patient with normal Ca as an alternative to BPs if high fx risk
CI IN HYPOCALCEMIA

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bisphosphonates contraindications

CI in hypocalcemia (all)
CI CrCl <35 alendronate
CI CrCl <30 ibandronate and risendronate

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alendronate
brand
dosing

Fosamax
35mg PO weekly for ppx
70mg PO weekly for treatment

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risendronate
brand
dosing

Actonel
35mg PO weekly for ppx
150mg PO monthly for treatment

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ibandronate
brand
dosing

Boniva
150mg po monthly for ppx and tx

what are the injectable bisphosphonates and when are they preferred

ibandronate and zoledronic acid
preferred when BP is ok but patient has esophagitis

ibandronate inj dosing

3mg IV q3mo

zoledronic acid IV dosing

5mg q2 years for ppx
5mg yearly for tx

side effects of po BPs

dyspepsia
dysphagia
GERD
N/V
hypocalcemia

ibandronate use counseling points

once monthly dose in am with 6-8oz water
separate from food & beverages by 30min
separate from cations by 2 hours
do not lie down for 1 hour after
remember I for ibandronate looks like the number 1 for 1 time a month and do not lie down for 1 hour after

alendronate use counseling

once weekly dose in am with 6-8oz water separate from food and meds by 30 min separate from cations by 2 hours do not lie down for 30 min after taking

risendronate use counseling

once monthly dose in am with 6-8oz water separate from food by 30 min separate from cations by 2 hours do not lie down for 30 min after

raloxifene MOA dosing CI

SERM: estrogen ag/antag in bone to prevent bone resorption 60mg PO QD CI: hypocalcemia, hx of VTE, pregnancy, cardiac events/CHD CAN CAUSE BLOOD CLOTS

can a patient with a CrCl of 31 mL/min receive zoledronic acid

no, CI CrCl <35

calcitonin role in therapy pearls

last line comes in nasal spray or IM

what happens to hormones in menopause? What does this cause?

drop in estrogen and progesterone causes hot flashes, night sweats, vaginal dryness, burning and painful sex

what does estrogen tx in menopause help with

decreases LH to provide a more stable temp control increases MBD vasomotor sx (hot flashes and night sweats)

what are local estrogen options for women in menopause?

cream (Estrace, Premarin) vaginal tab (Vagifem) ring (Estring)

what are systemic estrogen options for women in menopause?

estradiol gel, patch, ring 17-Beta-estradiol po tab (Premarin) injectable (Premarin)

Premarin comes in which dosage forms

po tab topical cream inj

BBW for estrogen treatment in menopause

endometrial cancer breast cancer VTE, stroke dementia if 65+ yo

is premarin monotherapy appropriate in menopause

NO never use unopposed estrogen need progestin too!

what are the progestin options for menopause

Prempro (conjugated equine estrogens + MPA) MPA = provera/depo micronized progestin = Prometrium

what is the first FDA approved bioidentical estrogen-progesterone for hot flashes

Bijuva

non-hormone tx options for menopause

paroxetine 7.5mg PO qd ospemifene (Osphena) estrogen ag/antag

what causes hypogonadism in males

age surgeries methadone chemo cimetidine spironolactone

what are s/sx of hypogonadism in males

low libido low muscle mass memory/concentration issues dec MBD dc energy

when should men receive testoeterone treatment

if there is a medical reason, not just for libido and muscle

adverse effects of testosterone replacement therapy (TRT)

HF, CV events, clots, edema liver tox, prostate enlargement, infertility depression, sleep apnea, aggression, acne inc SCr, gynecomastia abuse potential

what are the different options for TRT in males

gel (Androgel +- pump) depo testosterone (T cypionate) testopel (implantable pellet) Jatenzo (po tab)

what are counseling points for Androgel

let dry completely then clothe do not let others come in contact wait 2-6 hours before swimming or showering flammable apply deodorant beforehand pump must be primed before use!