Lippincott Chapter 35: Drugs for Bone Disorders

Question 1

35.1 Which of the following is correct regarding the
pharmacokinetics of the bisphosphonates?
A. Bisphosphonates are well absorbed after oral
administration.
B. Food or other medications greatly impair absorption
of bisphosphonates.
C. Bisphosphonates are mainly metabolized via the
cytochrome P450 system.
D. Elimination half-life of bisphosphonates ranges
from 4 to 6 hours.

Answer 1

Correct answer = B. Food and other medications do
decrease absorption of bisphosphonates, which are already
poorly absorbed (less than 1%) after oral administration.
Bisphosphonates are cleared from the plasma by binding to
bone and being cleared by the kidney (not metabolized by
the CYP450 system). The elimination half-life may be years.

Question 2

35.2 OP is a 65-year-old female who has been diagnosed
with postmenopausal osteoporosis. She has no history
of fractures and no other pertinent medical conditions.
Which of the following would be most appropriate for
management of her osteoporosis?
A. Alendronate.
B. Calcitonin.
C. Denosumab.
D. Raloxifene.
E. Teriparatide.

Answer 2

Correct answer = A. Bisphosphonates are first-line therapy
for osteoporosis in postmenopausal women without contra-
indications. Calcitonin and raloxifene are alternatives but
may be less efficacious (especially for nonvertebral frac-
tures). Teriparatide and denosumab should be reserved for
patients at high risk or those who fail other therapies.

Question 3

35.3 TT is a 55-year-old female who has been diagnosed with
postmenopausal osteoporosis. She has a past medical
history of ethanol abuse, alcoholic liver disease, erosive
esophagitis, and hypothyroidism. Which of the following
would be the primary reason oral bisphosphonates
should be used with caution in this patient?
A. Age.
B. Erosive esophagitis.
C. Liver disease.
D. Thyroid disease.

Answer 3

Correct answer = B. Bisphosphonates are known to cause
esophageal irritation and should be used with caution in a
patient with a history of erosive esophagitis. Age is not a
factor for consideration in bisphosphonate use. Liver dis-
ease is not a contraindication to bisphosphonate use, since
bisphosphonates are mainly cleared via the kidney. Thyroid
disease is not a contraindication to bisphosphonate use,
although overaggressive replacement of thyroid may con-
tribute to osteopo

Question 4

35.4 VS is a 70-year-old female who is being started on iban-
dronate once monthly for the treatment of osteoporosis.
Which of the following is important to communicate to
this patient?
A. Take this medication with orange juice to increase
absorption.
B. Take this medication after meals to minimize
stomach upset.
C. Remain upright for at least 60 minutes after taking
this medication.
D. Adverse effects may include blood clots and leg
cramps.

Answer 4

Correct answer = C. Patients need to remain upright for
60 minutes after ibandronate (30 minutes for other bisphos-
phonates). Ibandronate should be given on an empty
stomach with plain water only. Bisphosphonates, unlike ral-
oxifene, are not associated with blood clots and leg cramps.

Question 5

35.4 VS is a 70-year-old female who is being started on iban-
dronate once monthly for the treatment of osteoporosis.
Which of the following is important to communicate to
this patient?
A. Take this medication with orange juice to increase
absorption.
B. Take this medication after meals to minimize
stomach upset.
C. Remain upright for at least 60 minutes after taking
this medication.
D. Adverse effects may include blood clots and leg
cramps.

Answer 5

Correct answer = C. Patients need to remain upright for
60 minutes after ibandronate (30 minutes for other bisphos-
phonates). Ibandronate should be given on an empty
stomach with plain water only. Bisphosphonates, unlike ral-
oxifene, are not associated with blood clots and leg cramps.