Pharm2 8 Osteoporosis pt2 Flashcards Preview

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Flashcards in Pharm2 8 Osteoporosis pt2 Deck (16)

If someone needs to be pulled off a bisphosphonate, and needs another osteoporosis med, which is the next best (in general)?

Denosumab (also has evidence for reducing vertebral, nonvertebral, and hip fractures)


Adverse effects of bisphosphonate, depending on route of admin
Oral (3)
IV (5)

All: N/V
Oral: Irritation or burning of the esophagus, Difficulty swallowing, Painful swallowing
IV: Arthralgia, Myalgia, Bone pain, Fever, Flulike symptoms (prevent by giving acetaminophen 1 hr beforehand)


Calcitonin Nasal Spray
Significantly reduces ___.

What's the deal with it?

treatment of osteoporosis in women at least 5 years postmenopausal
Significantly reduces risk of new vertebral fractures
Not considered first-line monotherapy for osteoporosis
Efficacy not demonstrated for nonvertebral or hip fractures


Most common adverse effects of Calcitonin (2)

Rhinitis, nasal symptoms


What does/doesn't it reduce risk for?

Indications: prevention and treatment of osteoporosis in postmenopausal women
Significantly reduces risk of vertebral fracture
Not shown to reduce risk of nonvertebral or hip fractures


What's an absolute CI for Raloxifene?
3 other adverse fx

Deep vein thrombosis
Other side fx: hot flashes, leg cramps, fluid retention


Teriparatide [rDNA origin] injection
Indications (3)
What's it do?

Treatment of osteoporosis in postmenopausal women and men at high risk for fracture
Treatment of women and men with glucocorticoid-induced osteoporosis at high risk for fracture
Increasing bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture
Significantly reduces risk of vertebral and nonvertebral fractures

This is an IV-effusion, won’t see primary providers doing this.


What's the unique drug that builds up bone instead of preventing demineralization?



Denosumab: Newest Approved Agent .
How is it administered?

Twice Yearly Sub Q. builds up bone.
Fully human monoclonal antibody against RANKL
Indications: treatment of osteoporosis in postmenopausal women at high risk for fractures
Increases BMD


MoA of Denosumab

Denosumab is a fully human monoclonal antibody to the receptor activator of nuclear factor-κB ligand (RANKL) that blocks its binding to RANK, inhibiting the development and activity of osteoclasts, decreasing bone resorption, and increasing bone density
Given its unique actions, denosumab may be useful in the treatment of osteoporosis

This is something you’d switch to prevent the chalkstick fractures with bisphosphonates


Adverse fx (7)

Most common: back pain, pain in the extremities, musculoskeletal pain, high cholesterol levels, urinary bladder infections
Serious adverse reactions: infections of the skin, cellulitis


Quality of Evidence for Antifracture Efficacy In Postmenopausal Osteoporosis

Name the 4 drugs that have A's in each category (spine, nonvertebral, hip)

Zoledronic acid


Referral to an osteoporosis specialist is appropriate when a patient:

Is intolerant of approved therapies
Fails to respond to treatment
Apparent loss of BMD on serial studies
Fractures despite treatment


Assessing “Treatment Failure” with osteoporosis meds. If the BMD continuous to decline beyond any significant change: (2)

Rule out undiagnosed secondary problems
Evaluate compliance and absorption issues

Maybe they’re sneaking a liter of scotch w/o sharing some with me ☺


20%-30% of patients taking oral osteoporosis medications suspend their medications within 6-12 months of initiation due to: (3)

Side effects
Lack of knowledge
Reluctance to take regular medications


If you're about to start a cancer patient on a bisphosphonate, but realize their teeth are nasty, rotting (osteonecrosis of jaw). What should you do?

Get their teeth fixed before you start them on bisphosphonate/osteoporosis drugs.