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*OldPharm > Osteoporosis > Flashcards

Osteoporosis Flashcards

(54 cards)

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1
Q

what maintains serum calcium?

A

Parathyroid hormone

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2
Q

what organ does PTH act on to reabsorb calcium from the tubular filtrate?

A

kidney

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3
Q

PTH stimulates kidney to convert 25-OH-VitD to what?

A

1,25-(oh)2-VitD (calcitriol)

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4
Q

what is the endogenous (skin) form of vitamin D?

A

cholecalciferol (Vit D3)

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5
Q

What is the exogenous (diet) form of Vit D?

A

ergocalciferol (Vit D2)

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6
Q

this comes from the thyroid gland and is released in response to really high serum calcium levels.

A

Calcitonin

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7
Q

1 to 2.5 standard deviations below bone mass of a normal young adult

A

Osteopenia

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8
Q

It is 2.5 or more standard deviations below the bone mass of a normal young

A

Osteoporosis

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9
Q

What form of osteoporosis occurs in older people (usually >70), postmenopausal women

A

primary osteoporosis.

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10
Q

Type of osteoporosis that occurs in people with hyperthyroidism, steroid use, chronic kidney disease, smoking, excessive ETOH

A

secondary osteoporosis

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11
Q

does excess or too little protein in the diet lead to osteoporosis.

A

excess

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12
Q

what are some modifiable risk factors for osteoporosis

A 
Inadequate calcium and Vit D
Alochol use
sedentary
carbonated drinks
smoking
anorexia
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13
Q

what drugs used long term can lead to osteoporosis?

A 
heparin
lithium
anticonvulsants
thiazolidinediones 
aluminum
cytotoxic drugs
immunosuppressnats
TPN
GnRH agonists
progesterone
tamoxifen
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14
Q

What are Gonadotropin-releasing hormone agonist used for?

A

Polycystic Ovarian Syndrome

helps patients have normal cycles

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15
Q

who should be tested for osteoporosis?

A

All women >65 ( >60 w/ risk factors)

men >70 (>50 w/ risk factors)

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16
Q

Only calciums in IV preparation

A 
Calcium gluconate (replacement) 
Calcium chloride (code)
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17
Q

What calcium are available in PO form?

A

calcium gluconate
calcium carbonate (tums)
calcium lactate
calcium citrate

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18
Q

what type of calcium is also available in liquid form?

A

Calcium citrate

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19
Q

Indications for calcium

A

Hypocalcemia
calcium deficiency
osteoporosis or osteopenia

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20
Q

ADRs with calcium

A

GI problems
constipation
bradycardia
arrhythmias

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21
Q

what should be monitored anytime calcium is given IV?

A

monitor serum calcium levels every 6 hours

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22
Q

Inactive form of vit D (required liver and kidneys to convert)

Study These Flashcards
A

ergocalciferol

23
Q

what is the active form of Vit D?

24
Q

MOA of Vit D?

Study These Flashcards
A

acts on the gut to absorb calcium from the diet

25
Routes available for Vit D?
Oral IV UV reaction in skin
26
Indications for Vit D replacement
Hypocalcemia Vit D deficiency Postmenopausal osteoporosis renal failure
27
Expensive drug, recombinant paraythroid hormone that stimulates osteoblastic activity
Teriparatide
28
When is teriparatide only used?
Hx of osteoporotic fractures | multiple risk factors and failed/ intolerant to other therapies
29
ROA of teriparatide
20 mcg SubQ qday
30
C/I with teriparatide
Paget's dz increased alkaline phosphatase h/o radiation treatment
31
ADRs w/ teriparatide
dizziness, leg cramps | Transient increase in serum calcium
32
black box warning w/ teriparatide
osteosarcoma
33
what are Structural analogs of pyrophosphate
bisphosphonates
34
MOA of bisphosphonates?
MOA: works by inhibiting bone resorption via: Inhibits osteoclastic proton pump necessary for dissolution of hydroxyapatite Decreased osteoclastic formation/activation Increased osteoclastic apoptosis
35
bisphosphonates that are avaliable PO
alendronate (once a week) risedronate (once a week) ibadronate (once a month)
36
What bisphosphonates are given IV?
zoledronic acid (hypercalcemia of malignancy)
37
PO bisphosphonates should be administered how?
With a full glass of water 30 minutes before a meal remain upright for 30 minutes
38
C/I w/ bisphosphonates
renal impairment/ hypocalciemia | CrCl < 30-35 ml/min
39
what is a potential problem w/ the PO form of bisphosphonates
esophageal erosion
40
ADRs w/ IV form of bisphosphonates
Acute phase reactions (N/V, HA, myalgias, flue like symptoms)
41
works to increase mineral stores in bone, decreases activity of osteoclasts (and number) and acts in kidney. Found in salmon. increases spine BMD, bone architecture
calcitonin
42
ROA of calcitonin
intranasal | SubQ
43
what is calcitonin used for?
Hypercalcemia Paget's dz of the bone bone pain in metastatic dz bone pain in osteoporosis
44
ADRs of calcitonin
tingling in hands N/V flushing
45
Advnatages of calcitonin nasal spray
don't have to remain upright | don't have to avoid eating
46
disadvantages of calcitonin nasal spray
Is not as good at rebuilding bone Must remember which nare medication was placed previous day. Tolerance with continued use Must keep refrigerated
47
Acts like an estrogen in the bone, but estrogen antagonists in the breast and uterus. Decrease serum LDL and decreases vertebral fractures
Raloxifene
48
When to use raloxifene
1st line if patient postmenopausal and contraindication to bisphosphonates
49
ADRs with raloxifene
Chest pain and peripheral edema 3x risk for thromboembolism and PE hot flashes, weight gain
50
What is a 4th line treatment for osteoporosis
estrogen
51
disadvantages of estrogen
increases risk of breast cancer need to give w/ progesterone if intact uterus increased risk of thromboembolitic events
52
monoclonal antibody that slows bone breakdown and remodeling, is costly
Denosumab
53
who is Denosumab approved for?
Postmenopausal women with osteoporosis and high risk of fracture Patients with osteoporosis for whom other osteoporosis treatments have failed. Patients who cannot tolerate other osteoporosis treatments
54
ADRs of denosumab
``` decrease Ca levels back and extremity pain muscle and bone pain high cholesterol levels bladder infections ```

*OldPharm (12 decks)

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