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NAPLEX > Chapter 49: Osteoporosis, Menopause & Testosterone Use > Flashcards

Chapter 49: Osteoporosis, Menopause & Testosterone Use Flashcards

1
Q

Which medications can cause osteoporosis

A 
Anticonvulsants
Aromatase inhibitors
Depo-Provera
GnRH agonists
Lithium
PPIs
Steroids (>/= 5 mg daily of prednisone or prednisone equivalent for >/= 3 months)
Thyroid hormones
Others (heparin, loops, SSRIs, TZDs)
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2
Q

What is the gold standard to measure BMD and diagnose osteoporosis

A

DEXA scan

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3
Q

Who should have BMD measured

A

All women >/= 65 years & men >/= 70 years

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4
Q

What is a T-score

A

compares the patient’s measured BMD to the average peak BMD of a healthy, young, white adult of the same sex

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5
Q

A T-score at or above __ correlates with stronger (denser) bones

A

-1

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6
Q

A T-score = ___ correlates with osteoporosis

A

-2.5

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7
Q

What is the FRAX tool

A

estimates the risk of osteoporotic fracture in the next 10 years

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8
Q

Recommended daily intake of calcium for most adults

A

1,000-1200 mg elemental Ca

Do not exceed 500-600 mg of elemental Ca per dose

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9
Q

Calcium carbonate has __% elemental Ca & calcium citrate has __% of elemental Ca

A

40%

21%

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10
Q

Which form of calcium is acid-dependent

A

Carbonate

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11
Q

Which form of calcium must be taken with food

A

Carbonate

think of the word CARB = food

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12
Q

Calcium deficiency is defined as < ___ ng/mL

A

30

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13
Q

Vitamin deficiency should be treated with

A

cholecalciferol (D3) or ergocalciferol (D2) dosed daily (5,000-7,000 IU) or weekly (50,000 IU)

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14
Q

SE of calcium supplements

A

constipation

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15
Q

Calcium carbonate should NOT be taken with which drug class

A

PPIs (because it is acid-dependent)

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16
Q

Which drugs are approved for PREVENTION of osteoporosis

A

Bisphosphonates (except IV ibandronate); (1st line)

Raloxifene and Duavee

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17
Q

Which drugs are approved for TREATMENT of osteoporosis

A

Bisphosphonates (1st line)
Denosumab
Teriparatide
Calcitonin

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18
Q

Counseling for bisphosphonate administration

A

must stay upright for 30 min and drink 6-8 oz of plain water

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19
Q

bisphosphonate SE

A

esophagitis, hypocalcemia, GI effects (dyspepsia, dysphagia, heartburn, N/V)
RARE: atypical femur fractures, osteonecrosis of the jaw

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20
Q

Treatment duration with bisphosphonates in patients with low risk of fracture

A

3-5 years (this is because of the risk of femur fracture and ONJ)

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21
Q

Denosumab is given via what administration and how often

A

SC every 6 months

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22
Q

Denosumab SE/warnings

A

hypocalcemia, ONJ, atypical femur fractures

HTN, fatigue, edema, dyspnea, HA, NVD, ↓ PO4

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23
Q

Which drugs are recommended for very high risk patients only (e.g., hx of severe vertebral fractures)

A

Teriperatide & abaloparatide

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24
Q

How often are Teriperatide & abaloparatide given and via what route

A

SC daily

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25
Teriperatide & abaloparatide SE
hypercalcemia, arthralgias, leg cramps, nausea, orthostasis/dizziness
26
What drugs are alternatives to bisphosphonates if high risk of vertebral fractures
Raloxifene, Bazedoxifene/Estrogens
27
Raloxifene can be used if
low risk of VTE or high risk of breast cancer
28
Bazedoxifene/Estrogens can be used in women with ____ for prevention of osteoporosis
an intact uterus
29
Raloxifene & Bazedoxifene/Estrogens SE
increased risk of breast cancer
30
Bisphosphonate MOA
inhibit osteoclast activity and bone resorption
31
All Bisphosphonates reduce vertebral and hip fracture risk, except ____ which only reduces vertebral fractures
ibandronate
32
Alendronate brand name
Fosamax
33
Ibandronate is given via which route and how often
IV every 3 months
34
Zoledronic acid is given via which route and how often
IV once yearly
35
Bisphosphonates CI
Hypocalcemia, inability to stand or sit upright for at least 30 min
36
Bisphosphonates should be separated from ___ for how many hours
calcium, antacids, iron and Mg | 2 hrs
37
Atelvia DR (risedronate) should not be used with which drug classes
H2RA and PPIs (requires an acidic-gut)
38
Which drugs are preferred for osteoporosis if pt has esophagitis
IV bisphosphonates
39
Raloxifene drug class
SERM; ↓ bone resorption
40
Raloxifene & Duavee CI
VTE, pregnancy | -Duavee: breast CA, uterine bleeding
41
Duavee BW
Endometrial CA, ↑ risk of DVT and stroke
42
Calcitonin MOA
inhibits bone resorption by osteoclasts
43
Calcitonin brand name
Miacalcin
44
Calcitonin formulations
Injection, nasal spray
45
Calcitonin is used for
treatment of osteoporosis in women > 5 years postmenopause
46
Calcitonin warnings
Hypocalcemia, ↑ risk of malignancy with long-term use, hypersensitivity reactions to salmon-derived products
47
Teriparatide and abaloparatide MOA
analogs of human PTH, which stimulates osteoblast activity and increases bone formation
48
Teriparatide and abaloparatide BW
Osteosarcoma (bone cancer) | b/c you're increasing bone formation, i.e. uncontrolled growth of bone cells
49
Teriparatide and abaloparatide must be kept ____ | Teriperatide (Forteo) must be ___
refrigerated | protected from light
50
Denosumab MOA
binds to RANKL and blocks interaction with RANK to prevent osteoclast formation
51
When is denosumab used
When there is a high risk for fracture
52
Denosumab brand name
Prolia
53
Denosumab CI
Hypocalcemia, pregnancy
54
What is the most effective treatment for vasomotor symptoms
Estrogen
55
Women with a uterus should use estrogen in combination with ___ for vasomotor sx
progesterone
56
What are the criteria to meet for use or hormone therapy
- Healthy women within 10 years of menopause, < / = 60 years of age and no CI - Patients with RF (age, time since menopause, risk of blood clots, heart disease, stroke and breast cancer) should use non-hormonal treatments (SSRIs, SNRIs, gabapentin, or pregabalin)
57
Estradiol TD patch brand names
Alora, Climara, Vivelle-Dot
58
CEE brand name
Premarin
59
Micronized progesterone brand name
Prometrium
60
Vivelle-Dot and Alora are applied ___x/week | Climara is applied __x/week
2 | 1
61
Natural products to use in menopause
Black cohosh, evening primrose oil, red clover, soy
62
Paroxetine (Brisdelle) should not be used with which drugs
Warfarin or tamoxifen
63
Testosterone BW
secondary exposure to testosterone in children can cause early virilization
64
Testosterone SE
↑ appetite, acne, edema, hepatotoxicity, reduced sperm count Androderm: skin irritation Natesto (gel): nasal irritation
65
Testosterone gels should be applied when
same time every morning

NAPLEX (74 decks)

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