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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
Q

Bisphosphonates SE

A

Decreased serum calcium and phosphate levels
GI reflux, flatulence, GI ulcer, change in taste
Osteonecrosis of the jaw
Headache.

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26
Q

Which things can decrease bisphosphonate absorption?

A

Antacids, calcium supplements, and food significantly decreases bisphosphonate absorption.

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27
Q

Bisphosphonates combined with which meds cause increased GI SE?

A

Should not be taken with aspirin or NSAIDS because of the increased risk of GI side effects.

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28
Q

Which pts should NOT be on bisphosphonates?

A
  • decreased Cr clearance
    -hypocalcemia, any history of GI disease, and patients with invasive dental procedures due to risk of osteonecrosis.
29
Q

Which labs should be monitored periodically in pts on bisphosphonates?

A

Monitor patients by periodically testing serum calcium and phosphorous levels

30
Q

When should bisphosphonates be taken?

A

Same time in the AM - 30 minutes before other medications or food.

31
Q

How should oral bisphosphonates be taken?

A

Oral bisphosphonates must be taken with a full glass of water, patients should be instructed to remain upright for 30-60 minutes

32
Q

SERMs example

A

Raloxifene

33
Q

How do SERMs work?

A

Mimic estrogen agonists in some tissues and antiestrogen in others

34
Q

Raloxifene MOA

A

Acts like an estrogen agonist - Decreases bone resorption, increasing bone mineral density and decreasing fracture incidence

34
Q

Raloxifene MOA

A

Acts like an estrogen agonist - Decreases bone resorption, increasing bone mineral density and decreasing fracture incidence

35
Q

Raloxifene (Evista) use

A

Prevention and treatment of osteoporosis in postmenopausal women
Decreases the risk of invasive breast cancer in postmenopausal women with osteoporosis

36
Q

Raloxifene (Evista) SE

A

Peripheral edema, increased risk of venous thromboembolism
Hot flash, weight gain
Leg cramps
Flu-like symptoms, CVA
Infections

37
Q

Black box warning of Raloxifene

A

Increased risk of death d/t stroke (especially w/ hx of CAD)
Increased risk of DVT and PE

38
Q

Raloxifene (Evista) interaction

A

warfarin

39
Q

Which pts should not be on Raloxifene (Evista)?

A

History of thromboembolic events
Women of childbearing potential and during pregnancy and lactation

40
Q

Which supplements can be taken on Raloxifene?

A

Advise the patient of the importance of adequate calcium and vitamin D supplements

41
Q

Why should long travel be avoided on Raloxifene?

A

Increased risk of DVT or PE

42
Q

Calcitonin MOA

A

Calcitonin inhibits bone removal by osteoclasts and promotes bone formation by osteoblasts

43
Q

Calcitonin is available in what dosage modes?

A

Injection and spray

44
Q

Calcitonin use

A

Postmenopausal (at least 5 yrs) osteoporosis
Paget’s disease
Hypercalcemia

45
Q

When used as a nasal spray, calcitonin can help with what?

A

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
Q

Calcitonin SE

A

Rhinitis, Back pain, arthralgia, bone pain

47
Q

When is calcitonin contraindicated?

A

Pregnancy, kids, and nursing mothers

48
Q

Calcitonin can lower the concentration of which psych drug?

A

Lithium

49
Q

What is the long term concern of calcitonin?

A

Increased CA rates

50
Q

How often is calcitonin used for osteoporosis?

A

Not often - not 1st line

51
Q

How long does flushing s/p calcitonin SC/ IM injection last?

A

About 1 hr

52
Q

Recombinant Human Parathyroid Hormone meds

A

Teriparatide - SQ
Abaloparatide - SQ

53
Q

What does the parathyroid hormone do to bones?

A

Parathyroid hormone causes bone density to increase by its ability to maintain calcium and phosphorus levels as new bone is formed

54
Q

Recombinant Human Parathyroid Hormone MOA

A

An analog of human parathyroid hormone - Stimulates the growth of new bone formation by preferential stimulation of osteoblastic activity over osteoclastic activity.

55
Q

Recombinant Human Parathyroid Hormone use

A

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
Q

Recombinant Human Parathyroid Hormone SE

A

Increased uric acid
transient hypercalcemia

57
Q

Recombinant Human Parathyroid Hormone Black Box Warning

A

Increased risk of osteosarcoma in rats (should be avoided in those pts at risk)

58
Q

Recombinant Human Parathyroid Hormone interactions

A

None

59
Q

Which pts should not take Recombinant Human Parathyroid Hormone?

A

risk of osteosarcoma (patients with Paget’s disease), previous skeletal radiation, or unexplained elevation of their alkaline phosphatase level.

60
Q

Prior to starting Recombinant Human Parathyroid Hormone, which labs should be checked?

A

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
Q

Pts taking Recombinant Human Parathyroid Hormone should have this drug dose adjusted?

A

Digoxin

62
Q

Denosumab (Prolia/Xgeva) dosing?

A

Denosumab - SubQ 60mg Q 6 months

63
Q

Denosumab MOA

A

RANK Ligand inhibitor - Prevents osteoclast formation, leading to decreased bone resorption and increased bone mass in osteoporosis

64
Q

Denosumab (Prolia/Xgeva) use

A

Osteoporosis
Bone metastases
Giant cell tumor of bone
Hypercalcemia of malignancy
Multiple myeloma

65
Q

Denosumab (Prolia/Xgeva) SE

A

Hypocalcemia, hypophosphatemia
Peripheral edema
Back pain

66
Q

Denosumab (Prolia/Xgeva) drug intereactions

A

None - but may increase immunosuppression

67
Q

Denosumab (Prolia/Xgeva) contraindications

A

Preexisting hypocalcemia
Pregnancy

68
Q

Which tests should be done on a pt on Denosumab?

A
  • 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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