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Pharmacology quiz 5 > orthopedics > Flashcards

orthopedics Flashcards

(102 cards)

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1
Q

What is osteoporosis?

A

decreased cortical thickness, decrease in the number and size of trabeculae (but normal chemical composition), resulting in increased fracture

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2
Q

what is the most prevalent degenerative disease in the US

A

osteoporosis

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3
Q

True or false: 70% of fx in pts >45 are d/t osteoporosis

A

TRUE

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4
Q

Most common fractures in osteoporosis

A

vertebral bodies, distal radius, proximal femur

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5
Q

true or false: 1 in 5 pts is no longer living 1 year after sustaining hip injury

A

TRUE

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6
Q

compare osteoblasts and osteoclasts

A

osteoblasts lay down bone, osteoclasts resorb bone - work together to make adult skeletons in equilibrium

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7
Q

when does bone resorption begin to exceed formation?

A

3rd decade of life

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8
Q

What determines good bone future?

A

bone deposition in youth, exercise, diet, estrogen

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9
Q

RF of osteoporosis

A

gender, age, race, early menopause, low calcium intake, sedentary lifestyle

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10
Q

Describe type 1 osteoporosis

A

Women, d/t estrogen deficiency, greater than 50, trabecular bone loss, fx of vertebrae and radius

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11
Q

describe type 2 osteoporosis

A

anyone, d/t aging, greater than 70, trabecular and cortical bone loss, fx of vertebrae and hips

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12
Q

Treatment of early post menopause osteo.

A

estrogen replacement, caution with raloxifene (increases menopause)

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13
Q

treatment of pts >75 y/o osteo.

A

bisphosphonate, caution with estrogen

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14
Q

treatment of existing fx with osteo.

A

estrogen, bisphosphate

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15
Q

Name the calcium supplements

A

calcium carbonate, acetate, chloride, glubionate, gluconate, lactate

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16
Q

what should be checked before giving calcium

A

serum calcium

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17
Q

how are calcium supplements different?

A

elemental calcium present, side effects (GI), the need for calcium

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18
Q

Which calcium supplement needs an acidic medium?

A

calcium carbonate - take with meals 3 times a day

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19
Q

how much elemental calcium do I need per day?

A

1000mg per day

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20
Q

how much elemental calcium do teenagers need?

A

1200mg/day

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21
Q

how much elemental calcium do elderly need?

A

1500mg/day

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22
Q

what should be given along with calcium supplements?

A

vitamin D

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23
Q

how much vitamin D is needed per day?

A

600 international units per day

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24
Q

what is included in the combo of Ca and vit D

A

500mg Ca, 200mg Vit d

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25
ADR of calcium
GI (pain, constipation, diarrhea, flatulence), too much
26
what are the estrogen supplements?
estradiol, estrogens conjugated A synthetic, estrogens conjugated B synthetic, estrogens conjugated/equine, estrogens esterified
27
what is premarin
derived from urine of female horses (equine estrogens) - could cause cancer
28
natural forms of estrogens
soy, yams, black cohash
29
what do "conjugated estrogens" contain?
multiple forms of estrogens - multiple components in these supplements
30
do estrogens work?
yes, not the best
31
when should estrogens be given?
refractory cases, after menopause for <5 years
32
how can cancer risk be reduced in women?
give with progestin to even out, safe in women without uterus
33
ADR of estrogens
cancer, thromboembolic risk
34
MOA of estrogens
bisphosphonate, calcitonin and estrogens inhibit osteoclasts
35
name the selective estrogen receptor modulators
raloxifene
36
MOA of SERMs
looks like estrogens, taken up only in bone, inhibits osteoclasts
37
when should SERMs be given?
soon after menopause (if used in premenopause bone density will drop)
38
is there a risk of CA with SERMs?
yes but lower than estrogens
39
ADR of SERMs
increases hot flash rate, thromboembolic risk
40
what is calcitonin salmon
calcitonin from salmon that is 30-50x stronger than human calcitonin
41
MOA of calcitonin
decreases bone breakdown, inhibits osteoclasts
42
when should calcitonin be used?
bed ridden pts, 3rd level, very refractory
43
what also needs to be in place before giving calcitonin
calcium and vitamin D
44
ADR of calcitonin
cancer risk, rhinitis
45
does calcitonin work?
according to the FDA and europeans, NO (don't use more than 6 months d/t ADR)
46
name the bisphosphonates
alendronate, ibandronate, risedronate, zoledronic acid
47
MOA of bisphosphonates
increase bone density and decrease fx risk
48
what is the only osteoporotic meds that increases blast activity?
bisphosphonates (alendronate)
49
indications for alendronate
prevention and treatment of osteoporosis (prevention = 1/2 the dose)
50
which bisphosphonate is once a year?
zolendronic acid (IV infusion)
51
how frequenty can bisphosphonates be tken?
daily, weekly, monthly, yearly
52
onset of action of alendronate
1 year
53
onset of action of risedronate
6 months
54
how long should you be taking alendronate?
5 years, effects are lasting past then
55
ADR of bisphosphonates
osteonecrosis of the jaw (check Ca, vit D, dental problems), GI (don't lay down - could be erosive), increased fx risk
56
name the parathyroid hormone supplement
teriparatide
57
prophylactic dose of alendronate
5 mg/day (35mg/week)
58
MOA of teriparatide
high high high levels of PTH cause bone formation (normally causes bone degradation)
59
ROA of teriparatide
injection
60
what labs should be watched with teriparatide
serum Calcium, renal function, serum uric acid, replenish vitamin D
61
who should get teriparatide?
men and post-menopausal women with severe osteo.
62
ADR of teriparatide
fall risk (dizzy), d/c in 2 yrs or higher risk of osteosarcoma
63
name the monoclonal antibody
denosumab
64
MOA of monoclonal antibodies (denosumab)
inhibits RANKL to interrupt osteoclast activity
65
uses of denosumab
oncology (larger dose), osteoporosis (lower dose)
66
what should be monitored and supplemented if needed with denosumab use
calcium
67
ADR of denosumab
osteonecrosis, infection risk
68
what can reduce PTH secretion?
aluminum, ethanol
69
What can impair absorption of vitamin D?
olcer anticonvulsants, chronic laxative use, antilipemic resins
70
what can impair calcium absorption?
magnesium-wasters (cisplatin, cyclosporine), decreased gastric acidity (H2 blockers, PPIs)
71
what are the effects of corticosteroids on bone?
break down bone with chronic use
72
how can osteoporosis be prevented?
need to bone mass early in life, exercise early in life, adequate calcium and vitamin D intake
73
what causes gout?
over production of uric acid, underexcretion of uric acid (most cases) leads to deosition of crystals
74
what can hyperuricemia lead to?
acute gouty arthritis which can move to gout arthritis
75
define stage 1 gout
asymptomatic, elevated levels of uric acid with no manifestations
76
define stage 2 gout
acute gouty arthritis, sudden and itense pain and swelling in the joints, damage starts here
77
define stage 3 gout
intercritical gout, levels still elevated (period between attacks)
78
define stage 4 gout
chronic gout, most destructive stage, joints suffer permanent damage
79
treatment goals of gout
terminatino of acute attack, prevention of further attacks, assessment for contributing factors, long-term therapy
80
how is acute gout treated?
NSAIDs (naproxen, indomethicine - short term only!), corticosteroids, colchicine (low threshold for toxicity)
81
what is colchicine a derivative of
naked lady flower
82
MOA of colchicine
interferes with microtubules in metaphase of cell division
83
downsides of colchicine
drug interactions (3A4 substrate, can be increased with inhibitors of this), renal/hepatic adjustment
84
ADR of colchicine
diarrhea (acute attacks give multiple doses), fatality risk
85
uses of cochicine
acute and chronic gout (larger dose)
86
what is prescribed to pts who are over producing uric acid?
allopurinol
87
downsides of allopurinol
renal dose adjustment (50-60ml/min - 200-100mg daily), might make gout worse if you start it by itself - give with colchicine
88
ADR of allopurinol
allergic reaction (SJS) in first 5 weeks of therapy up to 2 years of therapy
89
uses for allopurinol
gout and chemotherapy pts
90
what is febuxostat?
works like allopurinol
91
ADR of febuxostat?
LFT elevation, lower chance of SJS
92
What is probenecid
blocks renal uric acid reabsorption
93
ADR of probenecid
large failure rate (25%), blocks PCN molecules from leaving the body
94
what is pegloticase
breaks down uric acid as a recombinant urate oxidase
95
ROA of pegloticase
IV infusion every 2 weeks
96
Contraindications of pegloticase
G6PD deficiency
97
treatment of breast cancer risk pts with osteo,
raloxifene, caustion with estrogens
98
treatment of osteo in pts with poor GI motility
estrogen, calcitonin, caution with alendronate (may cause esophageal ulcers)
99
treatment of osteo in pts at risk for DVT
bisphosphonate, calcitonin, caution with estrogens and raloxifene
100
treatment of osteo in pts with renal impairment
vitamin D, estrogens, calcitonin, caution with bisphosphonates (may be vit D deficient)
101
treatment of males with osteo
bisphosphonate, calcitonin, caution with estrogens (androgen replacement?)
102
treatment of osteo. In pts with painful fx
calcitonin

Pharmacology quiz 5 (6 decks)

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