Exam 2 - Bone Modifying Agents Weddle Flashcards
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
d. inc elimination (dec)
5 types of HCM
- humoral
- local osteolytic hypercalcemia
- 1,25(OH)2D-Secreting lymphomas
- ectopic hyperparathyroidism
- renal
most common type of HCM (~80%)
a. humoral
b. local osteolytic hypercalcemia
c. 1,25(OH)2D-Secreting lymphomas
d. ectopic hyperparathyroidism
e. renal
a. humoral
calcium levels for mild HCM (range)
10-12
calcium levels for moderate HCM (range)
12-14
corrected calcium equation
serum calcium + 0.8(4 - serum albumin)
normal calcium levels (range)
8.5-10 mg/dL
calcium levels for severe HCM
> 14 mg/dL
mild HCM tx for asymptomatic or mild sx
encourage hydration
which should NOT be used to treat mild HCM with moderate sx?
a. hydration
b. zoledronic acid
c. pamidronate
d. calcitonin
d. calcitonin
for moderate to severe HCM, which bisphosphonate was shown to be superior?
a. zoledronic acid
b. pamidronate
a. zoledronic acid
tx for severe HCM (3 things to know)
-hydrate!
-bisphosphonates
-calcitonin
MOA of denosumab for tx refractory HCM
RANK-L inhibitor
how long does it take for tachypylaxis to occur for calcitonin?
48 hours
calculate this corrected calcium:
-calcium 12.4 mg/dL
-albumin 1.9 g/dL
14.08 (severe HCM)
12.4 + 0.8(4 - 1.9) = 14.08
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
a. dilutes calcium and improves renal elimination
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
b. inc urinary calcium excretion
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
c. blocks bone resorption
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
d. blocks bone resorption and inc urinary calcium excretion
cancers with affinity for bone (5)
breast
prostate
myeloma
lung
kidney
skeletal related events (SRE’s) definition (there are 5 criteria)
- pathologic fracture
- need for bone radiation
- need for bone surgery
- spinal cord compression
- hypercalcemia
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
c. radionucleotide bone scan
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
b. BMI > 20
(< 20 is a risk factor)
two risk factors for fractures in men with prostate cancer
-ADT
-smoking
goal of tx of bone metastases
palliation of sx
what are some ways we can treat bone metastases? (4 things; slide 28 of 44)
-radiation
-chemotherapy
-IV bone modifying agents
-radioisotopes
radiation therapy for bone metastases will cause pain relief in ___-___ weeks
1-2
radioisotope for thyroid cancer
a. 131-iodine
b. radium-223
c. strontium and samarium
a. 131-iodine
radioisotope for prostate cancer (not metastatic)
a. 131-iodine
b. radium-223
c. strontium and samarium
b. radium-223
radioisotope used in metastatic breast and prostate cancers
a. 131-iodine
b. radium-223
c. strontium and samarium
c. strontium and samarium
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
pamidronate: 2 hours
zoledronic acid: 15 minutes
T or F: for prevention of SRE’s, pamidronate does not need to be renally adjusted, but zoledronic acid does
F (both must be renally dose adjusted)
T or F: zoledronic acid and pamidronate need to be renally dose adjusted when used for HCM
F (only renally dose adjust for prevention of SRE’s)
drug that may suppress residual osteoclast function in pts who respond poorly to bisphosphonates
denosumab
denosumab uses (2; slide 36 of 44)
-bone metastases from solid tumors
-osteopenia
is denosumab given IV or subQ?
subQ
if a pt is on denosumab, what 2 things should they be supplemented with?
calcium, vitamin D
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
b. pamidronate
bisphosphonates are not recommended to treat osteonecrosis of the jaw in pts with CrCl < ___
< 30
