Medications Flashcards
What two drug classes are involved with MRONJ?
- Bisphosphonates
2. RANKL inhibitors
Examples of bisphosphonates? (3)
How are they administered?
- Aledronate acid (Fosamax) - Oral
- Ibandronate sodium (Boniva) - IV and oral
- Zoledronic acid (Reclast) - IV - 4 mg every 4 weeks
Example of RANKL inhibitors?
How is it administered?
Dosage?
Denosumab (Prolia) - Subcutaneously (120 mg every 4 weeks)
How does hyperbaric oxygen provide any benefit for MRONJ?
Is it supported by the AAOMS?
Some improvement in wound healing, long-term pain scores
Produces reactive oxygen and nitrogen species - promoting bone turnover
As of 2014, it is not supported as the sole treatment
AAOMS definition of MRONJ includes which three criteria
- Current/previous tx with antiresorptive or antiangiogenic agents
- Exposed bone that has persisted more than 8 weeks
- No history of radiation therapy to jaws or obvious metastatic disease
Define osteonecrosis
Necrosis of bone due to obstruction of blood supply
How long does a patient need to take oral BP to have an increased risk of MRONJ? What’s the percent risk for oral BP and for IV bisphosphonates?
4 years of oral BP - 0.5% risk
IV bisphosphonate - 1.6 to 14%
General mechanism for NSAIDs and acetaminophen
Which one blocks transmission of pain signaling in the CNS?
Inhibit cyclooxygenase (COX) - an enzyme involved in converting arachidonic acid to prostaglandins
Prostaglandins are mediators of inflammation, fever, and pain.
Acetaminophen blocks transmission
Side effects of NSAIDs and acetaminophen
NSAIDs - GI mucosal protection and nausea, heartburn, bleeding
Acetaminophen - Liver toxicity, GI symptoms (over 4k mg a day can lead to acute liver toxicity)
Opioids general mechanism
Agonist at opioid receptors to alter response to painful stimuli
Opioids side effects
Nausea, sedation, dizziness, sweating, constipation, respiratory depression
- Interacts with cytochrome P450 inhibitors (warfarin)
Examples of steroids
Prednisone
Dexamethasone
Fluocinonide
