OP, Menopause and Testosterone Use Flashcards
risk factors for OP
inc age
causacian, asian
FHx
female
low weight
smoking
3+ drinks a day
dec Ca and Vit D intake
no exercise
diseases that inc risk for OP
DM
hyperthyroidism
eating disorders
hypogonadism
menopause
RA
autoimmune
drugs that inc OP risk
PPI
aromatase-i
depo provera
GnRH ags
steroids
T score interpretations
-1 and up = normal
-2.5 to -1 = osteopenic
-2.5 or less = OP
what is a FRAX score
risk of OP fracture in next 10 years
how much Ca should patients receive a day total
1000-1200 mg a day
what are the Ca supplement options? What are the pearls of each?
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
patients on a PPI should take calcium _____
citrate
calcium carbonate needs acidic gut
Ca doses above ______________ should be divided BID
500-600mg
vitamin D normal level
> 30
what are the vit D supplementation options and doses for deficiency (<30)
D2: 50,000 IU q week
D3: 5000-7000IU daily
x8-12 weeks then switch to QD MD
what are the tx criteria for OP
T score </= -2.5
T score -2.5 to -1 plus FRAX 20%+ OR 3%+ risk hip fx in next 10 years
first line for OP
bisphosphonates
why must hypocalcemia be corrected before OP tx
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
denosumab
brand
MOA
use
CI
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
bisphosphonates contraindications
CI in hypocalcemia (all)
CI CrCl <35 alendronate
CI CrCl <30 ibandronate and risendronate
alendronate
brand
dosing
Fosamax
35mg PO weekly for ppx
70mg PO weekly for treatment
risendronate
brand
dosing
Actonel
35mg PO weekly for ppx
150mg PO monthly for treatment
ibandronate
brand
dosing
Boniva
150mg po monthly for ppx and tx
what are the injectable bisphosphonates and when are they preferred
ibandronate and zoledronic acid
preferred when BP is ok but patient has esophagitis
ibandronate inj dosing
3mg IV q3mo
zoledronic acid IV dosing
5mg q2 years for ppx
5mg yearly for tx
side effects of po BPs
dyspepsia
dysphagia
GERD
N/V
hypocalcemia
ibandronate use counseling points
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
alendronate use counseling
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
risendronate use counseling
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
raloxifene
MOA
dosing
CI
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
can a patient with a CrCl of 31 mL/min receive zoledronic acid
no, CI CrCl <35
calcitonin
role in therapy
pearls
last line
comes in nasal spray or IM
what happens to hormones in menopause? What does this cause?
drop in estrogen and progesterone
causes hot flashes, night sweats, vaginal dryness, burning and painful sex
what does estrogen tx in menopause help with
decreases LH to provide a more stable temp control
increases MBD
vasomotor sx (hot flashes and night sweats)
what are local estrogen options for women in menopause?
cream (Estrace, Premarin)
vaginal tab (Vagifem)
ring (Estring)
what are systemic estrogen options for women in menopause?
estradiol gel, patch, ring
17-Beta-estradiol
po tab (Premarin)
injectable (Premarin)
Premarin comes in which dosage forms
po tab
topical cream
inj
BBW for estrogen treatment in menopause
endometrial cancer
breast cancer
VTE, stroke
dementia if 65+ yo
is premarin monotherapy appropriate in menopause
NO
never use unopposed estrogen
need progestin too!
what are the progestin options for menopause
Prempro (conjugated equine estrogens + MPA)
MPA = provera/depo
micronized progestin = Prometrium
what is the first FDA approved bioidentical estrogen-progesterone for hot flashes
Bijuva
non-hormone tx options for menopause
paroxetine 7.5mg PO qd
ospemifene (Osphena) estrogen ag/antag
what causes hypogonadism in males
age
surgeries
methadone
chemo
cimetidine
spironolactone
what are s/sx of hypogonadism in males
low libido
low muscle mass
memory/concentration issues
dec MBD
dc energy
when should men receive testoeterone treatment
if there is a medical reason, not just for libido and muscle
adverse effects of testosterone replacement therapy (TRT)
HF, CV events, clots, edema
liver tox, prostate enlargement, infertility
depression, sleep apnea, aggression, acne
inc SCr, gynecomastia
abuse potential
what are the different options for TRT in males
gel (Androgel +- pump)
depo testosterone (T cypionate)
testopel (implantable pellet)
Jatenzo (po tab)
what are counseling points for Androgel
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!
