ms pharm

Question 1

osteoporosis pharm

Answer 1

bisphosphonates
selective estrogen receptor modulators
hormone therapy: calcitonin - not as effective long term as above classes (used short term though), HRT no longer used d/t r/o blood clots, breast cancer, other cancers)

Question 2

aldendronate

Answer 2

Biphosphates
moa: Bind permanently to surfaces of bones to inhibit osteoclast activity (decrease bone breakdown)
i: Osteoporosis – prevent and treat

Question 3

aldendronate: SE

Answer 3

GI common – n/v/d, esophageal ulcerations – stay upright for 30 min after taking

Question 4

aldendronate: nc

Answer 4

Reduce fractures by 50%
Don’t take with Ca for 2 hrs bc low bioavail
Take with water
Typically 1/wk

Question 5

raloxifene

Answer 5

Selective estrogen receptor modulators (SERMs)
moa: Mimic estrogen by increasing bone density, inhibit bone resorption, increase bone density but not as well as bisphosphonates
i: Post-menopausal osteoporosis – prevent and treat

Question 6

raloxifene: SE

Answer 6

Hot flashes, leg cramping
BB!: stroke

Question 7

raloxifene: nc

Answer 7

Safer than estrogen (HRT)
Reduce risk of spinal fractures by 50%
Must take adequate Ca and vit D replacement to work
d/c at least 72 hr before planned procedures – any prolonged immobile periods, high risk of clot
don’t smoke or drink
don’t use if preg

Question 8

Calcitonin-salmon

Answer 8

moa: Inhibit bone removal by osteoclasts
Slow down bone loss and increase spinal bone density
I: Osteoporosis treatment – not long term
Acute analgesic effect with acute vertebral fractures
Reduce pain in hip fractures

Question 9

Calcitonin-salmon: SE and NC

Answer 9

SE: Intranasal – can cause irritation
nc: Reduce spinal fractures by 30% - must take for at least 5 years to see long term benefit
Expensive, not 1st line

Question 10

prednison

Answer 10

corticosteroid for RA
rapid suppression of inflam
use only when s not controlled with NSAIDs
not best choice long term - usually small doses <10mg/day
usually used in conjunction with DMARDs + NSAIDs

Question 11

biologic agents

Answer 11

newer gen of DMARDs
biologic response modifiers
target parts of immune S that trigger inflam that cause joint and tissue damage
usually given in combo with methotrexate
can increase r/o severe skin or lung infections, skin cancers, serious allergic reactions
v expensive -> creation of biosimilars
work well

Question 12

Methotrexate

Answer 12

DMARD
Antineoplastic, anti-rheumatic
moa: Immunosuppressive
I: 1st line for RA
Cancer therapy – smaller doses

Question 13

Methotrexate: SE

Answer 13

Lots – GI (nva), bone marrow suppression – chemo drug so monitor wbc and rbc, shortened life expectancy
Interfere with metabolism of folate
Toxic to liver (metabolized) – monitor ALT, AST, alk phos
11 BB!:

Question 14

Methotrexate: nc

Answer 14

PO or SQ/IV
Need folate replacement
Only admin 1/week – deadly if daily
NO OH (liver)
Teratogenic – never for preg, 2 forms of BC
Higher r/o infection – contact hcp if s/s (Pneumocystis carinii)
Caution with liver and KD
Aplastic anemia risk when using NSAIDs - CBC

Question 15

Hydroxychloroquine

Answer 15

DMARD
Antimalarial
Anti-rheumatic
moa: Unknown, anti inflam processes – dampen macrophage, t helper cell and inflam cytokine activity
Slow progression of RA hwne used in combo with other DMARDs
I: Used alone or in combo with methotrexate for early/mild RA
SE: Much better tolerated than methotrexate
Retinopathy – rare but report blurry vision or other s/s