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Osteoporosis Flashcards

(73 cards)

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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
how can bisphosphonates be dosed?
``` daily weekly monthly q3 months yearly ```
26
MOA of bisphosphonates?
inhibits bone reabsorption by acting on osteoclasts or osteoclast precursors leads to indirect increase in mineral density
27
how are bisphosphonates administered?
orally, effervescent, parenterally
28
benefits of parenteral bisphosphonates?
less GI irritation | larger doses
29
education for taking PO bisphosphonates?
take on an empty stomach (to help increase absorption)
30
how are bisphosphonates metabolized/excreted?
small amount attaches to bone and stays for 10 years
31
uses of bisphosphonates?
- 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
what is the only drug that prevents HIP fractures?
bisphosphonates
33
GI SE of bisphosphonates? how can you reduce them?
``` 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
HA, musculoskeletal pain, and rash are additional SE for what drug?
bisphosphonates
35
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?
osteonecrosis (AVN) of jaw usually associated with dental procedures in patients with cancer high dose IV administration has greater risk than PO
36
cancer associated with bisphosphonates?
esophageal
37
fractures associated with bisphosphonates?
atypical
38
contraindications for bisphosphonates?
esophageal motility disorders PUD renal dysfunction
39
drug analog to PTH?
teriparatide
40
what is the only anabolic therapy for bone (increases BMD, bone mass, and strength)?
teriparatide
41
MOA of teriparatide?
stimulates osteoblasts increases intestinal Ca reabsorption* increases kidney reabsorption of Ca and phosphate*
42
SE of teriparatide?
Nausea and orthostatic hypotension
43
contraindications for teriparatide?
if at risk for osteosarcoma hypercalcemia bone metastases
44
who is at risk for osteosarcoma?
paget's disease unexplain alk phase increase kids hx of bone radiation
45
what do you need to monitor with tripartite?
Ca levels
46
uses of teriparatide?
women at high risk of fracture (very low BMD or previous vertebral fx)
47
what type of fractures does teriparatide help with?
vertebral (65%) nonvertebral (53%) DOES NOT DECREASE HIP FX
48
dose of teriparatide
20 mcg/day SQ, first dose laying down to prevent orthostatic hypotension
49
how long should teriparatide be given for? why?
2 years max (than switch to bisphosphonates because of risk of bone cancer)
50
MOA of SERMS?
reduce bone reabsorption
51
SERM examples?
raloxifene
52
dose of raloxifine?
60 mg daily
53
fx that raloxifine helps with?
vertebral (30-50%) | DOES NOT HELP WITH HIP FX
54
SE of SERMs
hot flashes clots (first 4 months) leg cramps
55
contraindications of SERMs
pregnancy nursing kids history of VTE
56
administration of calcitonin?
SQ | inhaled
57
fx calcitonin helps with?
vertebral | NOT HIP FX
58
uses of calcitonin?
bone pain from vertebral compression fx (releases endorphins to decrease pain) paget's diease hypercalcemia osteoporosis in women postmenopausal for atleast 5 years
59
what line of treatment is calcitonin for osteoporosis?
third line (last line)
60
who is Ca supplement recommended for? why?
all people with osteoporosis to maintain normal Ca levels and prevent hypocalcemia from drug treatments
61
MOA of Ca supplements?
increases bone density
62
does Ca prevent bone fx?
no
63
dose of Ca for young males/females, old males/females, and those with steroid induce osteoporosis?
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
SE of Ca?
``` constipation gas (Ca carbonate) renal stones (Ca citrate) ```
65
who is vitamin D recommended to?
all patients with osteoporosis because it maximizes absorption of Ca from intestines
66
minimal dose of vitamin D for osteoporosis
600 IU younger than 70 800 IU older 70 steroid induced: 1200 IU higher doses if blood less less than 30 ng
67
when to use SERMs
only when pt won't take or can't tolerate bisphosphonates
68
what line of treatment is teriparatide for osteoporosis?
third (after bisphosphonates and SERMs)
69
how to treat male osteoporosis?
bisphosphonates avoid risk factors testosterone injections if low T
70
tx of steroid induced osteoporosis
bisphosphonates 1500 mg calcium 1200 IU vitamin D
71
what is paget's disease?
localized problem in bone at multiple sites (reabsorb bone and lay down poorly organized bone)
72
goal of tx for paget's disease?
reduce bone pain | stabilize or prevent other problems
73
first line agents for paget's disease?
calcitonin and bisphosphonates (at high doses... 4x)

Pharm Final (3 decks)

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