Metabolic Bone Medications Flashcards

1
Q

Bisphosphonates are a class of medications that do what?

A

Decrease osteoclast resorption (breakdown)

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2
Q

BISPHOSPHONATE:

Alendronate (Fosamax and Binisto)

A

Can be given daily or weekly
• Binosto is an effervescent tablet
• Given in AM with 4-8 ounces of water 30-60” AC breakfast [no recumbancy for 30-60”]
• Thought to have worst GI side effect profile
• Approved for prevention and treatment of osteoporosis of hip and spine

• Rapidly cleared from plasma—binds to hydroxyapalite in the bone; once bound they are
cleared over months to years; renally eliminated [cannot be given in severe renal disease—
GFR <35 cc/min]
• ADE—GI distress, esophagitis, osteonecrosis of jaw [associated with high doses over long
periods3 consecutive years]; atypical fractures [seen with long term use]

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3
Q

BISPHOSPHONATE

Drug name: Risedronate (Actonel, Atelvia)

A
Route: PO
Approved use for: hip and spine disease
DOSAGE: 
35 mg (weekly) PO
150mg (monthly) PO
35 mg pc (weekly)
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4
Q

BISPHOSPHONATE

Drug name: Ibandronate (Boniva)

A

Route: PO or IVP

Approved use for: spine disease

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5
Q

BISPHOSOPHONATE

Drug name: Zoledronic acid (Reclast, Zometa)

A

Route: IV infusion YEARLY
Approved use for: hip and spine disease
*contraindication: heart issues or high risk for a fib ; can have some flu like symptoms

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6
Q

Examples of SERMs

A
  1. Raloxifene (EVISTA)

2. Tamoxifen (Nolvadex, Solltamox)

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7
Q

Who do you give SERMs to?

A
  • given for people intolerant to bisphosphonates, hx breast cancer, contraindicatated for women with hx of DVT, stroke, etc
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8
Q

Selective Estrogen Receptor Blockers

Drug name: Raloxifene (EVISTA)

A
  • Oral daily agent – used for women intolerant to bisphosphonates
  • It has estrogen like effects on bone and estrogen antagonistic effects on breast and endometrium
  • This agent also lowers LDL cholesterol
  • CONTRAINDICATED in women with prior history of thromboembolic disease [DVT, stroke, etc.]
  • Main SE—HOT FLASHES!! MAJOR! 35% IN WOMEN
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9
Q

Bazedoxifne/conjugated estrogens (Duavee)

A
  • 0.45/20 [1] tab daily
  • Approved for vasomotor sx of menopause and osteoporosis prevention

• Estrogen + SERM—CANNOT be used in those with INTACT UTERUS; hx of breast, endometrial, ovarian cancers

  • ADE—thromboembolism
  • Same precautions as for estrogens & Evista
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10
Q

Calcitonin (Miacalcin)

A

Brand name: miacalcin

  • ANTIRESPORPTIVE
  • MAINLY USE TO HELP WITH PAIN AFTER A FX
  • Can be used for acute pain after a fracture
  • Approved to treat osteoporosis in women who are at least 5 year postmenopausal; also used in Paget’s disease
  • Can be used in patients with vertebral osteoporosis – NOT effective for HIP disease
  • Nasal spray used every day [alternate nostrils]
  • ADE—nosebleeds and rhinitis
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11
Q

Drug name: Teriparatide (Forteo)

A
  • Forteo is a synthetic form of parathyroid hormone (PTH)
  • for men and women with severe disease and can not take anything else

-synthetic form of parathyroid hormone which stimulates bone formation

Only agent that will build bone by stimulating osteoblasts

  • Approved for men and women with severe disease or those in need of treatment that cannot take the other agents
  • SC injection daily for 2 years; then off – best option is to follow this therapy with bisphosphonate or Prolia [so patient will not lose new bone that they have built] *****
  • Contraindicated in patients who have had skeletal XRT

ONLY DRUG THAT BUILDS BONE

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12
Q

Drug name: Denosumab (Prolia)

A

RANKL (receptor activator of nuclear factor kappa B) ligand inhibitor; prevents bone loss by blocking a certain receptor in the body to decrease bone breakdown

  • Indicated for post-menopausal women with osteoporosis at high risk for fracture or patients who have failed/cannot tolerant other available therapies
  • In post-menopausal women agent reduces the incidence of vertebral, non-vertebral, and hip fractures
  • SQ injection twice per year
  • Targeted for women and men with renal insufficiency **
  • ADE—dermatological reactions, hypocalcemia (will need to monitor calcium!)
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