Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SHPCPJEN2 > OsteoporosisSH > Flashcards

OsteoporosisSH Flashcards

1
Q

Osteoporosis

A

Prevention / lifestyle

Men 50 -70 y/o: 1000 mg / day
Men ≥ 71 & women ≥ 51 : 1200 mg/day

Vitamin D: ≈ 800 units per day
Milk ( 8oz ) 300 mg calcium
Celiac Dz: contributor to osteopenia: recommend gluten free diet

Weight bearing exercises

Reduc risk factors: smoking, coffee, alcohol use, glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Guidelines

A

Females 65 and over and 70 and over to get density testing
- post menopausal ≥ 50yo : earlier testing
-men > 50 with risk factors.

BMD: bone mineral density : DEXA ( quick painless preferred method )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

DEXA scan gives

A

T score
Normal = > -1
Between -1 to 2.5 osteopenia
Below - 2.5 osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Meds that causes osteoporosis

A

Corticosteroids
Antiepileptic drugs: phenytoin , pheno barb
•Aromatase inhibitors: Armidex, Femara, Aromasin : hormone therapy decrease production of estrogen. Estrogen is a protective agent.
GnRH : decreasing testosterone. Just like estrogen is a protective agent for female and their bones, testosterone is a protective agent for males for their bones.
PPI: decreases ca in system.
TZD: fracTures
SGLT inhibitors
SSRI
Depo Provera
Heparin
Lithium : can causes hypoparathyroidism and that can cause osteoporosis
Some chemo : MTX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Osteoporosis Tx

A

SERMS: selective estrogen receptor modulators

• Evista ( Raloxifene ): used for POSTMENOPAUSAL patients.

SE: #1 CLOTS, hot flashes , leg cramps, D/C 72 hours prior to and during immobilization.

DDI: cholestyramine ( decreases evista abs)
Levothyroxine ( evista can decrease levothyroxine level )

Counseling: with or without food. DVT sx monitor. Never use if hx of clots or pregnant. Not recommended pre menopausal. Use compression stockings.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bisphosphonates

A

1st line agent for men and women
MOA: inhibit osteoclast mediated bone resorption.
Stay in system for long period of time.

SE: GI N/V/D abdominal pain.
- GERD / ulcers
- pain( bone, muscle joints )
-osteonecrosis of the jaw. - uses peridot to for prevention of osteonecrosis of the jaw. Protects gums.
- All bisphonates cause hypocalcemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bisphosphonates B/G

A

Caution: hypocalcemia, inability to stand or sit upright, CKD

• Alendronate ( fosamax ) ( Binosto ) ( Tabs/Soln)
• Risendronate ( Actonel ) - tabs
• Risedronate delayed release ( atelvia ) - only Bisphosphonates that can be taken with food. All others on empty stomach.
• ibandronate ( Boniva)
• zoledronic acid ( reclast ) - IV 5 mg once a year used for osteoporosis
•zoledronic acid ( zometa ) IV 4 mg q 3 - 4 weeks. NOT indicated for osteoporosis
• pamidronate ( Aredia ) - IV NOT for osteoporosis

All can causes hypercalcemia, oral must stay upright. All worry about renal cant with CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Alendronate

A

Fosamax
Dose 5-10 mg QD or 35 to 70 mg once weekly

Indications: osteoporosis in POSTMENOPAUSAL females
Osteoporosis in men
Osteoporosis secondary to glucocorticoids
Paget disease :

Caution: if CrCl < 35 ml/Min dont give it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risendronate

A

Actonel / Atelvia

Paget’s disease
Osteoporosis for males
Glucocorticoid induced osteoporosis

Risendronate delayed release ( atelvia )

Caution: do not give if CrCl < 30 ml/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ibandronate

A

Boniva

Indication : tx and prevention of post menopausal osteoporosis

Caution: hypocalcemia , CrCl < 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Zoledronic acid

A

Reclast ( IV )

5 mg in a 100 mL ready to infuse soon

Avoid in renal impairment: dont use if CrCl < 35

Drink lots of water before this IV infusion. WHY? To protect kidneys.

4mg zometa : used for hypercalcemia
< 30 CrCl avoid zometa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pamidronate

A

Aredia ( IV only )

Not indicated for osteoporosis

Hypercalcemia
Multiple myeloma
Osteolytic
Pagets diseae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Denosumab

A

( prolix, Xgeva ) ( SQ )

If worried about CrCl and cant give Bisphosphonates you can give Denosumab instead

MOA: human IgG2 monoclonal a which inhibits or rather binds to the RANK ligand ( RANKL ) and prevents osteoclasts fomaton.

Contraindications: hypocalcemia
SE: hypocalcemia, osteonecrosis of the jaw

Use every 6 months.
Refrigerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Calcitonin

A

( miacalcin )

  • nasal spray IM subQ

Osteoporosis
Pagets
Hypercalcemia
Post menopausal osteoporosis

Caution: salmon allergy
Do not shake nasal spray.
1 spray per day. So alternate nostrils day to day.

Refrigerate: can be out 35 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Teriparatide

A

Forteo

Used for osteoporosis for only a total of 2 years.

Given subQ daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

For women: estrogen

A

Estrogen not recommended as first line. Can cause clots, breast cancer, endometrial cancer , hypercalcemia

DDI: inducers decrease effect.
• St. John’s wort, carbamazepine, rifampin

If patient has no hx of history of hysterectomy and pt getting estrogen, make sure they get it combined with estrogen and progesterone. Progesterone will help protect from endometrial cancer. If already had hysterectomy they can be on estrogen alone

17
Q

Estrogen used for HRT and osteoporosis

A

Estropipate ( ogen )

Activella ( estradiol + norethindrone )

Prefest ( estradiol + norgestimate )

Medroxyprogesterone + estrogen ( premphase )

18
Q

Estrogen patches

A

Vivelle - dot ( estradiol ) : twice weekly
Alora( estradiol ) : twice weekly

Menostar ( estradiol ) once weekly
Climara ( estradiol ) once weekly
Climara pro ( estradiol + levonorgestrel ) once weekly

19
Q

POSTmenopauasal women REview

A

Oral Bisphosphonates are first line - cant give if not upright or esophageal disorders

Can’t take oral maybe IV. If renal issues cant even give IV

Denosumab : prolia ( subq) : can give if renal impairment ( CrCl < 30 or 35) . Not a Bisphosphonates.

Teriparatide ( forteo ) : can only give for 2 years

Raloxifene: if the patient needs breast cancer prophylaxis - it’s a SERM ( SE: clots!)

20
Q

For men

A

Oral Bisphosphonates first line

Teriparatide ( forteo ) : only for patients with high fracture risk. Refrigerate. Max 2 years of use
Hypercalcemia, orthostatic hypotension

Denosumab ( prolia ) for men at high risk of fracture due to androgen deprivation therapy for prostate cancer.

Testosterone replacement for men with low serum levels

SHPCPJEN2 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions