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NAPLEX Prep > OP, Menopause and Testosterone Use > Flashcards

OP, Menopause and Testosterone Use Flashcards

1
Q

risk factors for OP

A

inc age
causacian, asian
FHx
female
low weight
smoking
3+ drinks a day
dec Ca and Vit D intake
no exercise

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2
Q

diseases that inc risk for OP

A

DM
hyperthyroidism
eating disorders
hypogonadism
menopause
RA
autoimmune

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3
Q

drugs that inc OP risk

A

PPI
aromatase-i
depo provera
GnRH ags
steroids

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4
Q

T score interpretations

A

-1 and up = normal
-2.5 to -1 = osteopenic
-2.5 or less = OP

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5
Q

what is a FRAX score

A

risk of OP fracture in next 10 years

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6
Q

how much Ca should patients receive a day total

A

1000-1200 mg a day

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7
Q

what are the Ca supplement options? What are the pearls of each?

A

Ca carb = 40% elem Ca, acid gut needed, needs to be with food

Ca citrate = 21% elem Ca, doesn’t care about gut acidity

both can cause constipation

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8
Q

patients on a PPI should take calcium _____

A

citrate
calcium carbonate needs acidic gut

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9
Q

Ca doses above ______________ should be divided BID

A

500-600mg

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10
Q

vitamin D normal level

A

> 30

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11
Q

what are the vit D supplementation options and doses for deficiency (<30)

A

D2: 50,000 IU q week
D3: 5000-7000IU daily

x8-12 weeks then switch to QD MD

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12
Q

what are the tx criteria for OP

A

T score </= -2.5
T score -2.5 to -1 plus FRAX 20%+ OR 3%+ risk hip fx in next 10 years

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13
Q

first line for OP

A

bisphosphonates

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14
Q

why must hypocalcemia be corrected before OP tx

A

most OP drugs decrease bone resorption/Ca release from bones to inc MBD, so if a patient is already hypocalcemic, OP meds will worsen it to build bone strength

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15
Q

denosumab
brand
MOA
use
CI

A

Prolia
binds RANK ligand to prevent binding and therefore osteoclast stimulation
use in patient with normal Ca as an alternative to BPs if high fx risk
CI IN HYPOCALCEMIA

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16
Q

bisphosphonates contraindications

A

CI in hypocalcemia (all)
CI CrCl <35 alendronate
CI CrCl <30 ibandronate and risendronate

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17
Q

alendronate
brand
dosing

A

Fosamax
35mg PO weekly for ppx
70mg PO weekly for treatment

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18
Q

risendronate
brand
dosing

A

Actonel
35mg PO weekly for ppx
150mg PO monthly for treatment

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19
Q

ibandronate
brand
dosing

A

Boniva
150mg po monthly for ppx and tx

20
Q

what are the injectable bisphosphonates and when are they preferred

A

ibandronate and zoledronic acid
preferred when BP is ok but patient has esophagitis

21
Q

ibandronate inj dosing

A

3mg IV q3mo

22
Q

zoledronic acid IV dosing

A

5mg q2 years for ppx
5mg yearly for tx

23
Q

side effects of po BPs

A

dyspepsia
dysphagia
GERD
N/V
hypocalcemia

24
Q

ibandronate use counseling points

A

once monthly dose in am with 6-8oz water
separate from food & beverages by 30min
separate from cations by 2 hours
do not lie down for 1 hour after
remember I for ibandronate looks like the number 1 for 1 time a month and do not lie down for 1 hour after

25
Q

alendronate use counseling

A

once weekly dose in am with 6-8oz water
separate from food and meds by 30 min
separate from cations by 2 hours
do not lie down for 30 min after taking

26
Q

risendronate use counseling

A

once monthly dose in am with 6-8oz water
separate from food by 30 min
separate from cations by 2 hours
do not lie down for 30 min after

27
Q

raloxifene
MOA
dosing
CI

A

SERM: estrogen ag/antag in bone to prevent bone resorption
60mg PO QD
CI: hypocalcemia, hx of VTE, pregnancy, cardiac events/CHD
CAN CAUSE BLOOD CLOTS

28
Q

can a patient with a CrCl of 31 mL/min receive zoledronic acid

A

no, CI CrCl <35

29
Q

calcitonin
role in therapy
pearls

A

last line
comes in nasal spray or IM

30
Q

what happens to hormones in menopause? What does this cause?

A

drop in estrogen and progesterone
causes hot flashes, night sweats, vaginal dryness, burning and painful sex

31
Q

what does estrogen tx in menopause help with

A

decreases LH to provide a more stable temp control
increases MBD
vasomotor sx (hot flashes and night sweats)

32
Q

what are local estrogen options for women in menopause?

A

cream (Estrace, Premarin)
vaginal tab (Vagifem)
ring (Estring)

33
Q

what are systemic estrogen options for women in menopause?

A

estradiol gel, patch, ring
17-Beta-estradiol
po tab (Premarin)
injectable (Premarin)

34
Q

Premarin comes in which dosage forms

A

po tab
topical cream
inj

35
Q

BBW for estrogen treatment in menopause

A

endometrial cancer
breast cancer
VTE, stroke
dementia if 65+ yo

36
Q

is premarin monotherapy appropriate in menopause

A

NO
never use unopposed estrogen
need progestin too!

37
Q

what are the progestin options for menopause

A

Prempro (conjugated equine estrogens + MPA)
MPA = provera/depo
micronized progestin = Prometrium

38
Q

what is the first FDA approved bioidentical estrogen-progesterone for hot flashes

A

Bijuva

39
Q

non-hormone tx options for menopause

A

paroxetine 7.5mg PO qd
ospemifene (Osphena) estrogen ag/antag

40
Q

what causes hypogonadism in males

A

age
surgeries
methadone
chemo
cimetidine
spironolactone

41
Q

what are s/sx of hypogonadism in males

A

low libido
low muscle mass
memory/concentration issues
dec MBD
dc energy

42
Q

when should men receive testoeterone treatment

A

if there is a medical reason, not just for libido and muscle

43
Q

adverse effects of testosterone replacement therapy (TRT)

A

HF, CV events, clots, edema
liver tox, prostate enlargement, infertility
depression, sleep apnea, aggression, acne
inc SCr, gynecomastia
abuse potential

44
Q

what are the different options for TRT in males

A

gel (Androgel +- pump)
depo testosterone (T cypionate)
testopel (implantable pellet)
Jatenzo (po tab)

45
Q

what are counseling points for Androgel

A

let dry completely then clothe
do not let others come in contact
wait 2-6 hours before swimming or showering
flammable
apply deodorant beforehand
pump must be primed before use!

NAPLEX Prep (57 decks)

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