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NAPLEX Prep > Osteoporosis > Flashcards

Osteoporosis Flashcards

(64 cards)

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1
Q

Patient risk factors of OP

A

Advanced age
Ethnicity (Caucasian and Asian)
Family hx
Females > males
Low body weight

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2
Q

Medical Diseases RF OP

A

Diabetes
Eating disorder
GI disease
Hyperthyroidism
Hypogonadism
Menopause
RA and autoimmune

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3
Q

Lifestyle RF of OP

A

Smoking
Excessive alcohol intake
Low calcium intake
Low vitamin D
Physical inactivity

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4
Q

Medications that can ↑ risk or OP

A

PPIs
Lithum
GnRH
Depo-Provera
Aromatase inhibitors
Antiseizure meds
Chronic steroids
Thyroid hormone excess
SSRIs, TZD, tenofovir, loop

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5
Q

Differentiate osteoblasts from osteoclasts

A

Osteoblasts: Cells involved with bone formation

Osteoclasts: Cells involved with bone breakdown and resorption

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6
Q

Gold standard of diagnosing Osteo

A

Measure BMD through DEXA (DXA) scan

Measuring T-score and Z-score

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7
Q

Recommended age for BMD scan

A

Women: ≥65YO
Men: ≥70YO

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8
Q

What is the FRAX tool?

A

Estimates the risk of osteoporotic fractures in the next 10 yrs

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9
Q

How do you interpret a T-score?

A

Normal: ≥1
Osteopenia: -1 to -2.4
Osteoporosis: ≤2.5

Standard deviation of an average, healthy, young, white adult

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10
Q

Osteoporosis prevention (non-pharm)

A
  1. Medications that cause sedation or orthostasis (sedatives, hypnotics, narcotics)
  2. Weight-bearing exercises and muscle-strengthening
  3. Dietary calcium and Vitamin D
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11
Q

Recommended dose of calcium

A

1000-1200 mg elemental Ca

Don’t exceed 500-600 mg E Cal per dose because calcium absorption is saturable

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12
Q

Elemental Ca in products

A

Calcium carbonate: 40% (acidic-dependent) → take with food

Calcium citrate: 21% (not acid-dependent) → take with or without food

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13
Q

What is considered Vit D deficient

A

<30

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14
Q

Doing of Vit D

A

Cholecalciferol: 125-175 mg (5000-7000 IU) QD

Ergocalciferol: 1250 mcg (50000 IU) QW

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15
Q

ADR of calcium

A

Constipation

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16
Q

Criteria to initiate treatment for OP

A

T-score ≤2.5 in the spine, femoral neck, total hip or 1/3 radius OR

Presence of fragility fracture regardless of BMD

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17
Q

Criteria to initiate treatment for osteopenia if high risk

A

Low bone density (-1 to -2.5)
AND
FRAX score indicates a 10-yr probability of a major osteoporosis-related fracture ≥20% or a 10-yr hip fracture probability of ≥3%

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18
Q

Tx indicated for prevention

A

Bisphosphonates (except IV ibandronate)
Estrogen-based therapies (Raloxifene, Duavee)

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19
Q

Drugs indicated for tx of OP

A

Bisphosphonates
Denosumab
PTH analogs
Calcitonin

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20
Q

MOA of bisphophonates

A

Inhibiting osteoclast activity and bone resorption

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21
Q

PO bisphosphonates

A

Alendronate
Ibandronate
Risendronate

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22
Q

Albendronate

A

Fosamax, Binosto

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23
Q

Ibandronate

A

Boniva

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24
Q

Risedronate

A

Actonel, Atelvia

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25
Dosing of Fosamax
Prevention (postmen only): 5 mg PO QD or 35 mg PO QW Treatment: 10 mg PO QD or 70 mg PO QW
26
Dosing of Risedronate
Prevention and treatment (postmen): 5 mg PO QD, 35 mg PO QW, or 150 mg PO QM
27
Dosing of Ibandronate
Prevention and treatment (postmen): 150 mg PO QM
28
CI of bisphosphonates
Hypocalemia, inability to stand or sit up for 30 min
29
ADR and warnings of bisphosphonates
ONJ, atypical femur fracture, esophagitis (esophageal ulcer), hypocalcemia, renal impairment Dyspepsia, dysphagia, heartburn, NV
30
Counseling for bisphosphonates
1. Dental work should be completed prior to starting treatment 2. Separate from cations by 2 hrs 3. Separate by 30 min from food and beverages (except water) 4. Take in the morning with 6-8 oz of plain water → 30 min before first food 5. Stay upright for 30 min (60 min for Bonita)
31
Counseling of Atelvia
1. Take with ≥4oz of water immediately after breakfast 2. Don't take acid suppressing med → need acidic gut for absorption
32
Counseling of Binosto
Dissolve in 4 o of plain water. Wait 5 min to dissolve, then stir for 10 sec
33
Inj bisphosphonates
Ibandronate Zoledronate
34
Duration of ibandronate IV
Q3M
35
Duration of zolendronate
Prevention (postmen): Q2Y Treatment: QY
36
When is IV bisphosphonates indicated
Preferred if esophagitis is present due to risk of esphageal cancer
37
MOA of raloxifene
SERM that ↓ bon resorption
38
What is in Duavee
Conjugated estrogens/Bazedoxifene
39
Indication for Duavee
Prevention in postmenopausal females with a uterus
40
BBW for raloxifene
↑ VTE → death due to stroke
41
CI of raloxifene
Pregnancy and hx of VTE
42
ADR of raloxifene
Hot flashes, peripheral edema, arthralgia, leg cramps
43
Raloxifene
Evista
44
BBW of Duavee
Endometrial cancer (unopposed estrogen) → ↑ DVT and stroke
45
CI of Duavee
Breast cancer, pregnancy, uterine bleeding, hx of VTE
46
Warning of Duavee
↑ risk of breast and ovarian cancer
47
MOA of calcitonin
Inhibits bone resorption by osteoclast
48
Calcitonin
Miacalcin
49
Indication for calcitonin
Treatment (females >5 yrs postmenopausal)
50
Warning of calcitonin
Hypocalcemia, increased risk of malignant, hypersensitivity to salmon derived products
51
MOA of PTH analogs
Stimulates osteoblast activity and increases bone formation
52
PTH analogs
Terparatide Abaloparatide
53
Formulation of PTH analogs
SC QD
54
ADR of PTH analogs
Osteosarcoma (bone cancer) Hypercalcemia Arthralgia, leg cramps, nausea, orthostasis/dz
55
Counseling of PTH analogs
Keep refrigerated Protect from light (Forteo) Higher risk for fractures → treatment duration is restricted to 2 years or less
56
MOA of denosumab
Monoclonal antibody that binds to RANKL and blocks its interaction with RANK (a receptor on osteoclasts) to prevent osteoclast formation → higher risk for fracture
57
Denosumab
Prolia, Xgeva (hypercalcemia)
58
Duration of Prolia
Q6M
59
BBW of Denosumab
Hypocalcemia in advanced kidney disease
60
CI of Prolia
Hypocalcemia, pregnancy
61
ADR of Prolia
ONJ, femur fracture HTN, fatigue, edem, NVD, ↓ PO4 If DC'd, bone loss can be rapid
62
Indication for romosozumab
Postmenopausal females with a history of osteoporotic fracture or multiple risk factors
63
Romosozumab
Evenity
64
Formulation of Calcitonin
Nasal spray and injection

NAPLEX Prep (71 decks)

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