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Theraputics Winter > Osteperosis √ > Flashcards

Osteperosis √ Flashcards

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1
Q

How long does it take for osteoblast and osteoclast to reform

A

Blast 3-4 months
Clast 3-4 weeks

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2
Q

2 types of fractures

A

Fragility and atraumatic

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3
Q

When do you start losing bone mass and at what rate

A

After 30
.4% per year

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4
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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5
Q

what are the 6 long term meds associated with osteoporosis

A
  1. Chronic glucocorticoid use (≥ 5 mg prednisone or equivalent for ≥ 3 months)
  2. Gonadotropin-releasing hormone agonists
  3. Cancer chemotherapy drugs
  4. Aromatase inhibitors (anastrozole, exemestane, letrozole)
  5. Anticonvulsant therapy > 2 years and age > 40 years old
  6. Anticoagulants (> 6 months UFH/LMWH)
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6
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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7
Q

what are the 4 patients we recommend screening for

A
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8
Q

When your T score is -1 to -2.4, when would we consider treatment

A

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

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9
Q

what are the Goals of therapy for OP

A
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10
Q

What are some 3 non pharm treatments for OP

A
  1. achieve peak bone mass from childhood to adolescence age
  2. lifestyle (sun, smoking, limit alch, and diet)
  3. Weight-bearing exercises ≥ 30 for children, ≥60 for adults
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11
Q

name 3 fall prevention stratagies

A
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12
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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13
Q

What amount of calcium do you want your pt taking

A

1000mg men
1200mg women

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14
Q

How do I determine Calcium dosing?

A

RDI - dietary intake
if dose 500-600 give BID to TID

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15
Q

What are some Calicum ADR

A

Flatulence and constipation
DNE 1200-1500 due to kidney stones

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16
Q

does Calcium reduce fractures?

A

No so needs to be paired with vita D

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17
Q

What form of calcium is the best

A

Chewable or liquid

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18
Q

2 Pros for calcium carbonate

A

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

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19
Q

2 Cons for calcium carbonate

A

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

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20
Q

What would calcium would i give a patient with heartburn

A

Caltrate

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21
Q

Pro of Citracal

A

Preferred for elderly
Don’t need to take it with food
Less constipating
includes vitamin D3

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22
Q

If I am having issues with Caltrate what should I switch to

A

Citracal

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23
Q

Cons for calcium citrate

A

Only 21% e Ca

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24
Q

What can decrease calcium absorption

A

Fiber laxatives

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25
What can cause hypercalcemia with calcium
Thiazide
26
What age can you not convert Vita D properly via the skin
> 70 year
27
What Vita D do we have
Ergocalciferol D2 - high dose RX Cholecalciferol D3 - OTC
28
What is the dose for vita D
1000-2000 IU 25-50 mcg
29
Why do I avoid D2 in older adults
bc the metabolism is impaired
30
Which is better D2 or D3
D3 because of the meta pathways
31
What is the goal vita D level
≥ 30 or 30-50 (preferred) Recheck after 3 months bc HL is 1 month
32
Vita D DDI
Increase metabolism Phenytoin Barbiturates CBZ Rifampin Decrease absorption Cholestryramine Colestipol Orlistat Mineral oil
33
What values raise alarms with Vita D
20-30 is low <20 is deficient
34
How do we treat low vita D labs
50K IU qwK for 8-12 weeks Then once monthly or 1000-2000 IU PO after
35
AD for vita D
hypercalemia hypercalciuria
36
What is the typical regiment for calcium and D3
1000-1200mg daily for calcium 600-1000 IU for D3
37
How do we RX treat pts with OP
1st bisphosphonates 2nd denosumab ( only if can tolerate above med)
38
What RX do we give to post meno OP with high risk fracture
Sclerosis inhibitor (romosozumab, Envity) PTH (teriparatide, Forteo) + bisphosphonate
39
What 3 patients do we consider RX treatment
1. Post meno women or men ≥50 that have low trauma hip or vertebra fracture 2. T score ≤ -2.5 at neck hip or spine 3. T score -1 - -2.5 that have a FRAX ≥20% frac or hip ≥3%
40
Alendronate treatment dosing
70 mg qwK 10 mg QD
41
Fosomax prevent dosing
35mg PO weekly or 5mg QD
42
What do we give if pt can’t swallow bisphosphonates
Binosto Oral alendronate (same dosing)
43
When can’t we use alendronate
CrCL ≤35
44
Risedronate dosing women OP
150 mg monthly (75mg taking 2 days in a row ) 35mg qwK 5mg QD (RARE)
45
Risedronate men OP
35mg qwK
46
Treatment of GIO w/ alendronate (glucocorticoids induce OP)
5mg QD
47
What is the Crcl cut off for risendronate
CrCl ≤ 30
48
What is 2 special things about Ibandronate
Boniva can only treat women and veterbral 3 months IV option at providers office
49
Ibrandonate dosing
150mg qmonth
50
Crcl cut off for Boniva
Ibandronate Crcl ≤30
51
What is special about Zoledronic acid
IV only 5mg once yearly Or 5mg every 2 years for prevention
52
Considerations for Reclast
zolendric acid need to be admin in 15 mins and pt needs to be well hydrates
53
CrCl for Zolendric acid
≤35
54
Major Barriers for bisphosphonates
GI (oral only) for 3 months Bone pain for 3 months
55
IV ibandonate ADR
Myalgia, cramps and limb pain
56
Zoledronic acid ADR
HYPOCALCEMIA absolute CI Flu like sysmtoms A fib Arthritis, arthralgias and headaches
57
DDI for bisphosphonates
Aminoglycoside Loops NSAIDs
58
what is the 2 very rare ADR for bisphosphonates
ONJ Mouth necrosis Risk with any immune suppression Prevent with oral hygiene and see dentist Femur fractures with use for 5+ years
59
How to reduce ADR and improve adherence with bisphosphonates
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 )
60
patient education point for Atelvia?
Risedronate Take right after breakfast
61
Patient education for Binosto
dissolve in 4 oz of warm water
62
3 Patent education for bisphosphonates
Space calcium 30-60 mins X NSAIDs except for aspirin Dental exam 2x a year Weekly Missed dose Take the next day and if more take at the next weekly dose Monthly Take up to 7 days before next month dose
63
How long should you use bisphosphonates
64
What cant denosumab (prolia be used for)
Prevention except 1. Women receiving adjuvant aromatase inhibitor therapy for breast cancer at high risk 2. Men receiving androgen-deprivation therapy for non- metastatic prostate cancer at high risk
65
who should usually get prolia
high risk patients
66
What is the dose for prolia
60mg subq every 6 months
67
Pros of denosumab
Improved adherence No drug holidays Can be used with any renal function
68
Cons of prolia
Expensive If poor adherence wears off quick
69
ADR with denosumab
Farting, skin rashes, increased cholesterol Rare but need to know UTI increased Hypocalcemia ONJ - more than bisphosphonates Less femur fracture than bisphosphonates
70
What to monitor for Prolia
Serious infections Skin reactions Can not be Hypocalcemic Dose cant bel delayed for more than one month
71
When do we use teriparatide
Treatment of OP with high risk (excluding hip) Treatment of GIO
72
What is the doses of Teriparatide
20 mcg sq QD
73
ADR for teriparatide
Well tolerated Hypercalcemia ORTHOSTATIC HYPOTENSION - important
74
what is the max treatment duration
2 years
75
what is the monitoring for teriparatide
BBW for osteosarcoma Beware Kidney stones Renal failure Hypotension Pagers disease Monitor calcium level And new fractures
76
When do we use abaloparatide
Salvage therapy No GIO or hip
77
Ad and monitoring for Abaloparatide
same as teriparatide
78
When do we use Romosozumab
Women and vertebral Not as recommended as teriparatide
79
BBW for romosozumab
BBW for MACE - can not start if MI/CVA within one year and dc if you do get one
80
When do we use Raloxifene
Women and spine Reduce breast cancer High breast cancer risk
81
What is kept if we stop raloxifene
Breast cancer reduction
82
When do we use bazedoxifene (Duavee)
Veterbral/ prevention with intact uterus X in hepatic impairment and kind of in renal
83
Estrogen/progestin when we use
Younger age or <10 year past menopause Low risk DVT, breast cancer
84
How do we treat GIO
Try bisphosphonates Then teriparatide
85
what patients are at risk for GIO
≥ 5 mg/day (or equivalent) for ≥ 3 months
86
Calcium and D3 dosing for GIO
Calcium 1200-1500 mg daily + vitamin D3 800-1200 IU daily
87
Ca levels
8.5-10.2 mg/dL

Theraputics Winter (16 decks)

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