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Oral Med BONES, GERIATRICS, MRONJ > Drugs for Osteoporosis > Flashcards

Drugs for Osteoporosis Flashcards

1
Q

What are two types of drugs that are used to treat osteoporosis?

A

SERMS and bisphosphonates

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2
Q

Osteoporosis Drugs: SERMS stand for

A

Selective estrogen receptor modulators

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3
Q

Osteoporosis Drugs: What are three types of oral bisphosphonates?

A

Fosamax, Acetonel, Boniva

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4
Q

Osteoporosis Drugs: Example of SERMS drug

A

Raloxifene

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5
Q

Osteoporosis Drugs: Raloxifene Function

A

Activates estrogen receptors in bone.

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6
Q

Osteoporosis Drugs: FDA approved Raloxifene for what use?

A

For prevention of osteoporosis in postmenopausal women

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7
Q

Osteoporosis Drugs: What does Raloxifene not do?

A

Does not activate estrogen receptors in breast, thus helping to prevent breast cancer

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8
Q

Osteoporosis Drugs: Raloxifene is primarily used by what population? Why?

A

Used by women with osteporosis risk who also have risk for breast cancer (therefore are unable/unwilling to take estrogen)

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9
Q

Osteoporosis Drugs: Raloxifene alternate name

A

Evista

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10
Q

Osteoporosis Drugs: Evista (Raloxifene) is the only medication to reduce what two events?

A
  1. Reduce risk for spinal fractures due to osteoporosis

2. Reduce risk of invasive breast cancer in postmenopausal women with osteoporosis

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11
Q

Osteoporosis Drugs: What does Evista (Raloxifene) not do?

A

Does not treat breast cancer, prevent it from returning, or reduce the risk of all forms of breast cancer.

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12
Q

Osteoporosis Drugs: Evista (Raloxifene) summary of effects (3)

A
  1. Anti-resorptive action on bone
  2. Absence of vaginal bleeding
  3. Absence of endometrial and breast stimulation
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13
Q

Osteoporosis Drugs: Evista (Raloxifene) side effects

A

Hot flashes, leg cramps

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14
Q

Osteoporosis Drugs: MOA of Bisphosphonates

A
  • Target osteoclasts

- Inhibit osteoclast formation and activity

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15
Q

What are the three oral bisphosphonates?

A
  • Alendronate
  • Risedronate
  • Ibandronate
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16
Q

Function of oral bisphosphonates

A

Prevention and treatment of osteoporosis

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17
Q

What are the three IV bisphosphonates?

A

Etidronate
Pamidronate
Zoledronic acid
Tiludronate

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18
Q

Function of IV bisphosphonates

A

Treatment of bone pathologies

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19
Q

What is the IV bisphosphonate that is used for osteoporosis prevention

A

Zoledronic acid

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20
Q

What are some challenges of bisphosphonates?

A
  • Low bio availability
  • Take with full glass of water only
  • Use with calcium but at different times
  • Remain upright for 30 minutes to 1 hour after taking
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21
Q

Common Side effects of bisphosphonates

A
  • Erosive esophagitis
  • Headache
  • GI distress
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22
Q

Oral complication of bisphosphonates

A

Osteonecrosis of the jaw

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23
Q

When are IV bisphosphonates used in most cases?

A

Given at higher doses for chemotherapy for cancers that have metastasized to the bone.

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24
Q

What are three examples of bisphosphonates given for chemotherapy and other bone pathologies

A
  • Etidronate disodium
  • Pamidronate
  • Tiludronate
  • Zoledronic acid
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25
Q

Bisphosphonates: Etidronate disodium uses

A

Paget’s disease, hypercalcemia (malignancy)

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26
Q

Bisphosphonates: Pamidronate Uses

A

Hypercalcemia (malignancy), bone cancers

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27
Q

Bisphosphonates: Tiludronate uses

A

Paget’s Disease

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28
Q

Bisphosphonates: Zoledronic acid uses

A

Hypercalcemia (malignancy), bone cancers

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29
Q

What is a complication of Bisphosphonates that occurs due to long-term use?

A

Increase prevalence of atypical fractures, especially in mid-shaft long bone and femur fractures

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30
Q

Two functions of calcitonin

A

Greatest effect in patients with rapid bone turnover.

Relieves osteoporotic bone pain

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31
Q

Teriparatide is a ____ derivative

A

Parathyroid

32
Q

Teriparatide Is given to what population

A
  • Postmenopausal osteoporotic women and hypogonadal osteoporotic men at high risk of fracture
  • Glucocorticoid induced osteoporosis in men and women at high risk for fracture
33
Q

Teriparatide Function

A

Stimulates osteoblasts, increases GI and kidney absorption of calcium.

34
Q

Denosumab is not a Bisphosphonate but is an _____ _____

A

Monoclonal antibody

35
Q

Denosumab Indications

A

Treatment of osteoporosis in men and postmenopausal women at high risk for fractures

36
Q

Denosumab are used for patients with what two conditions?

A

Bone metasteses from solid tumors

Multiple myeloma

37
Q

Prolia (Denosumab) is injected how often?

A

60 mg as a single dose every six months

38
Q

Prolia (Denosumab) Function

A

Receptor blocker on osteoclasts

39
Q

Prolia (Denosumab) MOA

A

Blocks interaction between ligand (RANKL) and receptor (RANK) located on osteoclast surfaces and prevents osteoclast formation

40
Q

Prolia (Denosumab) leads to ______ bone resportion and ____ bone mass

A

Decreased; increased

41
Q

Prolia (Denosumab) is associated with what oral complication?

A

Oral necrosis of the jaw

42
Q

Prolia and Bisphosphonates share what common target?

A

Osteoclast inhibition

43
Q

Calcium supplements dosage over 51

A

1200 mg/day

44
Q

Calcium supplements for postmenopausal women without HRT

A

1500 mg/day

45
Q

Calcium supplements max dose

46
Q

Calcium supplement doses should be split into ____-_____ mg

A

500-600 mg

47
Q

When should calcium supplements be taken?

A

At mealtime

48
Q

Calcium is combined with what two other elements to become dietary calcium? What is it known as?

A

Carbon and oxygen; calcium carbonate

49
Q

What happens when calcium carbonate is digested?

A

Carbon and oxygen breaks away to return to its elemental form

50
Q

How much elemental calcium is in calcium carbonate?

51
Q

What are two types of calcium supplements?

A

Calcium carbonate and calcium citrate

52
Q

Advantages of Calcium Carbonate

A
  • 40% elemental calcium
  • Inexpensive, requires few tablets
  • Absorption is acid-dependent
53
Q

Advantages of calcium citrate

A
  • 24% elemental calcium
  • Acid dependent
  • better for those taking Tagamet and Prilosec
54
Q

Total calcium intake and dietary calcium offer ____ protective effects

A

Cardiovascular

55
Q

Calcium supplements are associated with an increased risk for ____ ____ events; what are some examples?

A

Adverse cardiac

MI, stroke, coronary artery calcification, mortality

56
Q

Vitamin D is necessary for the absorption of ___ and _____

A

Calcium and phosphorus

57
Q

Function of Vitamin D

A
  • Increases bone mass

- Decreases fracture rate

58
Q

Vitamin D decreases PTH which decreases ___

A

Resorption

59
Q

VItamin D potentially increases ______ _____

A

Bone formation

60
Q

What is the vitamin D preparation?

A

Ergocalciferol

61
Q

The vitamin D2 supplement is known as

A

Ergocalciferol

62
Q

Ergocalciferol has a _____ half-life and decreased _____

A

Short; decreased

63
Q

The vitamin D3 supplement is known as

A

Cholecalciferol

64
Q

Cholecalciferol is synthesized where?

A

In humans in skin

65
Q

Cholecalciferol is more effective at raising and maintaing what?

A

Vitamin D test

66
Q

Why would vegans not want to use vitamin D3?

A

Because supplements are derived from animal source

67
Q

What is the normal vitamin D test?

A

30 to 74 ng/mL

68
Q

Vitamin D Deficiency can be avoided by

A

Going outside

69
Q

What is the right dose of vitamin D for preventing all cancer types?

A

Calcium 1400-1500 mg/day plus vitamin D3 1100 IU/day in postmenopausal women

70
Q

What is the right dose of vitamin D for muscle pain caused by meds called “statins”?

A

vitamin d2 or d3 50,000 unites once a week

71
Q

What is the right dose of vitamin D for preventing the flu?

A

vitamin D 12000 IU daily

72
Q

Most vitamin supplements contain only ____ IU vitamin D

73
Q

Vitamin D Dosage to prevent rickets/bone pain:

Birth through 50 years of age

74
Q

Vitamin D Dosage to prevent rickets/bone pain:

Adults 51 to 70 years old

75
Q

Vitamin D Dosage to prevent rickets/bone pain:

Adults greater than 70 years of age

Oral Med BONES, GERIATRICS, MRONJ (10 decks)

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