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Theraputics Winter > Osteperosis > Flashcards

Osteperosis Flashcards

1
Q

How long does it take for osteoblast and osteoclast to reform

A

Blast 3-4 months
Class 3-4 weeks

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2
Q

When do you start losing bone mass and at what rate

A

After 30
.4% per year

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3
Q

Why do we worry about osteoporosis for women

A

Menopause early years osteoclast reabsorb too much and later years osteoblast does activity decreased

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4
Q

What counts as chronic glucocorticoid

A

≥ 5mg for ≥ 3 months

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5
Q

How long for anticoagulants to have OP

A

Yes UFH/LMWH for > 6 months

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6
Q

What is the gold standard for OP X-ray

A

Central DEXA

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7
Q

What does the T score mean for DEXA OP

A

> -1 normal
-1 to -2.4 osteoporosis
≤ -2.5 osteoporosis
≤ -2.5 with one or more fracture - severe

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8
Q

When do we screen for OP

A

Men ≥ 70, women ≥ 65
Younger post meno women and men 50-69 with clinical risk factors
Fracture after the age of 50
Adult with medication that promotes bone loss

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9
Q

When your T score is -1 to -2.4 what constitutes OP

A

A FRAX ≥20 % major risk or hip fracture score of ≥ 3%

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10
Q

What are some non pharm testament for OP

A

Child peak bone mass - sun, no smoking, no alcohol, balance diet
Weight bearing exercise (≥30 adults or ≥60 for children)

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11
Q

Name 3 food that inhibits dietary calcium

A

Spinach, rhubarb, sweet potatoes, beans, collard greens, nuts, whole-grain and wheat brand

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12
Q

What amount of calcium do you want your pt taking

A

1000mg men
1200 women

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13
Q

What are some Calicum ADR

A

Flatulence and constipation
DNE 1200-1500 due to kidney stones

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14
Q

What form of calcium is the best

A

Chewable or liquid

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15
Q

Pros for calcium carbonate

A

Prefers salt and highest and cheapest of all the elemental CA
Can act like an ant- acids

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16
Q

Cons for calcium carbonate

A

Must be taking with meals or citrus juices
Rebound acids if taken on an empty

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17
Q

Pro of citracal

A

Preferred for elderly
Don’t need to take with food
Less constipating

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18
Q

Cons for calcium citrate

A

Only 21% e Ca

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19
Q

DDI for calcium

A

≥ 2hrs for all these meds
Tetracyclines
Azithromycin
Fluoroquinolones
Bisphosphonates
Itraconazole
Ketoconazole
Iron absorption

PPI reduce calcium absorption

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20
Q

What can decrease calcium absorption

A

Fiber laxatives

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21
Q

What can cause hypercalcemia with calcium

A

Thiazide

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22
Q

What age can you not convert Vita D properly

A

> 70 year

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23
Q

What Vita D do we have

A

Ergocalciferol D2 - high dose RX
Cholecalciferol D3 - OTC

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24
Q

What is the dose for vita D

A

1000-2000 IU 25-50 mcg

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25
Q

Which is better D2 or D3

A

D3 because of the meta pathways

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26
Q

What is the goal vita D level

A

≥ 30 or 30-50 (preferred)
Recheck after 3 months bc HL is 1 month

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27
Q

Vita D DDI

A

Increase metabolism
Phenytoin
Barbiturates
CBZ
Rifampin

Decrease absorption
Cholestryramine
Colestipol
Orlistat
Mineral oil

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28
Q

What is low Vita D labs

A

<30

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29
Q

How do we treat low vita D labs

A

50K IU qwK for 8-12 weeks
Then once monthly or 1000-2000 IU PO after

30
Q

How do we RX treat pts with OP

A

1st bisphosphonates
2nd denosumab ( only if can tolerate above med)

31
Q

What RX do we give to post meno OP

A

Sclerosis inhibitor (romosozumab)
PTH (terioaratide) + bisphosphonate

32
Q

When do we consider RX treatment

A

Post meno women or men ≥50 that have low trauma hip or vertebra fracture
T score ≤ -2.5 at neck hip or spine
T score -1 - -2.5 that have a FRAX ≥20% frac or hip ≥3%

33
Q

Alendronate treatment dosing

A

70 mg qwK
10 mg QD

34
Q

Fosomax prevent dosing

A

35mg PO weekly or 5mg QD

35
Q

What do we give if pt can’t swallow bisphosphonates

A

Binosto

36
Q

What can’t we use alendronate in

A

CrCL ≤35

37
Q

Risedronate dosing women OP

A

150 mg monthly (75mg taking 2 days in a row )
35mg qwK
5mg QD (RARE)

38
Q

Risedronate men OP

A

35mg qwK

39
Q

Treatment of GIO (glucocorticoids induce OP)

A

5mg QD

40
Q

What is the Crcl cut off for risendronate

A

CrCl ≤ 30

41
Q

What is special about Ibandronate

A

Boniva can only treat women and veterbral

42
Q

What is pros of boniva

A

Month admin on the same day 150mg
Crcl ≤30
3mg IV every 3 months

43
Q

What is special about Zoledronic acid

A

IV only
5mg once yearly
Or 5mg every 2 years for prevention

44
Q

Considerations for Reclast

A

need to be admin in 15 mins and pt needs to be well hydrates
CrCl ≤35 X

45
Q

Major Barriers for bisphosphonates

A

GI (oral only) for 3 months
Bone pain for 3 months

46
Q

IV ibradonate ADR

A

Myalgia, cramps and limb pain

47
Q

Zoledronic acid ADR

A

HYPOCALCEMIA
Flu like sysmtoms
A fib
Arthritis, arthralgias and headaches

48
Q

DDI for bisphosphonates

A

Aminoglycosde
Loops
NSAIDs

49
Q

what is the 2 very rare ADR for bisphosphonates

A

ONJ
Mouth necrosis
Risk with any immune suppression
Prevent with oral hygiene and see dentist

Femur fractures with use for 5+ years

50
Q

How to reduce ADR and improve adherence with bisphosphonates

A

take ≥30 mins (≥60 for ibandroate) before first food
Or take with a full glass of water
Remain up right for ≥ 30mins (60 for ibandroate )

51
Q

Patent education for bisphosphonates

A

Space calcium 30-60 mins
X NSAIDs for aspirin
Dental exam

Weekly
Missed dose
Take next day and if more then one change weekly dose day

Monthly
Take up to 7 days before nex month dose

52
Q

How long should you use bisphosphonates

A

2-5 loss at spine and hip but increase hip fractures
5 years positive BMD
10 year all sites get BMD

When to stop ( drug holiday )
Oral bisph - 5 years check if not risk okay to stop if high risk 6-10 more years
Zolendronate - 3 years in high risk up to 6 in high risk

53
Q

What cant denosumab (prolia be used for)

A

Prevention

54
Q

What is the dose for prolia

A

60mg subq every 6 months

55
Q

Pros of denosumab

A

Improved adherence
No drug holidays
Can be used with any renal function

56
Q

Cons of prolia

A

Expensive
If poor adherence wears off quick

57
Q

ADR with denosumab

A

Farting, skin rashes, increased cholesterol

Rare but need to know
UTI increased
Hypocalcemia
ONJ - more than bisphosphonates
Less femur fracture than bisphosphonates

58
Q

What to monitor for Prolia

A

Serious infections
Skin reactions
Can not be Hypocalcemic
Dose cant bel delayed for more than one month

59
Q

When do we use teriparatide

A

Treatment of OP with high risk (excluding hip)
Treatment of GIO

60
Q

What is the doses of Teriparatide

A

20 mcg sq QD

61
Q

ADR for teriparatide

A

Well tolerated
Hypercalcemia
ORTHOSTATIC HYPOTENSION - important

62
Q

what is the monitoring for teriparatide

A

BBW for osteosarcoma

Beware
Kidney stones
Renal failure
Hypotension
Pagers disease

Monitor calcium level
And new fractures

63
Q

When do we use abaloparatide

A

When they fail all other therapies
No GIO or hip

64
Q

When do we use Romosozumab

A

Women and vertebral
Not as recommended as teriparatide

65
Q

ADR for romosozumab

A

BBW for MACE - can not start if MI/CVA within one year and dc if you do get one

cant use in
Hypocalcemia
Sever CKD

66
Q

When do we use Raloxifene

A

Women and spine
Reduce breast cancer
High breast cancer risk

67
Q

What is kept if we stop raloxifene

A

Breast cancer reduction

68
Q

When do we use bazedoxifene (Duavee)

A

Veterbral/ prevention with intact uterus
X in hepatic impairment and kind of in renal

69
Q

Estrogen/progestin when we use

A

Younger age or <10 year past menopause
Low risk DVT, breast cancer

70
Q

How do we treat GIO

A

Try bisphosphonates
Then teriparatide

Theraputics Winter (12 decks)

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