MSK and Endocrine Flashcards
Risk factors for osteoporosis
Menopause
age over 60 years
Family Hx
prolonged use of systemic glucocorticoids/anticonvuls
Alcohol/Caffeine/Tobacco *prevention piece
low vitamin D/Calcium (ex. anorexia) - *prevention piece -1200mg/day calcium, 15 mcg/vit D
Physical inactivity *prevention piece - weight bearing
Testosterone/Estrogen defiency
Drugs that decrease bone resorption
Calcium/Vit D
ERT
Estrogen Replacement Moderators
Bisphonates
Calcitonin
Calcium supplements
1,000mg/day in premeno, postmeno 1200-1500
ADR: hypercalcemia
parenteral calcium available for severe systemic hypocalcemia
(calcium gluconate)
Vitamin D agents
Calcitriol, Ergocalciferol
usually rx’ed w/ calcium - inc absorption of Ca+
ADR: severe hypercalcemia - contraindicated in hypercalcemia
Bisphosphonates
most common drug class for osteoporosis
prevention + treatment
structure similar to “pyrophosphates” - natural inhibitor of osteoclast inhibitor
ibandronate, alendronate (fosomax)
poorly absorbed - no food
ADRs: Esophogitis/esophageal ulcer
administer morning - 30 minutes prior to food
take with full glass of water
upright for at least 30 minutes
admin PO or IV - daily, weekly, bi-weekly, monthly - PO ibondronate sodium (boniva) can be administered once a month, IV once/3mo
HRT
Osteoclasts inc as estrogen declines
risk of breast/uterine cx, cholecystitis, MI & CVA
no longer recommended
Raloxifene
SERM - “selective estrogen receptor modifier”
binds to estrogen receptors - produces estrogen-like effect
selective for bones - blocks estrogen receptors in uterus/breast (protective!)
prevention +treatment
not as effective, but safer
ADR: Black Box Warning - DVT & PE
Calcitonin
hormone secreted from the thyroid gland
lowers serum calcium - moves to the bone
less effective than other agents
SQ or nasal spray
Teriparatide (Forteo)
only med that creates bone formation - increases bone deposition by osteoblasts
form of human PTH
ADR:
Arthralgias, back pain, leg cramps
orthostatic hypotension - 4hrs following injection
Black box warning - osteosarcoma (seen only in animals)
daily dosing - SQ only - prefilled pen
Denosumab (Prolia, Xgeva)
Monoclonal antibody that decreases fxn osteoclasts
–> decreased bone resorption
SQ once/month
ADR:
back pain/extremity pain
hypocalcemia
serious infections
dermatologic rxns, dermatitis, eczema
osteonecrosis of the jaw
Rheumatoid Arthritis patho and classes of treatments
progressive inflammatory autoimmune disorder
inflammation of the synoviam, eventual destruction of articular cartilage
symmetrical joint stiffness and pain, most intense in the morning, can have systemic manifestations of inflammation (fever, weakness, weight loss)
nonpharm - pt, heat, exercise (need rest too), joint replacements
Classes:
NSAIDs
Glucocorticoids
DMARDs
NSAIDs
DMARD started early - w/in 3 months of dx
NSAIDs rx strength - relief until DMARD is effective
prostaglandin inhibitors
- reduce vasodilation
- reduce capillary permeability
- reduce fever
- reduce pain
Cox 1
protects the stomach lining
supports renal fxn regulates blood regulates platelet aggregation
Cox 2
triggers inflammation
pain and fever
maintains renal fxn
2nd gen selective cox 2 - celecoxib (celebrex)
ADR: inc risk of MI/CVA - suppression of vasodilation, dec risk of GI ulcer/bleeding, renal impairment (both generations), peripheral edema (sodium/fluid retention)
DMARD - methotrexate
Faster than other DMARDs (3-6wks)
first choice DMARD
chemotherapy drugs - kills fast growing cells
small doses - immunosuppressant - reduces B&T activity
once/week - PO or injection
ADR- hepatotoxic, nephrotoxic, pneumonitis, bone marrow suppression, GI ulceration
monitor liver/kidney fxn + CBC
DMARD - sulfasalazine
Used for decades for IBD
now used for RA
immunosuppressant +anti-inflammatory
can slow the progression of joint deterioration, effects within 1 mo
ADR - many GI effects (enteric coating dec these effects), cross-reactivity/hypersensitivity (sulfa drug), derm effects, bone marrow suppression/hepatotoxicity rare
DMARD - hydroxychloroquine
preferred for pts with mild RA sx
antimalarial
usually given in combo with methotrexate (not effective monotherapy)
ADR: toxicity can –> retinal damage - eye exam prior to trtmt, every 6 mo
DMARD - TNF Blockers
Neutralize TNF which contributes to pathology of RA
mabs except etanercept
given SQ except imfliximab - IV
ADRs: serious systemic infection, fungal - due to potent immunosuppressant
severe allergic rxns
hematologic disorders - neutropenia, thrombocytopenia, aplastic anemia
hepatotoxicity
Classes of drugs for treatment of gout attacks
NSAIDs - indomethacin, naproxen
Glucocorticoids - prednisone (if NSAIDs not tolerated or xindicated)
Colchicine - specific anti-inflammatory