Because Blessington said this pharm test sucks ass. Flashcards
(142 cards)
What are the three available treatment styles for osteoporosis?
- Lifestyle modifications (tobacco, exercise, nutrition, caffeine avoidance)
- Supplements (Calcium and Vitamin D)
- Pharm (Catabolic Inhibitors and Anabolic stimulants)
How much oral calcium is absorbed?
30-40%
What is the ceiling dose of calcium?
3 times per day
At what age does the daily dose of calcium change from 1,000 mg to 1,200 mg in women?
50
Tell me about the three types of calcium supplements…
- Calcium carbonate (cheap - cannot take with food)
- Calcium citrate (better absorbed)
- Calcium Gluconate (Expensive)
What calcium supplement should you take with a PPI?
Calcium Citrate
What is the dosing range for OTC Vitamin D supplement?
700-800IU (controversial)
When is estrogen therapy helpful in osteoporosis?
In peri-menopausal causes – prevents further break down
Not therapeutic so calcium and vitamin D also need to be given
How does estrogen work?
Reduces levels of cytokines, TNF-alpha, IL-1, and IL-6, which stimulate osteoclasts and directly modulate osteoclast activation
Why isn’t estrogen help in senile osteoporosis?
Because in senile, there is decreased osteoblast activity, NOT increased osteoclast activity
When is estrogen therapy cautioned?
Past history/family history of BC, endometrial cancer or history of thromboembolic disorder
Adverse effects of estrogen therapy?
Breakthrough bleeding, breast tenderness, increase risk of cancer - because of this, it is no longer recommended
What is Raloxifene [Evista]?
Selective Estrogen Receptor Modulators (SERM’s)
What does Raloxifene [Evista] do?
Estrogen-like effect on bone and lipids - decreasing bone resorption
Thought not to stimulate endometrium and breast tissue
When is Raloxifene [Evista] used?
Prevention and treatment of osteoporosis
What are the side effects of Raloxifene?
Flu-like syndrome, hot flashes, arthralgias, peripheral edema, headache, weight gain, vaginal bleeding
Who should not take Raloxifene?
History of venous thrombosis and caution when on thyroid medications - may decrease its absorption.
Do you cycle progesterone with Raloxifene?
Negatory.
What do bisphosphates do?
Suppress osteoclast activity with no negative effect on mineralization (except Etidronate)
When should you take bisphosphonates?
On an empty stomach with 8oz of fluids in the AM - sit upright for 30 minutes after to avoid esophagitis.
Who should avoid taking bisphosphonates?
Renal failure patients
What is a side effect of bisphosphonates?
Osteonecrosis of the jaw
Tell me about the 4 formulations of bisphosphonates and what do they do?
- Risedronate - reduces vertebral fractures (not hip)
- Etidronate - used in Paget’s disease only - inhibits mineralization
- Alendronate - most common -reduces both hip and vertebral fractures
- Zolendronic Acid - used in post-hip fractures (IV only - every 12 months)
What is Aldendronate’s MOA?
Decreases rate of bone resorption