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NAPLEX review 2024 RXPrep Book > Male & Female Health: Osteoporosis, Menopause & Testosterone Use > Flashcards

Male & Female Health: Osteoporosis, Menopause & Testosterone Use Flashcards

1
Q

Cells involved in bone formation

A

Osteoblasts

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2
Q

Cells involved in bone reabsorption

A

Osteoclasts

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3
Q

Gold standard to measure BMD and diagnose osteoporosis

A

Dual energy X-ray absorptiometry (DEXA or DXA scan)

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4
Q

Who should have BMD measured?

A

women > 65
men > 70

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5
Q

FRAX tool

A

estimates the risk of osteoporotic fracture in the next 10 years

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6
Q

Interpreting T-score

A

> -1 = normal
- 1 to -2.4 = Osteopenia (Low bone mass)
< -2.5 = Osteoporosis

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7
Q

Vitamin D daily recommended intake

A

800-2000 IU, up to 4000 IU safe for adults and adolescence

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8
Q

Calcium Saturability

A

doses over 500-600 mcg should be dividend

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9
Q

Calcium carbonate vs Calcium citrate

A

Carbonate = more elemental calcium per unit than citrate, but req acidic environment

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10
Q

Ergocalciferol is

A

Vitamin D2

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11
Q

Cholecalciferol is

A

Vitamin D3

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12
Q

Daily calcium recommendation adults

A

1000-1200mg elemental

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13
Q

How to treat Vit D deficiency?

A

Vit D2 or D3 for 8-12 wks followed by maintenance dosing

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14
Q

1g Calcium carbonate = how much elemental

A

400mg

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15
Q

1g Calcium citrate = how much elemental

A

210mg

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16
Q

Calcium side effects

A

constipation

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17
Q

Calcium Citrate & carbonate notes

A

Citrate = take w/ or w/o food
Carbonate = take w/ food, no PPIs

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18
Q

Criteria for initiating treatment Osteoporosis

A

T-score < -2.5 OR presence of fragility fracture

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19
Q

Criteria for initiating treatment Osteopenia if high risk

A

T score = -1 to -2.4
and FRAX > 20% major related fracture or >3% hip fracture

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20
Q

First line osteoporosis txm for most patients?

A

Bisphosphonates

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21
Q

How do bisphosphonates work

A

inc bone density by inhibiting osteoclast activity and bone reabsorption

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22
Q

When and who should get drug holiday from bisphophonates

A

3-5 yrs of treatment
low-risk patients

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23
Q

Alendronate dosing

A

usually weekly, can be daily

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24
Q

Risedronate (Atelvia) dosing

A

can be daily, weekly and monthly

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25
Q

Ibandronate dosing

A

usually monthly

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26
Q

Bisphosphonate CI

A

Hypocalcemia
inability to sit/stand for atleast 30min (60min for ibandronate)

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27
Q

Bisphosphonate Warnings

A

Osteonecrosis of Jaw (ONJ)
atypical femur fractures
Esophagitis, esophagel ulcers, erosions
Hypocalcemia
dont use CrCl < 35 (alendronate) CrCl < 30 others

28
Q

Bisphosphonate side effects

A

Dyspepsia
dysphagia
heartburn
N/V
hypocalcemia

29
Q

Bisphosphate notes

A

Do dental work before starting due to inc risk of ONJ
caution aspirin/NSAID due to GI irritation
Separate from Ca, antacids, iron and mg atleast 2hrs

30
Q

Risedronate (Altevia) should not be used with

A

H2RAs and PPIs

requires acidic gut

31
Q

Injectable Bisphosphonates

A

Ibandronate (Boniva)
Zoledronic Acid (Reclast)

32
Q

Injectable Bisphosphonates preferred if…..

A

esophagitis is present, due to risk of esophageal cancer

33
Q

Reclast

A

Dosing ranges from Q 2yrs for prevention, to once yearly

34
Q

Raloxifene is a…

A

SERM

dec bone reabsorption

35
Q

Conjugated estrogens/bazedoxifene (Duavee) is a…..

A

Equine (horse) estrogen/SERM combo

used for osteoporosis prevention in postmenopausal women with a uterus

36
Q

Raloxifene (Evista) boxed warnings

A

inc risk of DVT/PE
inc risk of death due to stroke in women w/ CHD

37
Q

Raloxifene contraindications

A

hx or current VTE and pregnancy

38
Q

Raloxifene side effects

A

hot flashes
peripheral edema
arthralgia
legt cramps/muscle spasm

39
Q

Conjugated estrogens/Bazedoxifene (Duavee) boxed warnings

A

Endometrial cancer
inc risk of DVT and stroke

40
Q

Duavee contraindications

A

Breastcancer
pregnancy
undiagnosed uterine bleeding
hx of or active VTE

41
Q

Duavee warnings

A

Inc risk of breast cancer and ovarian cancer

42
Q

Calcitonin works by…

A

inhibiting bone reabsorption by osteoclasts
less effective than other agents, barely used

43
Q

Calcitonin warnings

A

Hypocalcemia
inc risk of malignancy w/ long term use
hypersensitivity reactions to Salomon-derived products

44
Q

Human Parathyroid analogs

A

Teriparatide (Forteo)
Abaloparatide (Tymlos)

45
Q

human Parathyroid analog warnings

A

Osteosarcoma (bone cancer)
hypercalcemia

46
Q

human parathyroid analog side effects

A

Arthralgias
leg cramps
nausea
orthostasis & dizziness

47
Q

Human parathyroid analog notes

A

protect from light and keep in fridge

48
Q

RANKL inhibitor

A

Denosumab (Prolia)

used for txm of osteoporosis when high risk of fracture

49
Q

Denosumab (Prolia) Contraindications

A

Hypocalcemia - correct before using
pregnancy

50
Q

Denosumab (Prolia) warnings

A

ONJ
atypical femur fractures
hypocalcemia
infections

51
Q

Denosumab (Prolia) side effects

A

HTN
fatigue
edema
dyspnea
headache
N/V/D
dec PO4

52
Q

How long is Romosozumab (Evenity) used for treatment

A

Max of 12 months
decreased efficacy after

53
Q

Menopause is reached when

A

last menstraul period was 12 months ago
usually occurs ages 40-58, avg 52

54
Q

Which type of estrogen associated with lower VTE risk?

A

transdermal
local (topical)
low dose oral estrogen products

55
Q

Local estrogens preferred when….

A

pt has vaginal only symptoms

56
Q

Systemic Estrogen Hormone therapies Boxed warnings

A

Endometrial cancer
dementia
inc risk of VTE and stroke
breast cancer

57
Q

Systemic Estrogen Hormone therapy contraindications

A

Breast cancer
uterine bleeding
active VTE
pregnancy

58
Q

Systemic Estrogen Hormone therapy warnings

A

inc risk of breast cancer

59
Q

Vivelle-Dot and Minivelle patches are applied

A

twice weekly

60
Q

Climate and Menostar patches are applied

A

once weekly

61
Q

Natura products used for vasomotor symptoms of menopause include

A

black cohos
evening primrose oil
red clover
soy
flax seed

62
Q

Ospemifene is oral estrogen agonist/antagonist indicated for…

A

painful intercourse and moderate-severe vag dryness

63
Q

Which SSRI can be used for menopause symptoms?

A

Paroxetine
dosing is lower than for depression

64
Q

Testosterone Boxed warnings

A

For gel/ solutions = secondary exposure to children can case virilization

65
Q

Testosterone side effects

A

inc appetite
acne
edema
hepatotoxicity
reduced sperm count
roid rage

66
Q
A

NAPLEX review 2024 RXPrep Book (78 decks)

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