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pre-reg-thuri > ENDOCRINE - BONE DISORDERS > Flashcards

ENDOCRINE - BONE DISORDERS Flashcards

1
Q

What is osteoporosis?

A

Low bone mineral density + risk of fractures.

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2
Q

What are other risk factors for osteoporosis?

A

Elderly, hx of hip fractures

Low BMI, smoking , excess alcohol, diabetes, vit d + calcium deficiency, early menopause

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3
Q

What are 3 main risk factors for osteoporosis?

A

Menopause

50+ in men

Long term glucocorticoid

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4
Q

What is 1st line treatment for osteoporosis?

A

Oral bisphosphonates

e.g. alendronic acid + Risedronate

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5
Q

How to prevent osteoporosis?

A

Avoid Long term glucocorticoids

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6
Q

What dose of steroid is likely to give high risk of osteoporosis?

A

7.5mg or more daily prednisolone

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7
Q

What 3 situations should prophylactic bisphosphonate tx start for gluccocorticoid treatment in women?

A

If 70 or +
OR

Previous fracture
OR
Large dose steroid 7.5mg pred or more (>3 months)

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8
Q

What 3 situations should prophylactic bisphosphonate tx start for gluccocorticoid treatment in men?

A

70 and over AND either:

previous fracture

large doses steroid (>3 months)

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9
Q

What do menopause women go on to reduce risk. of osteoporosis?

A

HRT - if they are more than 60+ and have menopause symtpoms

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10
Q

What is calcitriol?

A

synthetic Vit d3

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11
Q

What are 3 examples of HRT which can reduce risk of osteopororis?

A

Oestrogens

Tibolone

Raloxifene

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12
Q

What is a risk of using strontium ranelate?

A

CV events, reports of severe allergy

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13
Q

MOA of bisphosphonates?

A

Slows bone resorption by adsorbing onto hydroxyapatite crystals.

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14
Q

How long is treatment with bisphosphonates?

A

5 years

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15
Q

What bisphosphonate has the highest risk of jaw osteonecrosis?

A

Zolendronic acid

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16
Q

What is the most potent bisphosphonate and what is route?

A

Zolendronic acid - iv

17
Q

What is dosing regimen like for alendronic acid?

A

ONCE weekly

18
Q

What are 4 patient counselling points for alendronic acid?

A

Swallow whole with water, sitting or standing

Take it on empty stomach for at least 30 min before breakfast and stand/ sit upright for 30 mins.

19
Q

What is administration instruction for for Risedronate?

A

Leave 2 hr gap between between food + drink, calcium products, antacids, iron or minerals

Take least 30 min before breakfast

Sit or stand upright for 30 mins - avoid at bedtime.

20
Q

What are 4 SEs of bisphosphonates?

A

Oesophageal reactions

Atypical femoral fractures

Osteonecrosis of jaw

osteonecrosis of auditory canal

21
Q

What are 4 counselling points regarding bisphosphonate SEs?

A

Report symptoms of oesophageal irritation e.g. dysphagia, heartburn, pain swallowing

Report hip, thigh, groin pain.

report ear symptoms

routine dental checkups

22
Q

What are 3 MHRA warnings about bisphosphonates?

A

osteonecrosis of the external auditory canal

osteonecrosis of the jaw

atypical femoral fractures

23
Q

what 4 things to minimise risk of osteonecrosis of the jaw rom bisphosphonates?

A

high risk of IV bisphosphonate tx for cancer pts.

dental check-up, good oral hygiene

report any oral symptoms such as dental mobility, pain, or swelling, non-healing sores

wear fitting dentures

patient reminder card

24
Q

What are some life style changes to reduce risk of fractures?

A

increase exercise

stop smoking

maintain good BMI

Reduce alcohol intake

increase vit D + Calcium

25
Q

When to review treatment with zolendronic acid?

A

3 years

26
Q

What is dose of alendronic acid for women?

A

10 mg once daily, OR 70 mg once weekly.

27
Q

What is dose of alendronic acid for Men?

A

10 mg once daily.

28
Q

What 4 bisphosphonates are used for post-menopausal women?

A

Ibandronic acid

denosumab

raloxifene

strontium

29
Q

When is teriparatide used?

A

Severe osteoporosis in post- meno women

30
Q

What 4 bisphosphonates are used for men?

A

Zolendronic acid

denosumab

teriparatide

strontium

31
Q

What is 1st line for glucocorticoid induced osteoporosis? (2)

A

alendronic acid or risedronate sodium

32
Q

What crcl to avoid alendronic acid?

A

less than 35 mL/minute

33
Q

What crcl to avoid Risendronate?

A

less than 30 mL/minute

pre-reg-thuri (44 decks)

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