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Pharmacology II > Osteoporosis > Flashcards

Flashcards in Osteoporosis Deck (52):
1

When do men and women begin to lose bone mass?

30s-40s (reduced bone formation)

2

What effect does Estrogen deficiency have during menopause

less estrogen increases osteoclast activity increasing bone resorption more than formation

3

Osteoblast function

osteoblasts "b"uild bone!

4

Name some drugs that cause osteoporosis

1. Systemic corticosteroids
2. Thyroid replacement
3. Antiepileptic drugs (ex. phenytoin and phenobarbital)

5

Risk factors for fracture

-age
-history of fracture
-rheumatoid arthritis
-excessive alcohol
-smoking
-inflammatory bowel disease, hypogonadism

6

FRAX tool

-created by WHO
-uses risk factors to predict probability of fracture in next 10 years

7

Garvan calculator

-uses 4 risk factors (age, sex, low-trauma fracture, falls)
-Calculates 5 and 10 year risk of hip fracture and major bone fx


[corrects some disadvantages of FRAX)

8

What is osteoporosis diagnosis based on?

1. Low trauma fracture

or

2. Central hip and/or spine DXA using WHO T-score thresholds

9

Osteopenia T score

T-score between -1 and -2.5

(low bone mass)

10

Osteoporosis T score

T-score -2.5 or less

11

Who does the T score apply to?

-postmenopausal women
-perimenopausal women
-men 50+

12

Who does the Z score apply to?

diagnosis of osteoporosis in

-children
-premenopausal women
-men under 50

13

What does the Z-score have to be to diagnose osteoporosis in children, premenopausal women, and men under 50?

Z score of less than 2 (in combination with other risk factors or fracture)

14

What is the antiresorptive therapy of choice along with calcium and vitamin D?

Bisphosphonates

15

What does Vitamin D increase intestinal absorption of?

calcium and phosphorous

16

What is the recommended dietary allowances of calcium for adults 19-50 years old?

1000-2,500mg

17

What is the recommended dietary allowance of vitamin D for ages 9 to 70?

600- 4,000mg

18

Which form of calcium is better tolerated

Calcium citrate (but, more expensive)

calcium carbonate (gas, bloating, constipation)

19

Adverse effects of calcium supplementation

1. Hypophosphotemia
2. Hypercalcemia

20

How do you treat Vitamin D deficiency

50,000iu weekly for 8-12 weeks

21

Who are bisphosphonates indicated for

-postmenopausal female
-men
-glucocorticoid-induced osteoporosis

22

Intravenous and oral ibandronate is indicated only for _______

postmenopausal women

23

Bisphosphonate: MOA

inhibit bone resorption:

-decreased osteoclast maturation, number, recruitment, and life span

24

Bisphosphonate 1/2 life

up to 10 years

25

What is important to remember about taking oral Alendronate (Fosamax)

Take in the morning on an empty stomach and don't eat or lie down for at least 30 minutes. Avoid taking with calcium and vitamin D

26

What is important to remember about oral Ibandronate (Boniva)?

Take in the morning on an empty stomach and don't eat for at least 60 minutes

27

What is important to remember about Risedronate (Atelvia)?

Immediate release like Alendronate (take on empty stomach and wait 30 min)

Delayed release- take immediately following breakfast

28

How is zoledronic acid given?

IV once a year

29

What can be given before infusion with zoledronic acid to decrease infusion reactions?

acetaminophen

30

When is zoledronic acid contraindicated?

if CrCl is <35 mL/min

31

ADEs of oral bisphosphonates

nausea
dyspepsia

32

ADEs of IV bisphosphonates

transient flu-like illness

33

What are 2 rare and adverse effect of bisphosphonates?

1. osteonecrosis of the jaw

2. Subtrochanteric femoral fracture

34

Bisphosphonate contraindications

1. Creatinine clearance of <30-35mL/min
2. Esophageal abnormalities
3. Pregnancy

35

Who can be considered eligible for a "drug holiday" on bisphosphonates?

1. Women without evidence of a low-trauma fracture

2. If good response to treatment

3. If BMD increasing to >-2 (getting into osteopenic range)

36

When can a drug holiday be considered?

If low risk can consider stopping after 5 years of treatment

If high risk for fracture (T-score below -3.5, consider alendronate for up to 10 years

37

At what age can calcitonin be used?

at least 5 years past menopause

38

What form does calcitonin come in?

nasal spray

(refrigerate until opening, then use at room temp)

39

Raloxifene (Evista) and bazedoxifene (Duavee) drug class

Estrogen Agonist/Antagonist

40

What is Teriparatide

recombinant pieces of PTH

41

Who is Teriparatide indicated for?

Very low bone density with T score

42

What is important for the first dose of teriparatide?

patient needs to be sitting or lying down as first dose can cause orthostatic hypotension

43

Teriparatide dosing?

daily subcutaneous injection

44

Abaloparatide

synthetic analog of human PTH

(acts as an anabolic agent to stimuate bone formation)

45

Who is abaloparatide used for?

high-risk postmenopausal osteoporosis

46

Denosumab: MOA

RANKL inhibitor that inhibits osteoclatogenesis and increases osteoclast apoptosis

47

Denosumab: ADEs

-back, extremity, and musculoskeletal pain
-increased cholesterol
-cystitis

48

When is calcitonin used?

LAST RESORT

49

First line therapy for osteoporosis

1. Alendronate
2. Risedronate
3. Zoledronic acid
4. Denosumab

50

What causes Osteomalacia?

Undermineralized bone from prolonged vitamin D deficiency

51

Osteomalacia treatment?

Vitamin D

52

What labs may be seen in osteomalacia

elevated alkaline phosphatase

hypocalcemia