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

Chapter 49: Osteoporosis, Menopause & Testosterone Use Flashcards

1
Q

T Score Results

A

Normal >=1
Osteopenia (low bone mass) -1 to -2.4
Osteoporosis <= -2.5

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2
Q

Medical Diseases/Conditions that Increase Osteoporosis Risk

A 
Anorexia
Diabetes
GI Diseases (IBD, Celiac, Gastric Bypass, malabsoprtion syndrome)
Hyperthyroidism
Hydogonadism in men
Menopause
RA (autoimmune diseases)
Epilepsy
HIV/AIDS
Parkinson disease
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3
Q

Lifestyle Factors that Increase Osteoporosis Risk

A 
Smoking
Excessive Alcohol (>=3 drink/day)
Low Ca intake
Low Vit D intake
Physical Inactivity
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4
Q

Medications that Increase Osteoporosis Risk

A 
Anticonvulsants
Aromatase Inhibitors
Depo-medroxyprogesterone
GnRH agonists
Lithium
PPIs
Steroids (>=5mg/day of prednisone)
Thyroid Hormones
Heparins
Loops, SSRIs TZD
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5
Q

Calcium Recommended Daily Intake

A

1,000 to 1,200 elemental Ca

Ca Carbonate is 40% elemental
Ca Citrate is 21% elemental

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6
Q

Vitamin D Deficiency

A

Vit D deficiency <30ng/ml

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7
Q

Vitamin D Deficiency Tx

A

5,000 - 7,000 iu qd
or
50,000iu qw

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8
Q

Bisphosphonates CI

A

Hypocalcemia

Inability to stand or sit upright for at least 30 minutes

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9
Q

Bisphosphonates Warnings

A 
Osteonecrosis of the Jaw
Atypical Femur fractures 
Esophagitis, esophageal ulcers, erorsion
Hypocalcemia
Renal Impairment (do not use of CrCl <35 alendronate or >30 ibandronate/risedronate)
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10
Q

Bisphosphonates SE

A 
Dyspepsia
Dysphagia
Heartburn
N/V
Hypocalcemia
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11
Q

Alendronate Dosing

A

10mg/day or 70mg/week

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12
Q

Risedronate

A

(actonel/atelvia)

5mg po qd
35mg po qweek
150mg q month

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13
Q

Ibandronate

A

(Boniva)

150mg po q month

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14
Q

Injectable Bisphosphonates CI

A

Hypocalcemia

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15
Q

Injectable Bisphosphonates Warnings

A

Same as Po

Renal impairment (monitor SCr)

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16
Q

Injectable Bisphosphonates Notes

A

Preferred if esophagitis is present (due to risk of esophageal cancer)

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17
Q

Ibandronate Injections

A

3mg q3months

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18
Q

Zoledronic Acid

A

(Reclast)

5mg Q year

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19
Q

Bisphosphonates MOA

A

Work by increasing bone density by inhibiting osteoclast activity and bone resorption.
Reduce vertebral and hip fracture risk (except ibandronate only vertebral)
1st line for prevention of osteoporosis

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20
Q

Raloxifene MOA

A

estrogen agonist/antagonist (SERM) that decreases bone resorption

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21
Q

Raloxifene Boxed Warnings

A

Increased risk of VTE

Increased risk of death due to stroke

22
Q

Raloxifene CI

A

Hx or current VTE

Pregnancy

23
Q

Raloxifene SE

A

Hot flashes
Peripheral edema
Arthralgia
Leg Cramps

24
Q

Duavee Indication

A

Conjugated estrogens/bazedoxifene

Osteoporosis prevention on postmenopausal women WITH a uterus

25
Q

Duavee Boxed Warnings

A 
Endometrial Cancer (due to unopposed estrogen)
Increased risk of DVT
26
Q

Duavee CI

A

Breast Cancer
Pregnancy
Uterine Bleeding
VTE

27
Q

Calcitonin MOA

A

Inhibits bone resorption by osteoclasts

28
Q

Calcitonin Dosing (nasal)

A

1 spray in one nostril qd (alternate nostril daily)

29
Q

Calcitonin Warnings

A

Hypocalcemia
Increased risk of malignancy
Hypersensitivity reaction to salmon derived products

30
Q

Teriparatide and abaloparatide MOA

A

Analogs of human parathyroid hormones, which stimulates osteoblast activity and increases bone formation.

Used to treat osteoporosis when there is a very high risk of fracture

Cumulative lifetime tx duration is 2 years of less

31
Q

Parathyroid Hormone Boxed Warnings

A

Osteosarcoma

32
Q

Parathyroid Hormone Warnings

A

Hypercalcemia

33
Q

Parathyroid Hormone SE

A

Arthralgias
Leg Cramps
Nausea
Orthostasis/Dizziness

34
Q

RANKL Inhibitors

A

Receptor Activator of Nuclear Factor Kappa-B Ligand

MAb thant bind to rankl and blocks its interaction with RANK (a receptor on osteoclasts) to prevent osteoclast formation;

This leads to decreased bone resorption and increase bone mass

35
Q

Denosumab Dosing

A

Prolia

60mg sc q6 months

36
Q

Prolia CI

A

Hypocalcemia

Pregnancy

37
Q

Prolia Warnings

A

ONJ
Femur Fractures
Hypocalcemia

38
Q

Prolia SE

A 
Hypertension 
Fatigue
Edema
Dyspnea
Headache
N/V/D
Decreased PO4
39
Q

Estrace

A

17 beta estradiol

Vaginal Cream

40
Q

Estring

A

17 beta estradiol

Vaginal ring

41
Q

Vagifem

A

17 beta estradiol

Vaginal tablet

42
Q

Premarin

A

Conjugated equine estrogens

Vaginal cream

43
Q

Systemic Hormone Therapies Boxed Warnings

A

Endometrial cancer (if estrogen used without progestin in women with uterus)
Dementia (>=65 years)
Increased risk of VTE and stroke
Breast Cancer

44
Q

Systemic Hormone Therapies CI

A

Estrogen containing products and breast cancer
Undiagnosed uterine bleeding
Active VTE
Pregnancy

45
Q

Systemic Hormone Therapies Warnings

A

Increased risk of breast cancer

46
Q

Estradiol Patches

A

Alora and Vivelle dot are biw

Climara qw

47
Q

Natural Products for Menopause

A 
Black cohosh
Evening Primrose
Red Clover
Soy
Flaxseed
48
Q

Brisdelle

A

Paroxetine
SSRI for moderate to severe vasomotor symptoms
Do not use with warfarin (increased bleeding risk)
Do not use with tamoxifen (decreased tamoxifen efficacy)

49
Q

Ospemifene

A

Osphena

Oral estrogen agonist/antagonist indicated for dyspareunia (painful intercourse) and moderate to severe vaginal dryness

50
Q

Testosterone Boxed Warnings

A

Secondary exposure in children can result in early virilization

51
Q

Testosterone SE

A 
Increased appetite 
Acne
Edema
hepatotoxicity
reduced sperm count

NAPLEX (45 decks)

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