gout deck 2

Question 1

Biphosphonates used to

Answer 1

Used to treat osteoporosis and Paget’s disease

Question 2

Biphosphonates examples

Answer 2

Alendronate (Fosomax), risedronate (Actonel)

Question 3

Biphosphonates pharamcodynamics

Answer 3

Pharmacodynamics
Inhibits osteoclastic activity, increases bone density
Beneficial effects on bone density: mass increases rapidly the first year of treatment, then plateaus after 2 to 3 years
Significant gastrointestinal (GI) and esophageal irritation

Question 4

Biphosphonates pharmacokinetics

Answer 4

Pharmacokinetics: oral 
Onset: 3 to 6 weeks, peak: 3 to 6 months
Half-life: 10 years
Metabolism: none
Excretion: urine, feces (unabsorbed drug)

Question 5

Biphosphonates route

Answer 5

Intravenous (IV) forms: onset in 4 days, peak in 1 week

Strong renal impact

Question 6

Biphosphonates ADR

Answer 6

Diarrhea, constipation, flatulence, nausea/vomiting (n/v), hypocalcemia, hypophosphatemia, abdominal pain, dyspepsia, esophageal ulcer, arthralgia, myalgia, headache, rash, cardiovascular (CV): atrial fibrillation
Pathological fractures femoral neck: rare, but raises concern
Osteonecrosis (jaw): rare, but raises concern

Question 7

Biphosphonates caution with

Answer 7

Caution with patients with renal impairment, heart failure (HF), liver disease, active GI problems

Question 8

Biphosphonates interactions

Answer 8

Drug interactions: ranitidine doubles alendronate bioavailability; unknown clinical significance

Question 9

Biphosphonates consider

Answer 9

Consider high-risk patients:

white, Asian, history of eating disorders, long-term steroid or thyroid medications

Question 10

Biphosphonates correct

Answer 10

Correct preexisting vitamin D deficiency or hypocalcemia prior to initiating therapy.

Question 11

Biphosphonates iv form

Answer 11

IV form can be used for those with GI intolerance.

Can use IV form to help for bone metastasis care as well

Question 12

Biphosphonates lab

Answer 12

Complete blood count (CBC), chemistry panel
Renal-, liver-function studies
Bone density studies (DEXA scan)

Question 13

Biphosphonates alkaline phosphatease indicator of bone turnover

Answer 13

Alkaline phosphatase indicator of bone turnover
This is not always bad, just need to monitor
Alkaline phosphatase starts high in Paget’s disease, so drop is sign of effect.

Question 14

Biphosphonates calcium and

Answer 14

and electrolytes: especially if on diuretics

Question 15

Bone density studies (DEXA scan)

Answer 15

No evidence or consensus on how often to do them
Typically takes 2 years to change
Questions remain about reliability for measuring therapeutic impact
Female T scores used for males until new system approved

Question 16

Etidronate is used off-label for

Answer 16

Etidronate is used off-label for Paget’s disease and for heterotropic ossification issues.

Question 17

Raloxifene, a

Answer 17

Raloxifene, a SERM drug, is less effective than bisphosphontes

Question 18

Receptor activator of nuclear factor-

Answer 18

Receptor activator of nuclear factor-ΚB (RANKL) and estrogen may play a role for some with progressing disease.

Question 19

Can combine bisphosphonates with

Answer 19

bisphosphonates with SERM and/or estrogen

Question 20

RANKL class medications

Answer 20

Cancer risks