Exam 2 - Bone Modifying Agents Weddle

Question 1

which of the following is FALSE about the pathophysiology of HCM?

a. inc parathyroid hormone related prote (PTHrP)
b. inc calcitriol
c. inc resorption
d. inc elimination
e. bone metastases present

Answer 1

d. inc elimination (dec)

Question 2

5 types of HCM

Answer 2

1. humoral
2. local osteolytic hypercalcemia
3. 1,25(OH)2D-Secreting lymphomas
4. ectopic hyperparathyroidism
5. renal

Question 3

most common type of HCM (~80%)

a. humoral
b. local osteolytic hypercalcemia
c. 1,25(OH)2D-Secreting lymphomas
d. ectopic hyperparathyroidism
e. renal

Answer 3

a. humoral

Question 4

calcium levels for mild HCM (range)

Answer 4

10-12

Question 5

calcium levels for moderate HCM (range)

Answer 5

12-14

Question 6

corrected calcium equation

Answer 6

serum calcium + 0.8(4 - serum albumin)

Question 7

normal calcium levels (range)

Answer 7

8.5-10 mg/dL

Question 8

calcium levels for severe HCM

Answer 8

> 14 mg/dL

Question 9

mild HCM tx for asymptomatic or mild sx

Answer 9

encourage hydration

Question 10

which should NOT be used to treat mild HCM with moderate sx?

a. hydration
b. zoledronic acid
c. pamidronate
d. calcitonin

Answer 10

d. calcitonin

Question 11

for moderate to severe HCM, which bisphosphonate was shown to be superior?

a. zoledronic acid
b. pamidronate

Answer 11

a. zoledronic acid

Question 12

tx for severe HCM (3 things to know)

Answer 12

-hydrate!
-bisphosphonates
-calcitonin

Question 13

MOA of denosumab for tx refractory HCM

Answer 13

RANK-L inhibitor

Question 13

how long does it take for tachypylaxis to occur for calcitonin?

Answer 13

48 hours

Question 14

calculate this corrected calcium:
-calcium 12.4 mg/dL
-albumin 1.9 g/dL

Answer 14

14.08 (severe HCM)

12.4 + 0.8(4 - 1.9) = 14.08

Question 15

chronic HCM: MOA of 0.9% normal saline

a. dilutes calcium and improves renal elim
b. inc urinary calcium excretion
c. blocks bone resorption
d. blocks bone resorption and inc urinary calcium excretion

Answer 15

a. dilutes calcium and improves renal elimination

Question 16

chronic HCM: MOA of loop diuretics

a. dilutes calcium and improves renal elim
b. inc urinary calcium excretion
c. blocks bone resorption
d. blocks bone resorption and inc urinary calcium excretion

Answer 16

b. inc urinary calcium excretion

Question 17

chronic HCM: MOA of bisphosphonates

a. dilutes calcium and improves renal elim
b. inc urinary calcium excretion
c. blocks bone resorption
d. blocks bone resorption and inc urinary calcium excretion

Answer 17

c. blocks bone resorption

Question 18

chronic HCM: MOA of calcitonin

a. dilutes calcium and improves renal elim
b. inc urinary calcium excretion
c. blocks bone resorption
d. blocks bone resorption and inc urinary calcium excretion

Answer 18

d. blocks bone resorption and inc urinary calcium excretion

Question 19

cancers with affinity for bone (5)

Answer 19

breast
prostate
myeloma
lung
kidney

Question 20

skeletal related events (SRE’s) definition (there are 5 criteria)

Answer 20

1. pathologic fracture
2. need for bone radiation
3. need for bone surgery
4. spinal cord compression
5. hypercalcemia

Question 21

most commonly used scan for diagnosis of skeletal related events (SREs)

a. radiograph
b. CT scan
c. radionucleotide bone scan
d. PET scan
e. MRI

Answer 21

c. radionucleotide bone scan

Question 22

which is NOT a risk factor for fractures in women with BC?

a. on aromatase inhibitors
b. BMI > 20
c. smoking
d. corticosteroid use > 6 months
e. age > 65

Answer 22

b. BMI > 20

(< 20 is a risk factor)

Question 23

two risk factors for fractures in men with prostate cancer

Answer 23

-ADT
-smoking

Question 24

goal of tx of bone metastases

Answer 24

palliation of sx

Question 25

what are some ways we can treat bone metastases? (4 things; slide 28 of 44)

Answer 25

-radiation
-chemotherapy
-IV bone modifying agents
-radioisotopes

Question 26

radiation therapy for bone metastases will cause pain relief in ___-___ weeks

Answer 26

1-2

Question 27

radioisotope for thyroid cancer

a. 131-iodine
b. radium-223
c. strontium and samarium

Answer 27

a. 131-iodine

Question 28

radioisotope for prostate cancer (not metastatic)

a. 131-iodine
b. radium-223
c. strontium and samarium

Answer 28

b. radium-223

Question 29

radioisotope used in metastatic breast and prostate cancers

a. 131-iodine
b. radium-223
c. strontium and samarium

Answer 29

c. strontium and samarium

Question 30

IV bisphosphonates for SRE’s:

-pamidronate is given IV over ____ ____ every 3 to 4 weeks
-zoledronic acid is given IV over ___ ____ every 3 to 4 weeks

Answer 30

pamidronate: 2 hours
zoledronic acid: 15 minutes

Question 31

T or F: for prevention of SRE’s, pamidronate does not need to be renally adjusted, but zoledronic acid does

Answer 31

F (both must be renally dose adjusted)

Question 32

T or F: zoledronic acid and pamidronate need to be renally dose adjusted when used for HCM

Answer 32

F (only renally dose adjust for prevention of SRE’s)

Question 33

drug that may suppress residual osteoclast function in pts who respond poorly to bisphosphonates

Answer 33

denosumab

Question 34

denosumab uses (2; slide 36 of 44)

Answer 34

-bone metastases from solid tumors
-osteopenia

Question 35

is denosumab given IV or subQ?

Answer 35

subQ

Question 36

if a pt is on denosumab, what 2 things should they be supplemented with?

Answer 36

calcium, vitamin D

Question 37

which of the following is the LEAST likely to cause osteonecrosis of the jaw? (not sure if this is right; slide 38)

a. zoledronic acid
b. pamidronate
c. denosumab

Answer 37

b. pamidronate

Question 38

bisphosphonates are not recommended to treat osteonecrosis of the jaw in pts with CrCl < ___

Answer 38

< 30