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NAPLEX 2023 > 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 -1 to -2.4 indicated

A

osteopenia

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7
Q

A T-score ≤ ___ correlates with osteoporosis

A

-2.5

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8
Q

What is the FRAX tool

A

estimates the risk of osteoporotic fracture in the next 10 years

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9
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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10
Q

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

A

40%
21%

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11
Q

Which form of calcium is acid-dependent

A

Carbonate

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12
Q

Which form of calcium must be taken with food

A

Carbonate

think of the word CARB = food

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13
Q

Vitamin D deficiency is defined as < ___ ng/mL

A

30

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14
Q

Vitamin D 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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15
Q

SE of calcium supplements

A

constipation

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16
Q

Calcium carbonate should NOT be taken with which drug class

A

PPIs (because it is acid-dependent)

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17
Q

Which drugs are approved for PREVENTION of osteoporosis

A

Bisphosphonates (except IV ibandronate); (1st line)
Raloxifene and Duavee

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18
Q

Which drugs are approved for TREATMENT of osteoporosis

A

Bisphosphonates (1st line)
Denosumab
Teriparatide
Calcitonin

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19
Q

Counseling for bisphosphonate administration

A

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

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20
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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21
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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22
Q

Denosumab is given via what administration and how often

A

SC every 6 months

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23
Q

Denosumab SE/warnings

A

hypocalcemia, ONJ, atypical femur fractures

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

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24
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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25
Q

How often are Teriperatide & abaloparatide given and via what route

A

SC daily

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26
Q

Teriperatide & abaloparatide SE

A

hypercalcemia, arthralgias, leg cramps, nausea, orthostasis/dizziness

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27
Q

What drugs are alternatives to bisphosphonates if high risk of vertebral fractures

A

Raloxifene, Bazedoxifene/Estrogens (Duavee)

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28
Q

Raloxifene can be used if

A

low risk of VTE or high risk of breast cancer

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29
Q

Bazedoxifene/Estrogens can be used in women with ____ for prevention of osteoporosis

A

an intact uterus

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30
Q

Raloxifene & Bazedoxifene/Estrogens SE

A

increased risk of breast cancer

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31
Q

Bisphosphonate MOA

A

inhibit osteoclast activity and bone resorption

32
Q

All Bisphosphonates reduce vertebral and hip fracture risk, except ____ which only reduces vertebral fractures

A

ibandronate

33
Q

Alendronate brand name

A

Fosamax

34
Q

ibandronate brand name

A

Boniva

35
Q

zolendronic acid bran

A

Reclast

Zometa for hypercalcemia of malignancy

36
Q

Ibandronate is given via which route and how often

A

Oral monthly or
IV every 3 months

37
Q

Zoledronic acid is given via which route and how often

A

Tx: IV once yearly

38
Q

Bisphosphonates CI

A

Hypocalcemia, inability to stand or sit upright for at least 30 min

39
Q

Bisphosphonates should be separated from ___ for how many hours

A

calcium, antacids, iron and Mg

2 hrs

40
Q

Atelvia DR (risedronate) should not be used with which drug classes

A

H2RA and PPIs (requires an acidic-gut)

41
Q

Which drugs are preferred for osteoporosis if pt has esophagitis

A

IV bisphosphonates

42
Q

Raloxifene drug class

A

SERM; ↓ bone resorption

43
Q

Raloxifene & Duavee CI

A

Raloxifene: hx of VTE, pregnancy
Duavee: breast CA hx, uterine bleeding, hx VTE

44
Q

Duavee BW

A

Endometrial CA, ↑ risk of DVT and stroke in post menopausal women

45
Q

Calcitonin MOA

A

inhibits bone resorption by osteoclasts

46
Q

Calcitonin brand name

A

Miacalcin

47
Q

Calcitonin formulations

A

Injection, nasal spray

48
Q

Calcitonin is used for

A

treatment of osteoporosis in women > 5 years postmenopause

49
Q

Calcitonin warnings

A

Hypocalcemia, ↑ risk of malignancy with long-term use, hypersensitivity reactions to salmon-derived products

50
Q

Teriparatide and abaloparatide MOA

A

analogs of human PTH, which stimulates osteoblast activity and increases bone formation

51
Q

Teriparatide and abaloparatide warnings

A

Osteosarcoma (bone cancer)
hypercalcemia

b/c you’re increasing bone formation, i.e. uncontrolled growth of bone cells

52
Q

Teriparatide and abaloparatide must be kept ____
Teriperatide (Forteo) must be ___

A

refrigerated
protected from light

53
Q

Denosumab MOA

A

binds to RANKL and blocks interaction with RANK to prevent osteoclast formation

54
Q

When is denosumab used

A

When there is a high risk for fracture

55
Q

Denosumab brand name

brand name for hypercalcemia of malignancy

A

Prolia

Xgeva

56
Q

Denosumab CI

A

Hypocalcemia, pregnancy

57
Q

denosumab warnings

A

ONJ, atypical femur fractures, hypocalcemia

58
Q

romosozumab indication

A

postmenopausal women with hx of osteoporotic fractures or multiple risk factors

59
Q

What is the most effective treatment for vasomotor symptoms

A

Estrogen

It causes a decrease in LH and more stable temperature control

60
Q

Women with a uterus should use estrogen in combination with ___ for vasomotor sx

Why?

A

progesterone

alone increases risk for endometrial cancer

61
Q

What are the criteria to meet for use or hormone therapy

A
  • Healthy women within 10 years of menopause, ≤ 60 years of age and no CI to use
  • 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)
62
Q

17-beta-estradiol brand names

A

Estrace, Estring, Vagifem

63
Q

Estradiol TD patch brand names

A

Alora, Climara, Vivelle-Dot

64
Q

Conjugated Eqiune Estrogens brand name

A

Premarin

65
Q

Medroxyprogesterone brand name (tablet)

A

Provera

66
Q

Micronized progesterone brand name

A

Prometrium

67
Q

Vivelle-Dot and Alora are applied ___x/week
Climara is applied __x/week

A

2
1

68
Q

Natural products to use in menopause

A

Black cohosh, evening primrose oil, red clover, soy

69
Q

Paroxetine (Brisdelle) should not be used with which drugs

A

Warfarin or tamoxifen

2D6 inhibitor - blocks effect of tamoxifen (prodrug)

SSRIs increase bleeding risk

70
Q

Ospemifene (Osphena) indication

A

oral estrogen agonist/antagonist indicated for dyspareunia (painful intercourse)

71
Q

Testosterone BW

A

secondary exposure to testosterone in children can cause early virilization

72
Q

Testosterone SE

A

↑ appetite, acne, edema, hepatotoxicity, reduced sperm count
Androderm: skin irritation
Natesto (gel): nasal irritation

73
Q

Testosterone gels should be applied when

A

same time every morning

74
Q

Androderm should be removed before ___

A

MRI

75
Q

testosterone increase ___ (lab value)

A

hematocrit

can increase clotting risk

NAPLEX 2023 (88 decks)

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