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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
Duavee Boxed Warnings
``` Endometrial Cancer (due to unopposed estrogen) Increased risk of DVT ```
26
Duavee CI
Breast Cancer Pregnancy Uterine Bleeding VTE
27
Calcitonin MOA
Inhibits bone resorption by osteoclasts
28
Calcitonin Dosing (nasal)
1 spray in one nostril qd (alternate nostril daily)
29
Calcitonin Warnings
Hypocalcemia Increased risk of malignancy Hypersensitivity reaction to salmon derived products
30
Teriparatide and abaloparatide MOA
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
Parathyroid Hormone Boxed Warnings
Osteosarcoma
32
Parathyroid Hormone Warnings
Hypercalcemia
33
Parathyroid Hormone SE
Arthralgias Leg Cramps Nausea Orthostasis/Dizziness
34
RANKL Inhibitors
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
Denosumab Dosing
Prolia | 60mg sc q6 months
36
Prolia CI
Hypocalcemia | Pregnancy
37
Prolia Warnings
ONJ Femur Fractures Hypocalcemia
38
Prolia SE
``` Hypertension Fatigue Edema Dyspnea Headache N/V/D Decreased PO4 ```
39
Estrace
17 beta estradiol | Vaginal Cream
40
Estring
17 beta estradiol | Vaginal ring
41
Vagifem
17 beta estradiol | Vaginal tablet
42
Premarin
Conjugated equine estrogens | Vaginal cream
43
Systemic Hormone Therapies Boxed Warnings
Endometrial cancer (if estrogen used without progestin in women with uterus) Dementia (>=65 years) Increased risk of VTE and stroke Breast Cancer
44
Systemic Hormone Therapies CI
Estrogen containing products and breast cancer Undiagnosed uterine bleeding Active VTE Pregnancy
45
Systemic Hormone Therapies Warnings
Increased risk of breast cancer
46
Estradiol Patches
Alora and Vivelle dot are biw | Climara qw
47
Natural Products for Menopause
``` Black cohosh Evening Primrose Red Clover Soy Flaxseed ```
48
Brisdelle
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
Ospemifene
Osphena | Oral estrogen agonist/antagonist indicated for dyspareunia (painful intercourse) and moderate to severe vaginal dryness
50
Testosterone Boxed Warnings
Secondary exposure in children can result in early virilization
51
Testosterone SE
``` Increased appetite Acne Edema hepatotoxicity reduced sperm count ```

NAPLEX (45 decks)

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