Osteoporosis and Other Metabolic Bone Disease

Question 1

Osteoporosis treatment of choice

Answer 1

Bisphosphonates

Question 2

Bisphosphonates MOA

Answer 2

Mimics pyrophosphate, an endogenous bone resorption inhibitor

Question 3

Bisphosphonates indicated for postmenopausal, male, and glucocorticoid-induced osteoporosis

Answer 3

Alendronate
risedronate
intravenous zoledronic acid

Question 4

Bisphosphonate ONLY indicated for postmenopausal osteoporosis

Answer 4

Intravenous and oral ibandronate

Question 5

Contraindications for Bisphosphonates

Answer 5

Pts with creatinine clearances less than 30 to 35 mL/min
Pts who have serious GI conditions
Pts who are pregnant

Question 6

Adverse effect of Bisphosphonates

Answer 6

Osteonecrosis of the jaw- Black Box Warning

Question 7

What should the pt do when taking Bisposphonates?

Answer 7

The patient should remain upright for at least 30 minutes after alendronate and risedronate and 1 hour after ibandronate administration

Question 8

Patient’s serum calcium concentrations must be _______ prior to using bisphosphonates

Answer 8

Normal

Question 9

Administration

Answer 9

Oral dose should be taken with at least 6 ounces of plain tap water (not coffee, juice, mineral water, or milk) at least 30 minutes before consuming any food, supplements (including calcium and vitamin D), or medications

Question 10

What is a full human monoclonal antibody used for osteoporosis?

Answer 10

Denosumab

Question 11

Denosumab MOA

Answer 11

Inhibits RANKL from binding RANK receptor on the surface of osteoclast precursor cells and mature osteoclasts

aka It inhibits osteoclastogenesis and increases osteoclast apoptosis

Question 12

Indication for Denosumab

Answer 12

women and men at high risk for fracture (used to increase bone mass in men receiving androgen deprivation therapy and in women receiving adjuvant aromatase inhibitor therapy)

Question 13

Adverse Effects of Denosumab

Answer 13

Bone turnover suppression and serious skin infections (Rare)

Question 14

What is Raloxifene (Mixed Estrogen Agonists/Antagonists) indicated for?

Answer 14

prevention and treatment of postmenopausal osteoporosis

invasive breast cancer risk reduction

Question 15

Raloxifene MOA

Answer 15

estrogenic agonist actions in bone but antagonist actions in breast and uterine tissue

Question 16

Does Raloxifene have positive Lipid effects?

Answer 16

Yup.

Question 17

Does Raloxifene have reduction in cardiovascular effects?

Answer 17

Na.

Question 18

Raloxifene contraindications

Answer 18

Pts with active or past history of venous thromboembolic event

Question 19

When should therapy be stopped?

Answer 19

If the pt anticipates extended immobility

Question 20

Adverse Reaction

Answer 20

Hot flashes

Question 21

What is Calcitonin

Answer 21

endogenous hormone released from the thyroid gland when serum calcium is elevated

Question 22

If a pt is allergic to fish (salmon) should Calcitonin be given?

Answer 22

No. It comes from salamon

Question 23

What line treatment is Calcitonin?

Answer 23

LAST

Question 24

Name an Anabolic Therapy

Answer 24

Teriparatide

Question 25

What is Teriparatide?

Answer 25

It is a recombinant product representing the first 34 amino acids in human PTH

Question 26

Teriparatide is indicated in who?

Answer 26

postmenopausal women, men, and patients on glucocorticoids who are at high risk for fracture

Question 27

What position should the pt be in when receiving the first dose?

Answer 27

sitting or lying down in case orthostatic hypotension occurs

Question 28

Teriparatide Adverse Effects

Answer 28

Transient hypercalcemia ( measure serum Ca at 1 month and decr Ca intake if high)

Question 29

Teriparatide black box warning

Answer 29

Incr risk of osteosarcoma

Question 30

Can you use Estrogen and Testosterone as therapy for osteoporosis?

Answer 30

Yeah

Question 31

RA is associated with an incr risk of what?

Answer 31

Cardiovascular mortality

Question 32

What can be used for symptomatic relief?

Answer 32

NSAIDS and/or corticosteriods

Question 33

What does DMARD stand for?

Answer 33

Disease-modifying antirheumatic drug

Question 34

How long does it take for DMARDs to show benefit?

Answer 34

Weeks to months

Question 35

Examples of Non-Biologic DMARDS

Answer 35

- Methotrexate - hydroxychloroquine - sulfasalazine - leflunomide - Minocycline

Question 36

Examples of Biologic DMARDS

Answer 36

- Anti-TNF drugs (etanercept, infliximab, adalimumab, certolizumab, golimumab) - abatacept - rituximab

Question 37

What do biologic DMARDS do?

Answer 37

Deplete Perif B cells

Question 38

What is less commonly used for RA?

Answer 38

-IL-1 receptor antagonist anakinra, azathioprine, D-penicillamine - gold - minocycline - cyclosporine - cyclophosphamide

Question 39

What properties does Methotraxate have?

Answer 39

Anti-inflam

Question 40

When given Methotrexate what also needs to be given?

Answer 40

Folic acid suppliment

Question 41

Leflunomide has a risk of?

Answer 41

Liver Tox

Question 42

Leflunomide is contraindicated in who?

Answer 42

Pts planning to be pregnant or are pregnanat

Question 43

What is the main advantage to Hydroxychlotoquine?

Answer 43

the lack of myelosuppressive, hepatic, and renal toxicities

Question 44

What are some short term toxicities of hydroxychloroquine? How can you manages them?

Answer 44

nausea, vomiting and diarrhea. Take with a meal

Question 45

Major side effect of hydroxychloroquine

Answer 45

Ocular Toxicity

Question 46

Contraindication of Anti-TNF agents

Answer 46

CHF

Question 47

Abatacept is approved for .....

Answer 47

the treatment of RA in patients with moderate to severe disease who fail to achieve an adequate response from one or more DMARDs

Question 48

How does Abatacept function?

Answer 48

by binding to CD80/CD86 receptors (prevents inflammatory process)

Question 49

Who is Rituximab used for?

Answer 49

patients who failed methotrexate or TNF inhibitors

Question 50

What does Tocilizumab do?

Answer 50

attaches to IL-6 receptors (IL-6 plays a role in RA inflam)

Question 51

What is Anakinra?

Answer 51

naturally occurring IL-1 receptor antagonist

Question 52

Can NSAIDs and Acetaminophen be used for Osteoarthritis?

Answer 52

Yup

Question 53

If they have kidney problems what should you do?

Answer 53

Use Acetaminophen. If you have to us NSAIDs fort some reason use the smallest possible dose.

Question 54

What should you use if they have cardiovascular problem?

Answer 54

Naproxen--> Max dose is 1000mg

Question 55

Max dose of Ibuprofen?

Answer 55

3200mg

Question 56

Example of a COX2 inhib?

Answer 56

Celebrex

Question 57

Where is COX1 expressed?

Answer 57

Gastric Mucosa and vascular endothelial cells

Question 58

What should the pt do to minimize adverse drug reactions from NSAIDs?

Answer 58

Take with food or milk

Question 59

Do NSAIDs incr BP?

Answer 59

Yeah

Question 60

What is a topical Therapy for OA?

Answer 60

Capsaicin--> Depletes substance P

Question 61

Alternative Therapies for OA

Answer 61

- glucosamine and chondroitin - Coticosteroids - Hyaluronic acid - Tramadol - Low dose opioids

Question 62

How is uric acid cleared form the body?

Answer 62

Renally

Question 63

Who is gout consistently higher in?

Answer 63

obese individual or those who consume large amounts of alcohol or higher amounts of meat or fish

Question 64

What drugs are capible of inducing hyperuricemia and gout?

Answer 64

Diuretics | Salicylates

Question 65

What is a antimitotic drug that is highly effective at relieving acute attacks of gout?

Answer 65

Colchicine

Question 66

What happens if you delay the initiation of Colchicine?

Answer 66

The probability of success diminishes substantially

Question 67

What does Xanthine Oxidase do?

Answer 67

Lowers uric acid Concentration

Question 68

Examples of Xanthine Oxidases

Answer 68

Allopurinol (first line but needs renal adjustment) and febuxostat (no renal adjustment needed)

Question 69

What are examples of Uricosuric Drugs?

Answer 69

Probenecid and sulfinpyrazone

Question 70

How should uricosuric drugs be administered?

Answer 70

Start with a low dose to avoid stone formation

Question 71

What is a major disadvantage of Uricosurics?

Answer 71

Salicylates may interrupt its mechanism resulting in treatment failure

Question 72

Contraindication of uricosurics

Answer 72

Creat clearance <50 mL/min and hx of renal calculi

Question 73

Major adverse effects of uricosurics

Answer 73

gi irritation, rash, hypersensitivity, precipitation of acute gouty arthritis, stone formation

Question 74

When taking uricosurics they should be kept...

Answer 74

well hydrated