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Therapeutics > Lecture 41+42: Osteoporosis > Flashcards

Lecture 41+42: Osteoporosis Flashcards

1
Q

Action of Drug therapies for Osteopororsis

A

-ensure adequate Ca and Vit D
-antiresorptive action
-anabolic action

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2
Q

Romosozumab

A

-sclerostin inhibitor
-antiresorptive action AND anabolic action
-drug therapy for osteoporosis

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3
Q

Antiresorptive action

A

-inhibits bone resorption
-maintain/inc bone mass
-reduce fracture risk

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4
Q

Drug therapies with antiresorptive action

A

-romosozumab*
-bisphosphonates
-SERMs
-calcitonin
-Estrogen replacement therapy (ERT)
-RANK ligand inhibitor

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5
Q

Anabolic action of osteoporosis drug therapy

A

-stimulate bone formation
-inc bone mass
-reduce frac risk

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6
Q

Osteoporosis drug therapies with anabolic action

A

-Romosozumab*
-Parathyroid hormones (teriparatide, abaloparatide)

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7
Q

Bisphonates products

A

-Alendronate (Fosamax)
-Risedronate (Actonel)
-Ibandronate (Boniva)
-Zoledronic acid (Reclast)

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8
Q

Bisphonates use

A

-treatment/prevention of POSTmenopausal osteoporosis
-treatment of osteoporosis to inc bone mass in males
-treatment of glucocorticoid-induced osteoporosis in males and females

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9
Q

Bisphosphonates contraindications

A

-hypocalcemia
-renal insufficiency
-esophageal abnormalities (except IV formulations)
-inability to sit/stand for at least 30 min (at least 60 min)
-avoid alendronate oral solution in patients at risk for aspiration
-avoid oral after bariatic surgery
-pregnancy or breast feeding (IV zoledronic acid)

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10
Q

Absorption of Bisphosphates

A

-reduced w coffe/joice
-reduced before breakfast
-reduced taken during breakfast

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11
Q

Metabolism of Bisphosphates

A

-does not affect hepatic CYP 450 system

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12
Q

Elimination of Bisphosphates

A

-50% bone
-50% renal
->10 year half life in bone

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13
Q

Adverse effects of oral bisphosphonates

A

-esophogeal irritation/ulceration
-ab pain
-musculoskeletal pain
-headache
-nausea
-thigh fracture
-occular inflammation
-aFib
-esophogeal cancer?
-osteonecrosis of the jaw

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14
Q

Osteonecrosis of the jaw

A

-necrotic maxillary bone and sequestrum formation

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15
Q

Bisphosphonates counseling

A

-must be taken on empty stomach 1st thing in the morning
-take delayed release after breakfast
-Full glass of water for tablet
-do not lie down at least 30 minutes after ingestion and until after first food of day (60 min for ibandronate)
-wait at least 30 min before eating, drinking, taking other meds (60 for ibandronate)
-avoid minaeral water w high calcium
-do NOT chew

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16
Q

discontinue bisphosphonate use if

A

-dysphagia (trouble swallowing)
-odynophagia (painful swallowing)
-retrosternal pain
-heartburn

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17
Q

Oral Bisphosphonate drug interations

A

-chelates w multivalent cations (Al, Ca, Fe, Mg)
-antacids
-mineral supplements
-vitamins
-osmotic laxatives (not magaldrate or sodium bicarbonate tho

-also inc GI side effects w NSAIDs

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18
Q

Bisphosphonate dosing

A
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19
Q

Menopausal Hormone Therapy for osteoporosis recommended for

A

-prevention of postmenopausal osteoporosis for women with SIGNIFICANT RISK

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20
Q

SERMs for osteoporosis

A

-Raloxifene
-Bazedoxifene + conjugated estrogens

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21
Q

Raloxifene use

A

-SERM
-prevent/treat postmenopausal osteoporosis
-breast cancer prophylaxis for postmenopausal women at high risk

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22
Q

Bazedoxifene + conjugated estrogen (Duavee) use

A

-SERM
-prevention of osteoporosis in women w a UTERUS

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23
Q

SERM contraindications

A

-active or past history of venous thromboembolic events
-pregnancy/lactating

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24
Q

Raloxifene BLACK BOX warning

A

-inc risk of deep vein thrombosis and pulmonary embolism
-inc risk of stroke

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25
Q

Raloxifene common side effects

A

-host flashes
-leg cramps
-weight gain
-peripheral edema

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26
Q

SERM mech of action on hypothalamus

A

-act as antiestrogens
-disrupts thermoregulation
=hot flashes

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27
Q

SERM doses

A

slide 24

28
Q

Salmon-calcitonin use

A

-TREAT postmenopausal osteoporosis in women >5years menopause

29
Q

salmon-calcitonin analgesic effects

A

-acute and chronic pain associated with vertebral fracture
-not shown to reduce pain in other instances

30
Q

Calcitonin dosing

A

-200 units in ONE nostril qd
-100 units SQ/IM qd

31
Q

salmon-calcitonin intranasal side effects

A

-rhinitis
-epistaxis
-dryness
-nasal irritation
-inc cancer risk (prostate and liver)

32
Q

Subcutaneous salmon-calcitonin side effects

A

-Flushing (vasomotor sx)
-Nausea
-Rash
-Allergic reaction

33
Q

RANK ligand inhbitor drug

A

Denosumab

34
Q

Denosumab use

A

-TREAT osteoporosis in MEN and postmenopausal women at HIGH risk
-treat bone loss in women w breast cancer on aromatase inhibitor therapies
-failed or intolerant to other therapy
-Glucocorticoid-induced osteoporosis in men and women

35
Q

Denosumab contraindication

A

-HYPOcalcemia

36
Q

Denosumab rebound effect

A

-inc risk of vertebral fracture after discontinuation of denosumab

37
Q

CONSIDER INDEFINATE TREATMENT OF BLANK

A

SLIDE 32

38
Q

NEED CAREFUL STRATEGY CONSIDER BLANK

A

SLIDE 32

39
Q

Denosumab common side effects

A

-back pain
-high cholesterol
-musculoskeletal pain
-bladder infection, uti

40
Q

denosumab serious side effects

A

-dermatitis, cellulitis, rash eczema
-hypocalcemia
-serious infections
-osteonecrosis of the jaw
-Atypical femur fractures
-Hearing Loss?
-Deafness?

41
Q

Denosumab dosing

A

-60 mg SQ every 6 months
-admin in office
-$4K/year

42
Q

Parathyroid hormone drugs

A

-Teriparatide
-Abaloparatide

43
Q

Parathyroid hormone use

A

-TREAT postmenopausal women w HIGH risk of fractures
-inc bone mass in MEN w osteoporosis
-glucocorticoid-induced osteoporosis in men and women (teriparatide only)

44
Q

High risk candidates for parathyroid hormone therapy

A

-hist of osteoporotic fracture
-multiple risk factors for fracture
-extremely low BMD (T-score below -3.5) w/o fragility fracture)
-failer/intolerant to other osteoporosis therapy

45
Q

Black Box warning of parathyroid hormones

A

-inc incidence of osteosarcoma (bone tumor)

46
Q

Contradindication od parathyoid hromones

A

-pts w higher risk of osteosarcoma
-Paget’s disease of bone
-unexplained elevations of alkaline phosphatase
-Pts w open epiphyses (head of bone)
-prioir radition therapy involving skeleton
-bone metastases
-hist of skeletal malignancies
-metabolic bone diseases other than osteoporosis
-pre-existing hyper calcemia

47
Q

Parathyroid hormone adverse effects

A

-dizzinees
-orthostatic hypotension (lay down during admin)
-nausea
-leg cramps
-arthralgias (joint pain)
-hypercalciuria
-hypercalcemia (dec Ca intake or change to QOD dose)

48
Q

TeriPARAtide (parathyroid hormone) dosing

A

-20 mcg SQ daily
-2 years max duration (allow repeat if appropriate)
-28 days discard

49
Q

AbaloPARAtide (parathyroid hormone) doing

A

-80 mcg SQ daily
-18 month max duration
-30 days discard

50
Q

Other parathyroid hormone condiserations

A

-subsequent resorptive agent
- extensive pt education
-must refrigerate 36-46F
-must discard after 1st use
-expensive

51
Q

AACE TREATMENT CONDISERATIONS

A

SLIDE 43!!

52
Q

Monoclonal anti-sclerostin antibody drug

A

Romososzumab

53
Q

Romosozumab (Evenity) use

A

-TREAT osteporosis in POSTmenopausal women at HIGH risk of fracture
-hist of fracture
-low BMD
-failed/intolerant osteoporosis therapy

54
Q

Romosozumab (evenity) contraindications

A

-Uncorrected Hypocalcemia

55
Q

Discontinuation of romosozumab results in

A

-bone loss
-return of pre-treatment BMD levels

56
Q

When discontinuing, Romosozumab,

A

-consider subsequent treatment w bisphosphonate or denosumab

57
Q

Romosozumab Black box warning

A

-inc risk of myocardial infarction, stroke, cardiovascular death

58
Q

Romosozumab adverse effects

A

-headache
-hypocalcemia
-arthralgias (joint pain)
-injection site reactions

59
Q

Romosozumab dosing

A

-210mg as 2 injections SQ monthly

60
Q

Romosozumab considerations

A

-12 month max duration
-extensive pt education
-must refrigerate 36-46F
-must discard after 30 days

61
Q

Which drugs should be carefully administered to patients w chronic kidney disease

A

-Alendronate
-Risendronate
-Ibandronate
-Denosumab
-Raloxifene/Bazedozifene
-Teriparatide

62
Q

Which drugs ware contraindicated in pts w chronic kidney disease w GFR < 35

A

-Alendronate
-Risendronate
-Ibandronate

63
Q

Glucocorticoid-induced osteoporosis should be treated

A

aggressively esp in high risk pts

64
Q

Monitoring Treatment

A

-assess BMD changes w DXA
-look for stable/inc BMD and no new fractures
-renal, calcium, vit D tests every 1-2 years
-duration of therapy needs to be individualized

65
Q

Consider stopping oral bisphophonate after

A

5 years

66
Q

consider stopping IV bisphosphonate after

A

3 years

67
Q

High-risk patients benefit from

A

longer treatments

Therapeutics (78 decks)

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