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PR3154 > IC14 Drugs for Osteoporosis > Flashcards

IC14 Drugs for Osteoporosis Flashcards

1
Q

What are the 3 ways to treat osteoporosis?

A
  1. Lifestyle & diet
  2. Antiresorptive agents
  3. Anabolic agents
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2
Q

What are examples of lifestyle and diet that we can incorporate to help treat osteoporosis?

A
  1. Weight bearing exercises
  2. Calcium
  3. Vitamin D
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3
Q

What are some examples of antiresorptive agents?

A
  1. Bisphosphonates
  2. Denosumab
  3. Oestrogens
  4. Calcitonin
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4
Q

What are the 4 lab tests we should conduct in pts w osteoporosis?

A
  1. Sr Creatine
  2. Vitamin D levels
  3. FBC
  4. Corrected calcium
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5
Q

What is the effect of biphosphonates and what are some examples of bisphosphonate agents?

A

Bisphosphonates help to slow down bone loss by increasing osteoclast death.

Osteoclasts - cells that degrade bone to initiate normal bone remodeling and mediate bone loss in pathologic conditions by increasing their resorptive activity.

Examples of bisphosphonates:
- Alendronate (PO)
- Risedronate (PO)
- Zoledronic acid (IV)

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6
Q

How should oral bisphosphonates be taken?

A

It should be taken 1st thing in the morning, with a full glass of water, at least 30minutes before taking food.

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7
Q

What are some ADRs associated with oral bisphosphonates’ use?

A
  1. *Upper GI irritation - nausea, abdominal pain
  2. *Hypocalcaemia
  3. *Osteonecrosis of the jaw
  4. Atypical femoral fractures (prolonged use)
  5. *Flu-like symptoms - for IV bisphosphonates only
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8
Q

Which special populations are contraindicated in the use of bisphosphonates?

A
  1. Pregnant & breastfeeding patients
  2. Pt w severe renal impairment (CrCL < 30ml/min)
  3. Hypocalcaemia
  4. Pt w oesophageal abnormalities
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9
Q

What is Denosumab and what is its mechanism of action?

A

Denosumab is a RANKL antibody.

The MOA of denosumab is to prevent the development of osteoclast.

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10
Q

How is denosumab administered?

A

It is administered subcutaneously, every 6 months.

Calcium and Vit D supplements are co-administered with denosumab.

Do not discontinue as it can increase risk of spinal column fractures.

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11
Q

What are the things that should be done before we initiate SC denosumab?

A
  1. Check Cr levels & 25 OH vitamin D levels
  2. Restore back Vitamin D levels if levels are depleted
  3. Give Ca supplement if pt is renally impaired
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12
Q

What are the ADRs of denosumab?

A
  1. N&V
  2. Constipation of diarrhoea
  3. Osteonecrosis of the jaw
  4. Atypical femoral fractures
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13
Q

Which special populations are contraindicated with denosumab’s use?

A
  1. Hypocalcaemia
  2. Pregnancy.
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14
Q

How does oestrogen help in osteoporosis?

A

Oestrogen helps to maintain bone density.

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15
Q

What are the downsides of oestrogens?

A

Oestrogen can increase the risk of breast cancer, and blood clots that can lead to strokes.

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16
Q

What is an oestrogen alternative that can be used?

A

Raloxifene

Raloxifene is a selective oestrogen receptor modulator.

Raloxifene can help to maintain bone density, with reduced risk in breast cancer.

However, it still increases risk of blood clots and hot flashes.

17
Q

What is the effect of calcitonin and how is it administered?

A

Calcitonin helps to inhibit osteoclastic bone resorption.

Calcitonin is often administered by injection or nasal spray.

18
Q

What are examples of anabolic agents?

A
  1. Romosozumab
  2. Parathyroid hormone therapies
19
Q

What is the general MOA of anabolic agents?

A

They help to increase bone growth & bone strength.

20
Q

What is Romosozumab?

A

It is a monoclonal antibody that stops sclerostin.

Sclerostin is a gene product that reduces osteoblastic bone formation.

By inhibiting sclerostin, bone formation increases while bone resorption decreases.

21
Q

Who should Romosozumab be used for?

A

Romosozumab should be used in female patient with high risk of fracture OR who have failed other osteoporosis therapies

22
Q

How is romosozumab given?

A

It is given once a month, for 12 months.

23
Q

What are the ADRs of romosozumab?

A
  1. History of MI*
  2. History of Stroke*
  3. Increased risk of CV death
  4. Hypersensitivity reactions
24
Q

What is an example of parathyroid hormone therapy?

A

Teriparatide is an example of parathyroid hormone therapy.

25
Q

How does parathyroid hormone therapy work?

A

Intermittent high dose to PTH will increase bone growth.

If left at the basal level of PTH, bone resorption is favoured to increase plasma calcium levels.

26
Q

What is the effect of giving vitamin D to a patient?

A

Vitamin D helps to increase dietary calcium absorption.

When vitamin D intake increases, more calcium will be absorbed.

27
Q

What is the effect of parathyroid hormones?

A

Parathyroid hormone helps to:
1. Increase activation of Vitamin D
2. Cause break down of bone and mobilize calcium.

28
Q

What is the maximum treatment duration of PTH therapy?

A

2 years

PR3154 (19 decks)

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