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Pharm Final > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What organs does PTH use to control calcium and phosphate concentrations?

A

bone (uses Ca stores), blood/small intestines, and kidney

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2
Q

normal effect of PTH on bone?

A

increases turnover by acting on osteoblasts to release RANK ligand proteins which activate/upregulating osteoclasts increasing turnover

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3
Q

dose changes the effect of PTH on bone, what is the effect of low and intermittent dosing?

A

increased bone formation without bone reabsorption

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4
Q

what effect does PTH have on blood calcium levels?

A

increases Ca concentrations by acting on kidneys:

  • to increase uptake from small intestines
  • to increase reabsorption from urine
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5
Q

what effect does PTH have on the kidneys?

A

increases vitamin D formation which increases absorption of Ca from the small intestines

increases reabsorption of Ca from the urine

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6
Q

how is vitamin D stored?

A

in fat

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7
Q

how is vitamin D cleared from the body?

A

the liver

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8
Q

what is vitamin D? how is vitamin D activated?

A

a prohormone

it is activated by the liver and kidneys

the liver hydroxylates it to 25-hydrocyvitamin

the kidney than hydroxylates it again to 1,25 dihydroxyvitamin D (active form)

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9
Q

which form of vitamin D is given in ESRD?

A

1,25 dihydroxyvitamin D

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10
Q

MOA of vitamin D?

A

increases blood Ca & phosphate levels

stimulates intestinal & urinary Ca reabsorption, indirectly stimulates bone reabsorption (like PTH), and stimulates phosphate absorption

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11
Q

MOA of PTH?

A

increases Ca blood levels and decreases phosphate levels (in creases kidney secretion)

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12
Q

what is the drug that is an analog of the biologically active form of vitamin D (1,25 dihydroxyvitamin D)

A

calcitriol (vitamin D3)

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13
Q

principal naturally occurring hormones involved in bone remodeling?

A

PTH

vitamin D

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14
Q

secondary regulators of bone metabolism (having a minor effect on bone)?

A

calcitonin
glucocorticoids
estrogen

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15
Q

What stimulates the release of calcitonin? what organ secretes it?

A

increases blood CA levels stimulates secretion of calcitonin from the thyroid gland

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16
Q

MOA of calcitonin?

A

decreases osteoclast activity (inhibits bone reabsorption) and increases life span of osteoblasts (bone formation and reabsorption is reduced)

decreases Ca and phosphate reabsorption from the kidney

(opposite vitamin D)

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17
Q

what is calcitonin used to treat?

A

paget’s disease
hypercalcemia
osteoporosis

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18
Q

MOA of steroids?

A

antagonizes vitamin D (decreases Ca reabsorption from intestines)

stimulates renal calcium excretion

blocks bone formation (chronic use can cause osteoporosis/growth impairment)

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19
Q

disease steroids be used for hypercalcemia?

A

with lymphomas

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20
Q

estrogen stimulates receptors on bone to:

A

inhibit bone reabsorption by PTH

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21
Q

effect of estrogen on bone?

A

increases formation (and decreased turnover)

usually: just prevent bone loss more than build bone

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22
Q

what form of osteoporosis is estrogen used to treat?

A

postmenopausal

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23
Q

bisphosphonate examples

A

alenronate, risedronate, zolendronic (1st line)

ibandronate (2nd line)

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24
Q

treatment of choice for osteoporosis

A

bisphosphonates

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25
Q

how can bisphosphonates be dosed?

A 
daily
weekly
monthly
q3 months
yearly
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26
Q

MOA of bisphosphonates?

A

inhibits bone reabsorption by acting on osteoclasts or osteoclast precursors

leads to indirect increase in mineral density

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27
Q

how are bisphosphonates administered?

A

orally, effervescent, parenterally

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28
Q

benefits of parenteral bisphosphonates?

A

less GI irritation

larger doses

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29
Q

education for taking PO bisphosphonates?

A

take on an empty stomach (to help increase absorption)

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30
Q

how are bisphosphonates metabolized/excreted?

A

small amount attaches to bone and stays for 10 years

31
Q

uses of bisphosphonates?

A
  • osteoporosis prevention/treatment (increases bone density and prevents vertebral AND hip fractures)
  • increases BMD in men
  • steroid induced osteoporosis
  • hypercalcemia from cancer
  • paget’s disease (higher doses)
32
Q

what is the only drug that prevents HIP fractures?

A

bisphosphonates

33
Q

GI SE of bisphosphonates? how can you reduce them?

A 
abdominal distention
gas
gastritis
acid regurgitation
esophageal ulcer
dysphasia

take with water and remain upright for 30-60 minutes (30 for first line, 60 for ibandronate)

take risedronate sodium delayed release with food (only one to take with food)

34
Q

HA, musculoskeletal pain, and rash are additional SE for what drug?

A

bisphosphonates

35
Q

rare SE of bisphosphonates? usually associated with what procedure in what population? what dose/route of administration puts you at highest risk for this SE?

A

osteonecrosis (AVN) of jaw usually associated with dental procedures in patients with cancer

high dose IV administration has greater risk than PO

36
Q

cancer associated with bisphosphonates?

A

esophageal

37
Q

fractures associated with bisphosphonates?

A

atypical

38
Q

contraindications for bisphosphonates?

A

esophageal motility disorders
PUD
renal dysfunction

39
Q

drug analog to PTH?

A

teriparatide

40
Q

what is the only anabolic therapy for bone (increases BMD, bone mass, and strength)?

A

teriparatide

41
Q

MOA of teriparatide?

A

stimulates osteoblasts
increases intestinal Ca reabsorption*
increases kidney reabsorption of Ca and phosphate*

42
Q

SE of teriparatide?

A

Nausea and orthostatic hypotension

43
Q

contraindications for teriparatide?

A

if at risk for osteosarcoma
hypercalcemia
bone metastases

44
Q

who is at risk for osteosarcoma?

A

paget’s disease
unexplain alk phase increase
kids
hx of bone radiation

45
Q

what do you need to monitor with tripartite?

A

Ca levels

46
Q

uses of teriparatide?

A

women at high risk of fracture (very low BMD or previous vertebral fx)

47
Q

what type of fractures does teriparatide help with?

A

vertebral (65%)
nonvertebral (53%)
DOES NOT DECREASE HIP FX

48
Q

dose of teriparatide

A

20 mcg/day SQ, first dose laying down to prevent orthostatic hypotension

49
Q

how long should teriparatide be given for? why?

A

2 years max (than switch to bisphosphonates because of risk of bone cancer)

50
Q

MOA of SERMS?

A

reduce bone reabsorption

51
Q

SERM examples?

A

raloxifene

52
Q

dose of raloxifine?

A

60 mg daily

53
Q

fx that raloxifine helps with?

A

vertebral (30-50%)

DOES NOT HELP WITH HIP FX

54
Q

SE of SERMs

A

hot flashes
clots (first 4 months)
leg cramps

55
Q

contraindications of SERMs

A

pregnancy
nursing
kids
history of VTE

56
Q

administration of calcitonin?

A

SQ

inhaled

57
Q

fx calcitonin helps with?

A

vertebral

NOT HIP FX

58
Q

uses of calcitonin?

A

bone pain from vertebral compression fx (releases endorphins to decrease pain)
paget’s diease
hypercalcemia
osteoporosis in women postmenopausal for atleast 5 years

59
Q

what line of treatment is calcitonin for osteoporosis?

A

third line (last line)

60
Q

who is Ca supplement recommended for? why?

A

all people with osteoporosis to maintain normal Ca levels and prevent hypocalcemia from drug treatments

61
Q

MOA of Ca supplements?

A

increases bone density

62
Q

does Ca prevent bone fx?

A

no

63
Q

dose of Ca for young males/females, old males/females, and those with steroid induce osteoporosis?

A

20-50 males and females: 1000 mg
50-70 males: 1000 mg
50 70 females: 1200 mg
steroid induced: 1500 mg

do not exceed 2500 mg

64
Q

SE of Ca?

A 
constipation
gas (Ca carbonate)
renal stones (Ca citrate)
65
Q

who is vitamin D recommended to?

A

all patients with osteoporosis because it maximizes absorption of Ca from intestines

66
Q

minimal dose of vitamin D for osteoporosis

A

600 IU younger than 70
800 IU older 70
steroid induced: 1200 IU
higher doses if blood less less than 30 ng

67
Q

when to use SERMs

A

only when pt won’t take or can’t tolerate bisphosphonates

68
Q

what line of treatment is teriparatide for osteoporosis?

A

third (after bisphosphonates and SERMs)

69
Q

how to treat male osteoporosis?

A

bisphosphonates
avoid risk factors
testosterone injections if low T

70
Q

tx of steroid induced osteoporosis

A

bisphosphonates
1500 mg calcium
1200 IU vitamin D

71
Q

what is paget’s disease?

A

localized problem in bone at multiple sites (reabsorb bone and lay down poorly organized bone)

72
Q

goal of tx for paget’s disease?

A

reduce bone pain

stabilize or prevent other problems

73
Q

first line agents for paget’s disease?

A

calcitonin and bisphosphonates (at high doses… 4x)

Pharm Final (3 decks)

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