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Pharm 2 > Bone and Joint 3 > Flashcards

Bone and Joint 3 Flashcards

1
Q

Osteoporosis

A

characterized by structural deterioration of bone

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2
Q

Osteopenia

A

A spinal or hip BMD score between –1 and –2.5 SD below the mean

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3
Q

Common causes of osteoporosis

A

EtOH abuse
Chronic renal disease
Cushing’s
CF
Eating disorders

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4
Q

Prevention of osteoporosis can start w/?

A

calcium and vitamin D

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5
Q

How does Vit D work on bone?

A

Vitamin D required for uptake of calcium and phosphorus from gut and absorption into bone

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6
Q

What is Calcium needed for?

A

Calcium required for vascular contraction and dilation, nerve transmission, intracellular signaling, hormonal secretion

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7
Q

Daily Calcium intake per FDA

A

FDA: calcium needs are 1,000 mg/day for males and 1,200 mg/day for females.

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8
Q

Daily Vit D need

A

IOM: 600IU vitamin D for females 51-70 yo, 800 IU/day for females 71 yo and older.

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9
Q

Vit D interactions

A

calcitrol (Rocaltrol), paricaltrol (Zemplar) and doxercalciferol (Hectoral) - can increase the effects of Vit D (sxs of acute hypercalcemia)
hydrochlorothiazide - hypercalcemia
steroids - have their metabolism affected by Vit D

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10
Q

Sxs of hypercalcemia

A

headache, nausea, dizziness, vomiting, and loss of appetite

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11
Q

Which pts should avoid taking Vit D?

A

Contraindicated in those with primary hyperparathyroidism.

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12
Q

Pts w/ these conditions should avoid calcium supplementation?

A

history of ventricular fibrillation, hypercalciuria, hyperphosphatemia and renal stones.

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13
Q

Which medications can become decreased by the co-administration of calcium?

A

levothyroxine, fluoroquinolones, tetracycline, phenytoin, ACE inhibitors, iron, and bisphosphonates

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14
Q

Which calcium supplementation is the one of choice d/t its high concentration of elemental Ca?

A

Calcium carbonate

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15
Q

When should calcium carbonate be given?

A

Should be given at mealtimes so that increased acid secretion will enhance absorption.

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16
Q

What skin color makes the most Vit D?

A

Lighter skin

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17
Q

What dietary advice should be given in those w/ osteoporosis?

A

to eat a balanced diet that includes calcium-rich foods, especially calcium-rich non-dairy foods (soy beverage, collard greens, sardines, spinach, tofu, okra, turnip greens)

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18
Q

Which OTC formulations contain both Ca and Vit D?

A

Os-Cal, Caltrate, Citracal, Calcium phosphate

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19
Q

First line drug for osteo in postmenopausal women?

A

Bisphosphonates

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20
Q

Examples of bisphosphonates

A

Alendronate - once a wk
Ibandronate
Pamidronate - IV infusion
Zoledronic acid - IV infusion once a yr

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21
Q

Describe the bone remodeling cycle

A

Osteoblasts: mature into new osteocytes

Osteocytes: are mature permanent bone cells - 120 days

Osteoclasts: resorb old osteocytes - 30-40 days

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22
Q

Bisphosphonates MOA

A

By inhibiting osteoclastic activity, they inhibit both normal and abnormal bone resorption

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23
Q

Bisphosphonate uses

A

Osteoporosis
Paget disease
Treatment of glucocorticoid-induced osteoporosis in both men and women who have low BMD and are taking steroids.

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24
Q

Zoledronic acid, uses additional to normal bisphosphonates

A

Bone metastases
Multiple myeloma
Hypercalcemia of malignancy

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25
Bisphosphonates SE
Decreased serum calcium and phosphate levels GI reflux, flatulence, GI ulcer, change in taste Osteonecrosis of the jaw Headache.
26
Which things can decrease bisphosphonate absorption?
Antacids, calcium supplements, and food significantly decreases bisphosphonate absorption.
27
Bisphosphonates combined with which meds cause increased GI SE?
Should not be taken with aspirin or NSAIDS because of the increased risk of GI side effects.
28
Which pts should NOT be on bisphosphonates?
- decreased Cr clearance -hypocalcemia, any history of GI disease, and patients with invasive dental procedures due to risk of osteonecrosis.
29
Which labs should be monitored periodically in pts on bisphosphonates?
Monitor patients by periodically testing serum calcium and phosphorous levels
30
When should bisphosphonates be taken?
Same time in the AM - 30 minutes before other medications or food.
31
How should oral bisphosphonates be taken?
Oral bisphosphonates must be taken with a full glass of water, patients should be instructed to remain upright for 30-60 minutes
32
SERMs example
Raloxifene
33
How do SERMs work?
Mimic estrogen agonists in some tissues and antiestrogen in others
34
Raloxifene MOA
Acts like an estrogen agonist - Decreases bone resorption, increasing bone mineral density and decreasing fracture incidence
34
Raloxifene MOA
Acts like an estrogen agonist - Decreases bone resorption, increasing bone mineral density and decreasing fracture incidence
35
Raloxifene (Evista) use
Prevention and treatment of osteoporosis in postmenopausal women Decreases the risk of invasive breast cancer in postmenopausal women with osteoporosis
36
Raloxifene (Evista) SE
Peripheral edema, increased risk of venous thromboembolism Hot flash, weight gain Leg cramps Flu-like symptoms, CVA Infections
37
Black box warning of Raloxifene
Increased risk of death d/t stroke (especially w/ hx of CAD) Increased risk of DVT and PE
38
Raloxifene (Evista) interaction
warfarin
39
Which pts should not be on Raloxifene (Evista)?
History of thromboembolic events Women of childbearing potential and during pregnancy and lactation
40
Which supplements can be taken on Raloxifene?
Advise the patient of the importance of adequate calcium and vitamin D supplements
41
Why should long travel be avoided on Raloxifene?
Increased risk of DVT or PE
42
Calcitonin MOA
Calcitonin inhibits bone removal by osteoclasts and promotes bone formation by osteoblasts
43
Calcitonin is available in what dosage modes?
Injection and spray
44
Calcitonin use
Postmenopausal (at least 5 yrs) osteoporosis Paget's disease Hypercalcemia
45
When used as a nasal spray, calcitonin can help with what?
When used as a nasal spray, it protects against spine fractures and is sometimes used to help treat the pain of an acute spine fracture.
46
Calcitonin SE
Rhinitis, Back pain, arthralgia, bone pain
47
When is calcitonin contraindicated?
Pregnancy, kids, and nursing mothers
48
Calcitonin can lower the concentration of which psych drug?
Lithium
49
What is the long term concern of calcitonin?
Increased CA rates
50
How often is calcitonin used for osteoporosis?
Not often - not 1st line
51
How long does flushing s/p calcitonin SC/ IM injection last?
About 1 hr
52
Recombinant Human Parathyroid Hormone meds
Teriparatide - SQ Abaloparatide - SQ
53
What does the parathyroid hormone do to bones?
Parathyroid hormone causes bone density to increase by its ability to maintain calcium and phosphorus levels as new bone is formed
54
Recombinant Human Parathyroid Hormone MOA
An analog of human parathyroid hormone - Stimulates the growth of new bone formation by preferential stimulation of osteoblastic activity over osteoclastic activity.
55
Recombinant Human Parathyroid Hormone use
postmenopausal women with osteoporosis at high risk for fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or patients who have failed or are intolerant to other available osteoporosis therapy
56
Recombinant Human Parathyroid Hormone SE
Increased uric acid transient hypercalcemia
57
Recombinant Human Parathyroid Hormone Black Box Warning
Increased risk of osteosarcoma in rats (should be avoided in those pts at risk)
58
Recombinant Human Parathyroid Hormone interactions
None
59
Which pts should not take Recombinant Human Parathyroid Hormone?
risk of osteosarcoma (patients with Paget’s disease), previous skeletal radiation, or unexplained elevation of their alkaline phosphatase level.
60
Prior to starting Recombinant Human Parathyroid Hormone, which labs should be checked?
Screen for hyperparathyroidism - If there are high levels of calcium or alkaline phosphatase in the patient’s blood, this medication should not be prescribed.
61
Pts taking Recombinant Human Parathyroid Hormone should have this drug dose adjusted?
Digoxin
62
Denosumab (Prolia/Xgeva) dosing?
Denosumab - SubQ 60mg Q 6 months
63
Denosumab MOA
RANK Ligand inhibitor - Prevents osteoclast formation, leading to decreased bone resorption and increased bone mass in osteoporosis
64
Denosumab (Prolia/Xgeva) use
Osteoporosis Bone metastases Giant cell tumor of bone Hypercalcemia of malignancy Multiple myeloma
65
Denosumab (Prolia/Xgeva) SE
Hypocalcemia, hypophosphatemia Peripheral edema Back pain
66
Denosumab (Prolia/Xgeva) drug intereactions
None - but may increase immunosuppression
67
Denosumab (Prolia/Xgeva) contraindications
Preexisting hypocalcemia Pregnancy
68
Which tests should be done on a pt on Denosumab?
- Serial bone mineral density (BMD) should be evaluated at baseline and every 1 to 3 years (usually at ~2 years following initiation of therapy) - Routine oral exams

Pharm 2 (8 decks)

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