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OsteoHormone Flashcards

(91 cards)

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1
Q

the most common location of fracture

A

lower lumbar spine

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2
Q

a T score of what is indicative of osteoporosis

A

< -2.5

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3
Q

a T score of what is indicative of osteopenia

A

-1 to - 2.5

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4
Q

a T score of what indicates normal bone health

A

> -1

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5
Q

what are Z scores

A

compare a pt BMD to the mean BMD of a pt of their age and gender

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6
Q

what are T scores

A

compare a pt BMD to the BMD of a normal young adult of the same gender

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7
Q

cells involved in bone formation

A

osteoblast

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8
Q

break down bone, resorption

A

osteoclast

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9
Q

what are the high risk areas that a DEXA scan looks at

A

hips, lumbar vertebrae

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10
Q

at what age should ALL women get a DEXA scan

A

65

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11
Q

what is the purpose of the FRAX tool

A

estimates risk of fracture in the next 10 years

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12
Q

what steroid use is considered a risk of osteoporosis

A

prednisolone greater than 5mg or prednisone equivalent for > = 3 months

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13
Q

genetic factors for osteoporosis are most important with what races

A

white, asian

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14
Q

what are some risk factors for low bone density

A

> 2 alcoholic drinks a day, smoking, low vit d and ca intake over life, roid use for >= 3 months at > 5 mg prednisone equivalent dose, previous fracture, < 127 lbs, low physical activity for life, decrease estrogen (menopaus, hypogonadism, lactation, anorexia)

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15
Q

what are drugs that put you at risk for osteoporosis

A

long term steroid use ( >= 3 months @ > 5mg prednisolone or prednisone equivalent), warfarin, heparin, anticonvulsants (carbamazepine, phenytoin, fosphenytoin, phenobarbital), aromatase inhibitors (tx breast cancer), androgen blockers (treat prostate cancer), loop diuretics, excess thyroid hormone

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16
Q

bone accumulates until what age

A

30

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17
Q

when is calcium intake very important

A

childhood, pregnancy, menopause

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18
Q

vit d deficiency in children causes

A

rickets

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19
Q

vit d deficiency in adults causes

A

osteomalacia

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20
Q

recommended daily Ca intake for 14-18 y/o

A

1300 mg

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21
Q

recommended daily Ca intake for 19-50 y/o

A

1000 mg

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22
Q

recommended daily Ca intake for > 50 y/o

A

1200 mg

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23
Q

how much elemental Ca is in Ca-citrate

A

21%

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24
Q

how much elemental Ca is in Ca-carbonate

A

40%

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25
daily Vit D recommendation for up to 70 y/o
600 IU
26
daily Vit D recommendation for > 70 y/o
800 IU
27
what is the preferred source of Vit D
cholicalciferol (Vit D3)
28
what is used 1st line in treatment of osteoporosis
bisphosphonates
29
what are the bisphosphonates (generic)
zolidronic acid, ibandronate, risedronate, alendronate
30
what agent will increase a patients fracture risk due to it decreasing calcium carbonate absorption
PPI
31
fosamax
alendronate
32
reclast
zoledronic acid injection
33
actonel
risedronate
34
boniva
ibandronate
35
dose of fosamax for prevention and treatment
5mg prevention 10mg treatment qd
36
daily dose of actonel
5 mg daily
37
monthly dose of boniva
150 mg
38
monthly dose of actonel
150 mg
39
Atelvia
long acting risedronate
40
what are the contraindication for oral bisphosphonates
inability to stand or sit upright for 30 mins, hypocalcemia, severe renal impairment (CrCl < 30)
41
at what CrCl is PO bisphosphonate use contraindicated
< 30
42
how long should bisphosphonates be used
3-5 years
43
why is there a time limit on how long bisphosphonates can be used
risk of atypical femur fracture, esophageal cancer, jaw necrosis
44
what are SE of bisphosphonates
back pain, joint pain, dyspepsia, dysphagia, esophagitis, GI issues, N/V
45
what must you notify the patient about taking Atelvia
no H2RA or PPI, seperate from Mg, Ca, Fe supplements
46
why should patients get dental work done before starting bisphosphonates
risk of jaw necrosis
47
Zometa
zoledronic acid injection
48
Reclast treats
osteoporosis, paget's disease
49
zometa treat
hypercalcemia of malignancy
50
what is the dose and frequency of Reclast
5mg infusion yearly (treatment) or every 2 years (prevention)
51
what are the SE of Reclast
flu like syndrome: aches, runny nose, headache
52
what can be done to prevent the transient post dose syndrome seen with reclast
NSAID before and after infusion
53
at what CrCl is Reclast contraindicated
< 35
54
what are the lipid effects of raloxifene
decrease cholesterol and LDL
55
what is the black box warning for raloxifene
increase risk of thromboembolic events (DVT, PE, MI, stroke)
56
when is Raloxifene contraindicated
previous thromboembolism, hepatic dysfunction, pregnancy
57
what are the SE of Raloxifene
hot flashes, vaginal bleed/dischcarge, flushing, mood changes, htn
58
raloxifene is used most frequently in which women
that have fear of breast cancer or at risk
59
Evista
Raloxifene
60
Fortical
calcitonin
61
when is calcitonin contraindicated
salmon allergy
62
Forteo
teriparatide
63
what agents are used in patients at HIGH RISK for fracture
teriparatide, denosumab
64
what is the dose and frequency for teriparatide
20 mcg SQ injection daily
65
how long can a patient be on teriparatide
2 years
66
what is the black box warning for teriparatide
osteosarcoma
67
2/2 the black box warning of teriparatide caution must be used when using this agent in patients that have
paget's disease, bone metastasis, hypercalcemia
68
what are the SE of teriparatide
dizziness, increase HR (especially with first few doses), injection site pain
69
Prolia
Denosumab
70
Xgeva
Denosumab
71
Prolia treats
osteoporosis
72
Xgeva treats
hypercalcemia of malignancy
73
when is use of denosumab contraindicated
hypocalcemia
74
what agents have a risk of atypical femur fractures and jaw necrosis
bisphosphonates, denosumab
75
if a patient is on a weekly schedule of bisphosphonate and they miss one dose what should they do
take the following morning (not 2 doses in 1 day)
76
if a patient is on a daily schedule of bisphosphonate and they miss one dose what should they do
skip until next dose
77
if a patient is on a monthly schedule of bisphosphonate and they miss one dose what should they do
take as soon as you remember (DON'T TAKE 2 IN ONE WEEK!!)
78
Zometa
zolidronic acid
79
Reclast treats
osteoporosis
80
Zometa treat
hypercalcemia of malignancy
81
Reclast is the same drug as
Zometa
82
what should you counsel the patient on taking teriparatide
may feel dizzy or have increased HR for first few doses so inject where you can sit or lie down right away
83
where should the pen for the teriparatide injection be kept
fridge
84
discard the teriparatide pen after
28 days
85
where do you inject teriparatide
thigh or abdomen (lower stomach)
86
how long can a patient take teriparatide
2 years
87
how long must you be sitting/standing upright when taking bisphosphonates
30 MINUTES, 60 minutes with monthly Boniva
88
when should Atelvia be taken
after breakfast
89
what should you not use w/ Atelvia
H2Ra, PPI, Mg, Ca, Iron supplements
90
what is the dose of raloxifene
60 mg qd
91
if a patient is experiencing nausea on fosamax or actonel what are you option
Switch to Atelvia (taken after breakfast) or Zoledronic acid (injection)

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