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PR3154 > IC 14 - Osteoporosis Drugs > Flashcards

IC 14 - Osteoporosis Drugs Flashcards

1
Q

How does bisphosphonates work?

A

Slow bone loss by increasing osteoclast cell death

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2
Q

List three bisphosphonates drugs for osteoporosis.

A
  1. Risedronate (oral)
  2. Alendronate (oral)
  3. Zoledronic acid(intravenous)
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3
Q

What are some counselling points for bisphosphonate use?

A

Take orally on empty stomach with at least 240ml of plain water and wait before taking food (at least 30 minutes for risedronate and alendronate)

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4
Q

List 2 significant adverse effects of bisphosphonates.

A
  1. Atypical femoral fractures (prolonged use)
  2. Severe bone, joint or muscle pain
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5
Q

What are the three side effects associated with oral bisphosphonate?

A
  1. Nausea
  2. Abdominal pain
  3. Heartburn-like symptoms.
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6
Q

What is one side effect associated with IV bisphosphonates?

A

Flu-like symptoms

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7
Q

Which population should use bisphosphonates with caution?

A
  1. Active upper gastrointestinal disease
  2. Risk factors for developing osteonecrosis of the jaw or external auditory canal
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8
Q

What are the five groups of people who cannot use bisphosphonates?

A
  1. Hypocalcaemia
  2. Abnormalities of the oesophagus which may delay emptying
  3. Severe renal impairment (CrCl <30 mL/minute)
  4. Pregnancy
  5. Lactation.
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9
Q

How does denosumab works?

A

Prevent development of osteoclasts

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10
Q

How is denosumab given?

A

SQ injection every 6 months

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11
Q

What drugs/ supplements should be given concurrently with denosumab in treatment of osteoporosis?

A

1000 mg Ca + ≥ 400 IU vitamin D daily

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12
Q

What are the common side effects of denosumab?

A
  1. Muscle back, bone or joint pain
  2. N/V, constipation or diarrhoea
  3. Slight tiredness
  4. Increased cholesterol levels
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13
Q

Which group of patients should not use denosumab?

A
  1. Hypocalcaemia
  2. Pregnancy
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14
Q

Why should denosumab not be discontinued?

A

May increase risk of spinal column fractures

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15
Q

Name one example of estrogens that is used in treatment of osteoporosis.

A

Raloxifene

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16
Q

How does raloxifene works?

A

Selective oestrogen receptor modulator: with mixed oestrogen receptor agonism and antagonism

17
Q

Raloxifene _____ risk of certain breast cancer but ____ risk of blood clots.

A

reduce, increase

18
Q

How does Calcitonin works?

A
  1. Reduces blood calcium, opposing effects of parathyroid hormone
  2. Inhibits osteoclastic bone resorption
19
Q

How can calcitonin be given?

A
  1. Injection (IV, SC, or IM)
  2. Nasal spray
20
Q

Calcitonin is contraindicated in _____ and ______.

A
  1. Hypersensitivity
  2. Hypocalcaemia
21
Q

What are the adverse effects of calcitonin?

A
  1. Red streaks on skin
  2. Injection site reaction
  3. Feeling of warmth
  4. Redness of the face, neck, arms, occasionally, upper chest
22
Q

What kind of agent is romosozumab?

A

Anabolic agents

23
Q

How does romosozumab works?

A
  1. Removes sclerostin inhibition of the canonical Wnt signalling pathway that regulates bone growth
  2. Increases bone formation and decreases bone resorption
24
Q

What is the indication for romosozumab?

A
  1. Women at high risk of fracture
  2. Women who failed or are intolerant to other osteoporosis therapies
25
Q

How is romosozumab given?

A

Subcutaneous injection once monthly for 12 months

26
Q

Who cannot be given romosozumab?

A
  1. Hypersensitivity
  2. Uncorrected hypocalcaemia
  3. History of MI or stroke (within the preceding year)
27
Q

List three significant adverse effects of romosozumab.

A
  1. MI
  2. Increased risk of CV death
  3. Stroke
28
Q

List one parathyroid hormone therapy.

A

Teriparatide

29
Q

How does teriparatide works?

A

Stimulates new bone formation and increase bone strength

30
Q

How is teriparatide given?

A

Once daily SC injection

31
Q

What is the maximum duration of treatment of PTH therapy?

A

24 months in lifetime

32
Q

List 3 groups of patients that cannot be given parathyroid hormone therapies.

A
  1. Hypersensitivity
  2. Severe renal impairment
  3. Pregnancy

PR3154 (16 decks)

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