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BCACP > Bone/Joint and Rheumatology > Flashcards

Bone/Joint and Rheumatology Flashcards

1
Q

Which medications may cause decrease BMD/osteoporosis?

A

-Antiepileptic agents
-Cyclosporine
-Lithium
-PPIs
-Systemic corticosteroids
-SSRIs
-TCAs
-TZDs

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2
Q

What is the recommended calcium intake to prevent fractures?

A

1000 mg (elemental)/day

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3
Q

What is the recommended vitamin D intake to prevent fractures?

A

400 units/day

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4
Q

Who qualifies for osteoporosis screening per AACE recommendations?

A

All post-menopausal women 50 years or older

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5
Q

Who qualifies for osteoporosis screening per BHOF recommendations?

A

-Women 65 years or older
-Men 70 years or older
-Post-menopausal women and men age 50-69 years with a history of adult-age fractures

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6
Q

What T-score is diagnostic for osteopenia?

A

1-2.5 SDs below the mean

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7
Q

What T-score is diagnostic for osteoporosis?

A

> 2.5 SDs below the mean

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8
Q

When would treatment be warranted in a patient with osteopenia?

A

When FRAX score reveals one of the following:
-Hip fracture risk > 3%
-Major fracture risk > 20%

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9
Q

What is first-line treatment for osteoporosis?

A

Bisphosphonates
-Alendronate
-Ibandronate
-Risedronate
-Zoledronic acid

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10
Q

What are rare but serious concerns of bisphosphonates?

A

-ONJ
-Atypical femur fracture/subtrochanteric fracture

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11
Q

What are counseling points on the administration of bisphosphonates?

A

Should be taken with 6-8 oz of water at least 30-60 min before eating or drinking

Should remain upright for at least 30 min after being administered an oral dose

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12
Q

In general, when should you consider a drug holiday with bisphosphonates?

A

After 5 years of oral therapy or 3 years of IV therapy

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13
Q

What are second-line treatments for osteoporosis?

A

-RANKL Antagonist (Denosumab)
-Estrogen
-Parathyroid Hormone (Teriparatide/Abaloparatide)
-SERM

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14
Q

What is third-line treatment for osteoporosis?

A

Sclerostin Inhibitor (Romosozumab)

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15
Q

What are safety concerns related to denosumab?

A

-Increasing renal dysfunction
-Cellulitis
-ONJ
-Infections

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16
Q

What is a benefit of denosumab over bisphosphonate therapy?

A

Every 6 month dosing

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17
Q

When should denosumab not be recommended?

A

If ongoing or long-term continuation is not feasible

Drug holiday is not recommended

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18
Q

What are contraindications to teriparatide/abaloparatide?

A

-Alkaline phosphatase elevation
-Open epiphyses
-Paget disease
-Prior skeletal radiation

19
Q

What is a con of administration of teriparatide/abaloparatide?

A

Daily subcutaneous injections

20
Q

What is the black box warning associated with romosozumab?

A

Increased risk of MI, stroke, and CV death - should not be initiated in patients who had a MI or stroke within previous year

21
Q

Who would be a candidate for romosozumab therapy?

A

One of the following:
-Multiple fragility fractures
-High risk of fracture who cannot tolerate any other therapies
-Other therapies have failed (fracture with loss of BMD despite adherence to therapy)

22
Q

Which agents require antiresorptive therapy after treatment discontinuation?

A

-Romosozumab
-Teriparatide/abaloparatide

23
Q

How often should DEXA be repeated after osteoporosis diagnosis?

A

Yearly (some insurances will only cover every 2 years if not on therapy)

24
Q

What is the only intervention shown to reduce progression of OA?

A

Nonpharmacologic interventions (weight loss, low-impact exercise, PT, support braces)

25
Q

What is the first-line therapy for mild OA?

A

Acetaminophen (as needed or scheduled)

-Not recommended for hand OA

26
Q

How long should topical NSAIDs be used for OA?

A

< 12 weeks

27
Q

Which patients may topical NSAIDs be preferred over oral NSAIDs?

A

-> 75 years old
-History of CV disease
-Contraindications to oral NSAIDs

28
Q

What is the second-line therapy for mild OA and first-line therapy for moderate OA?

A

NSAIDs

-Consider COX-2 inhibitor (celecoxib) for less GI side effects

29
Q

What therapy is reserviced for refractory, severe OA?

A

Opioids (although not routinely recommended)

30
Q

What therapy can be considered for OA after inadequate pain relief w/ APAP and NSAIDs?

A

Tramadol

31
Q

What is the first-line therapy for pain/symptoms associated with fibromyalgia?

A

TCAs
-Amitriptyline
-Cyclobenzaprine
-Nortriptyline

32
Q

What are second-line therapies for pain/symptoms associated with fibromyalgia?

A

-Gabapentin/pregabalin
-Dopamine D3 receptor agonists (pramipexole)
-SSRIs (fluoxetine, paroxetine)
-SNRI (duloxetine)
-Nonopioid mu-receptor antagonist (tramadol)

33
Q

How should SSRIs be taken when being used for fibromyalgia?

A

In combination w/ TCAS (if possible)

34
Q

What are medications that can increase uric acid and can precipitate gout?

A

-Thiazide diuretics
-Aspirin
-Nicotinic acid
-Vitamin B12
-Cyclosporine
-Levodopa
-Pyrazinamide

35
Q

When is monotherapy indicated for an acute gouty attack?

A

Mild-to-moderate pain, particularly for an attack affecting only 1 or a few small joints, or 1-2 large joints

36
Q

When is initial combination therapy indicated for an acute gouty attack?

A

Severe pain, particularly for a polyarticular attack or an attack affecting multiple large joints

37
Q

What medications are available for first-line management of an acute gouty attack?

A

-NSAID or COX-2 inhibitor
-Systemic corticosteroids
-Colchicine

38
Q

What is a risk of colchicine therapy?

A

Adverse hematologic events (myelosuppression, leukopenia, thrombocytopenia, and pancytopenia)

39
Q

Which treatment for an acute gouty flare is recommended for patients with renal insufficiency?

A

Corticosteroids

40
Q

When should uric acid lowering therapy be considered?

A

-2 or more acute gouty attacks per year
-Presence of tophi
-Stage II CKD or worse
-History of urolithiasis

41
Q

What is the goal uric acid level for patients with gout?

A

-< 5 mg/dL (with tophi)
-< 6 mg/dL (without tophi)

42
Q

What are safety concerns with allopurinol?

A

-Severe cutaneous adverse reactions (SCARs)
-Drug reaction with eosinophilia and systemic symptoms (DRESS)
-Mucositis
-Hepatotoxicity

43
Q

When would it be appropriate to use fuboxostat?

A

-Absolute contraindication to allopurinol
-Allopurinol therapy has failed

BCACP (20 decks)

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