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pre reg afsha endocrine > bisphosphonates + other drugs > Flashcards

bisphosphonates + other drugs Flashcards

1
Q

what is licensed for men for osteoporosis

A

alendronic acid 10mg tablets, OD
risedronate sodium 35mg tablets, once weekly

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2
Q

MHRA safety info - what is there

A
  • atypical femoral fractures
  • osteonecrosis of jaw
  • osteonecrosis of external auditory canal
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3
Q

signs of atypical femoral features that pt should report

A

any thigh, hip, or groin pain during treatment with a bisphosphonate.

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4
Q

pt should carry out the following measures to prevent osteonecrosis of jaw during treatment

A

patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms e.g. dental mobility, pain, swelling, non-healing sores or discharge

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5
Q

signs to report which may indicate osteonecrosis of external auditory canal

A

report any ear pain, discharge from ear or an ear infection during treatment with a bisphosphonate.

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6
Q

signs of oesophageal reactions pt should report and what action to take

A

stop taking drug and to seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, new or worsening heartburn, pain on swallowing or retrosternal pain.

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7
Q

who is more likely to have atypical femoral feature

A

mainly in patients receiving long-term treatment for osteoporosis

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8
Q

bisphosphonate treatment should be reviewed after 5 years, except for this drug which should be reviewed after 3 years

A

zolendronic acid

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9
Q

who is more likely to have osteonecrosis of the jaw

A

risk of osteonecrosis of the jaw is substantially greater for patients receiving intravenous bisphosphonates in the treatment of cancer than for patients receiving oral bisphosphonates for osteoporosis or Paget’s disease

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10
Q

risk factors for developing osteonecrosis of the jaw

A

potency of bisphosphonate (highest for zoledronate), route of administration, cumulative dose, duration and type of malignant disease, concomitant treatment, smoking, comorbid conditions, and history of dental disease.

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11
Q

which bisphosphonate holds the highest risk of osteonecrosis of the jaw

A

zolendronate

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12
Q

what to do before prescribing an IV bisphosphonate

A
  • patients should be given a patient reminder card and informed of the risk of osteonecrosis of the jaw.
  • Advise patients to tell their doctor if they have any problems with their mouth or teeth before starting treatment, and if the patient wears dentures, they should make sure their dentures fit properly.
  • Patients should tell their doctor and dentist that they are receiving an intravenous bisphosphonate if they need dental treatment or dental surgery
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13
Q

what to do for all pt with cancer and pt its poor dental status before bisphosphonate treatment (in regards to risk of osteonecrosis of jaw)

A

dental check up and any necessary remedial work should be performed before treatment, or ASAP after starting

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14
Q

who is at risk of osteonecrosis of the external auditory canal

A

has been reported very rarely with bisphosphonate treatment, mainly in patients receiving long-term therapy (2 years or longer)

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15
Q

consider the possibility of osteonecrosis of the external auditory canal in pt receiving bisphosphonates who present with…

A

ear symptoms, including chronic ear infections, or suspected cholesteatoma.

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16
Q

risk factors for developing osteonecrosis of the external auditory canal

A

steroid use, chemotherapy, infection, an ear operation, or cotton-bud use.

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17
Q

alendronic acid contraindication

A

Abnormalities of oesophagus; hypocalcaemia; other factors which delay emptying (e.g. stricture or achalasia)

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18
Q

cautions for all bisphosphonates

A

oral: elderly in pt with a current or recent history of upper gastrointestinal disease or bleeding (risk of relapse/exacerbation of oesophagitis, oesophageal ulcer or oesophageal stricture).

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19
Q

common SE for all bisphosphonates includes

A
  • alopecia
  • anaemia
  • decreased appetite
  • arthralgia
  • constipation, diarrhoea
  • dizziness
  • dysphagia
  • eye inflammation
  • fever
  • GI discomfort
  • headache
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20
Q

which side effects warrant discontinuation of treatment

A

oesophageal ulcer (discontinue); oesophagitis (discontinue)oesophageal stenosis (discontinue)

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21
Q

avoid alendronic acid if creatine clearance

A

less than 35

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22
Q

monitoring requirements of alendronic acid

A
  • Correct disturbances of calcium and mineral metabolism (e.g. vitamin-D deficiency, hypocalcaemia) before starting treatment.
  • Monitor serum-calcium concentration during treatment. (they reduce C levels by inhibiting bone resorption)
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23
Q

directions for admin - alendronic

A

tablets should be swallowed whole and oral solution should be swallowed as a single 100 mL dose. Doses should be taken with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after administration.

24
Q

how do bisphosphonates work

A

adsorbed onto hydroxyapatite crystals in bone, slowing both their rate of growth and dissolution, and therefore reducing the rate of bone turnover

25
Q

what is ibandronic acid licensed for and what is the dose

A

treatment of postmenopausal osteoporosis
dose is 150mg once a month by mouth
alternatively can be used IV (diff dose)

26
Q

when used for postmenopausal osteoporosis, avoid ibandronic acid if creatinine clearance is less than

A

30

27
Q

monitoring requirements for ibandronic acid

A

Monitor renal function and serum calcium, phosphate and magnesium.

28
Q

directions for admin for ibandronic acid

A

tablets should be swallowed whole with plenty of water while sitting or standing; to be taken on an empty stomach at least 30 minutes (for most ibandronic acid tablets, 50 mg) or 1 hour (for Bonviva ® tablets, 150 mg) before first food or drink (other than water) of the day, or another oral medicine; patient should stand or sit upright for at least 1 hour after taking tablet.

29
Q

A patient reminder card should be provided to patients receiving intravenous bisphosphonates due to…

A

risk of osteonecrosis of the jaw

30
Q

dose of risedronate in men vs women

A

men = 35mg once weekly
females = 5mg daily, alternatively 35mg once weekly (weekly dose not for prevention osteoporosis in postmenopausal women)

31
Q

all bisphosphonates are contraindicated in the following electrolyte disturbance

A

hypocalcaemia

32
Q

monitoring for risedronate

A

Correct hypocalcaemia before starting.

Correct other disturbances of bone and mineral metabolism (e.g. vitamin-D deficiency) at onset of treatment.

33
Q

directions for admin for risedronate

A

swallow tablets whole with full glass of water; on rising, take on an empty stomach at least 30 minutes before first food or drink of the day or, if taking at any other time of the day, avoid food and drink for at least 2 hours before or after risedronate (particularly avoid calcium-containing products e.g. milk; also avoid iron and mineral supplements and antacids); stand or sit upright for at least 30 minutes; do not take tablets at bedtime or before rising.

34
Q

what are the IV bisphosphonates

A

zolendronate, ibrandronic acid (also oral), pamidronate

35
Q

raloxifene dose for treatment and prevention of postmenopausal osteoporosis

A

60mg once daily

36
Q

CI for raloxifene (4)

A

Cholestasis; endometrial cancer; history of venous thromboembolism; undiagnosed uterine bleeding

37
Q

two drug classes to avoid with raloxifene

A

CHC and HRT potentially oppose the effects of Raloxifene. Manufacturer advises avoid.

38
Q

MOA strontium

A

Strontium ranelate stimulates bone formation and reduces bone resorption.

39
Q

when would you use strontium

A

Severe osteoporosis in men and postmenopausal women at increased risk of fractures [when other treatments are contra-indicated or not tolerated] (initiated by a specialist)

40
Q

CI strontium

A

Cerebrovascular disease; current or previous venous thromboembolic event; ischaemic heart disease; peripheral arterial disease; temporary or permanent immobilisation; uncontrolled hypertension

41
Q

teriparatide is given SC for max ..

A

20 micrograms daily for maximum duration of treatment 24 months (course not to be repeated).

42
Q

teriparatide CI

A

Bone metastases; hyperparathyroidism; metabolic bone diseases; Paget’s disease; pre-existing hypercalcaemia; previous radiation therapy to the skeleton; skeletal malignancies; unexplained raised alkaline phosphatase

43
Q

MOA romosuzumab

A

Romosozumab is a humanised monoclonal antibody that inhibits sclerostin, thereby increasing bone formation and decreasing bone resorption.

44
Q

when is romosozumab indicated

A

Severe osteoporosis in postmenopausal women at increased risk of fractures (specialist use only)
for romosozumab
By subcutaneous injection

45
Q

CI for romosozumab

A

History of myocardial infarction or stroke—discontinue if occurs during treatment; hypocalcaemia

46
Q

do not give romosozumab if pt has this electrolyte disturbance

A

hypocalcaemia

47
Q

bisphosphonates have MHRA advice re atypical femoral fractures & osteoporosis of the jaw. However, its also a possible SE of this drug aswell so ensure to counsel pt (no MHRA advice for it though)

A

romosozumab -

patients should be advised to report any new or unusual thigh, hip, or groin pain during treatment. (atypical femoral fracture)

maintain good oral hygiene, receive routine dental check-ups, and immediately report any oral symptoms such as dental mobility, pain, or swelling. (osteonecrosis of jaw)

48
Q

when is tibolone indicated

A

Osteoporosis prophylaxis in women at high risk of fractures when other prophylaxis contra-indicated or not tolerated
for tibolone

49
Q

CI for tibolone

A

Acute porphyrias; history of arterial thromboembolic disease (e.g. angina, MI, stroke, or TIA); history of breast cancer; oestrogen-dependent cancer; thrombophilic disorder; undiagnosed vaginal bleeding; untreated endometrial hyperplasia; VTE

50
Q

why is tibolone cautioned in diabetes

A

increased risk heart disease

51
Q

Patient on tibolone has bleeding. Is this ok?

A

Investigate for endometrial cancer if bleeding continues beyond 6 months or after stopping treatment.

52
Q

tibolone is unsuitable for use wihtin …

A

unsuitable for use within 12 months of last menstrual period (may cause irregular bleeding).

53
Q

interaction with all NSAIDs

A

increased GI irritation risk

54
Q

interaction with AGs

A

increased risk hypocalaemia

55
Q

stop this drug used for osteoporosis immediately if rash develops

A

strontium

pre reg afsha endocrine (29 decks)

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