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Pharmacology quiz 5 > orthopedics > Flashcards

orthopedics Flashcards

1
Q

What is osteoporosis?

A

decreased cortical thickness, decrease in the number and size of trabeculae (but normal chemical composition), resulting in increased fracture

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2
Q

what is the most prevalent degenerative disease in the US

A

osteoporosis

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3
Q

True or false: 70% of fx in pts >45 are d/t osteoporosis

A

TRUE

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4
Q

Most common fractures in osteoporosis

A

vertebral bodies, distal radius, proximal femur

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5
Q

true or false: 1 in 5 pts is no longer living 1 year after sustaining hip injury

A

TRUE

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6
Q

compare osteoblasts and osteoclasts

A

osteoblasts lay down bone, osteoclasts resorb bone - work together to make adult skeletons in equilibrium

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7
Q

when does bone resorption begin to exceed formation?

A

3rd decade of life

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8
Q

What determines good bone future?

A

bone deposition in youth, exercise, diet, estrogen

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9
Q

RF of osteoporosis

A

gender, age, race, early menopause, low calcium intake, sedentary lifestyle

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10
Q

Describe type 1 osteoporosis

A

Women, d/t estrogen deficiency, greater than 50, trabecular bone loss, fx of vertebrae and radius

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11
Q

describe type 2 osteoporosis

A

anyone, d/t aging, greater than 70, trabecular and cortical bone loss, fx of vertebrae and hips

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12
Q

Treatment of early post menopause osteo.

A

estrogen replacement, caution with raloxifene (increases menopause)

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13
Q

treatment of pts >75 y/o osteo.

A

bisphosphonate, caution with estrogen

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14
Q

treatment of existing fx with osteo.

A

estrogen, bisphosphate

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15
Q

Name the calcium supplements

A

calcium carbonate, acetate, chloride, glubionate, gluconate, lactate

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16
Q

what should be checked before giving calcium

A

serum calcium

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17
Q

how are calcium supplements different?

A

elemental calcium present, side effects (GI), the need for calcium

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18
Q

Which calcium supplement needs an acidic medium?

A

calcium carbonate - take with meals 3 times a day

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19
Q

how much elemental calcium do I need per day?

A

1000mg per day

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20
Q

how much elemental calcium do teenagers need?

A

1200mg/day

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21
Q

how much elemental calcium do elderly need?

A

1500mg/day

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22
Q

what should be given along with calcium supplements?

A

vitamin D

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23
Q

how much vitamin D is needed per day?

A

600 international units per day

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24
Q

what is included in the combo of Ca and vit D

A

500mg Ca, 200mg Vit d

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25
Q

ADR of calcium

A

GI (pain, constipation, diarrhea, flatulence), too much

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26
Q

what are the estrogen supplements?

A

estradiol, estrogens conjugated A synthetic, estrogens conjugated B synthetic, estrogens conjugated/equine, estrogens esterified

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27
Q

what is premarin

A

derived from urine of female horses (equine estrogens) - could cause cancer

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28
Q

natural forms of estrogens

A

soy, yams, black cohash

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29
Q

what do “conjugated estrogens” contain?

A

multiple forms of estrogens - multiple components in these supplements

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30
Q

do estrogens work?

A

yes, not the best

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31
Q

when should estrogens be given?

A

refractory cases, after menopause for <5 years

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32
Q

how can cancer risk be reduced in women?

A

give with progestin to even out, safe in women without uterus

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33
Q

ADR of estrogens

A

cancer, thromboembolic risk

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34
Q

MOA of estrogens

A

bisphosphonate, calcitonin and estrogens inhibit osteoclasts

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35
Q

name the selective estrogen receptor modulators

A

raloxifene

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36
Q

MOA of SERMs

A

looks like estrogens, taken up only in bone, inhibits osteoclasts

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37
Q

when should SERMs be given?

A

soon after menopause (if used in premenopause bone density will drop)

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38
Q

is there a risk of CA with SERMs?

A

yes but lower than estrogens

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39
Q

ADR of SERMs

A

increases hot flash rate, thromboembolic risk

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40
Q

what is calcitonin salmon

A

calcitonin from salmon that is 30-50x stronger than human calcitonin

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41
Q

MOA of calcitonin

A

decreases bone breakdown, inhibits osteoclasts

42
Q

when should calcitonin be used?

A

bed ridden pts, 3rd level, very refractory

43
Q

what also needs to be in place before giving calcitonin

A

calcium and vitamin D

44
Q

ADR of calcitonin

A

cancer risk, rhinitis

45
Q

does calcitonin work?

A

according to the FDA and europeans, NO (don’t use more than 6 months d/t ADR)

46
Q

name the bisphosphonates

A

alendronate, ibandronate, risedronate, zoledronic acid

47
Q

MOA of bisphosphonates

A

increase bone density and decrease fx risk

48
Q

what is the only osteoporotic meds that increases blast activity?

A

bisphosphonates (alendronate)

49
Q

indications for alendronate

A

prevention and treatment of osteoporosis (prevention = 1/2 the dose)

50
Q

which bisphosphonate is once a year?

A

zolendronic acid (IV infusion)

51
Q

how frequenty can bisphosphonates be tken?

A

daily, weekly, monthly, yearly

52
Q

onset of action of alendronate

53
Q

onset of action of risedronate

54
Q

how long should you be taking alendronate?

A

5 years, effects are lasting past then

55
Q

ADR of bisphosphonates

A

osteonecrosis of the jaw (check Ca, vit D, dental problems), GI (don’t lay down - could be erosive), increased fx risk

56
Q

name the parathyroid hormone supplement

A

teriparatide

57
Q

prophylactic dose of alendronate

A

5 mg/day (35mg/week)

58
Q

MOA of teriparatide

A

high high high levels of PTH cause bone formation (normally causes bone degradation)

59
Q

ROA of teriparatide

60
Q

what labs should be watched with teriparatide

A

serum Calcium, renal function, serum uric acid, replenish vitamin D

61
Q

who should get teriparatide?

A

men and post-menopausal women with severe osteo.

62
Q

ADR of teriparatide

A

fall risk (dizzy), d/c in 2 yrs or higher risk of osteosarcoma

63
Q

name the monoclonal antibody

64
Q

MOA of monoclonal antibodies (denosumab)

A

inhibits RANKL to interrupt osteoclast activity

65
Q

uses of denosumab

A

oncology (larger dose), osteoporosis (lower dose)

66
Q

what should be monitored and supplemented if needed with denosumab use

67
Q

ADR of denosumab

A

osteonecrosis, infection risk

68
Q

what can reduce PTH secretion?

A

aluminum, ethanol

69
Q

What can impair absorption of vitamin D?

A

olcer anticonvulsants, chronic laxative use, antilipemic resins

70
Q

what can impair calcium absorption?

A

magnesium-wasters (cisplatin, cyclosporine), decreased gastric acidity (H2 blockers, PPIs)

71
Q

what are the effects of corticosteroids on bone?

A

break down bone with chronic use

72
Q

how can osteoporosis be prevented?

A

need to bone mass early in life, exercise early in life, adequate calcium and vitamin D intake

73
Q

what causes gout?

A

over production of uric acid, underexcretion of uric acid (most cases) leads to deosition of crystals

74
Q

what can hyperuricemia lead to?

A

acute gouty arthritis which can move to gout arthritis

75
Q

define stage 1 gout

A

asymptomatic, elevated levels of uric acid with no manifestations

76
Q

define stage 2 gout

A

acute gouty arthritis, sudden and itense pain and swelling in the joints, damage starts here

77
Q

define stage 3 gout

A

intercritical gout, levels still elevated (period between attacks)

78
Q

define stage 4 gout

A

chronic gout, most destructive stage, joints suffer permanent damage

79
Q

treatment goals of gout

A

terminatino of acute attack, prevention of further attacks, assessment for contributing factors, long-term therapy

80
Q

how is acute gout treated?

A

NSAIDs (naproxen, indomethicine - short term only!), corticosteroids, colchicine (low threshold for toxicity)

81
Q

what is colchicine a derivative of

A

naked lady flower

82
Q

MOA of colchicine

A

interferes with microtubules in metaphase of cell division

83
Q

downsides of colchicine

A

drug interactions (3A4 substrate, can be increased with inhibitors of this), renal/hepatic adjustment

84
Q

ADR of colchicine

A

diarrhea (acute attacks give multiple doses), fatality risk

85
Q

uses of cochicine

A

acute and chronic gout (larger dose)

86
Q

what is prescribed to pts who are over producing uric acid?

A

allopurinol

87
Q

downsides of allopurinol

A

renal dose adjustment (50-60ml/min - 200-100mg daily), might make gout worse if you start it by itself - give with colchicine

88
Q

ADR of allopurinol

A

allergic reaction (SJS) in first 5 weeks of therapy up to 2 years of therapy

89
Q

uses for allopurinol

A

gout and chemotherapy pts

90
Q

what is febuxostat?

A

works like allopurinol

91
Q

ADR of febuxostat?

A

LFT elevation, lower chance of SJS

92
Q

What is probenecid

A

blocks renal uric acid reabsorption

93
Q

ADR of probenecid

A

large failure rate (25%), blocks PCN molecules from leaving the body

94
Q

what is pegloticase

A

breaks down uric acid as a recombinant urate oxidase

95
Q

ROA of pegloticase

A

IV infusion every 2 weeks

96
Q

Contraindications of pegloticase

A

G6PD deficiency

97
Q

treatment of breast cancer risk pts with osteo,

A

raloxifene, caustion with estrogens

98
Q

treatment of osteo in pts with poor GI motility

A

estrogen, calcitonin, caution with alendronate (may cause esophageal ulcers)

99
Q

treatment of osteo in pts at risk for DVT

A

bisphosphonate, calcitonin, caution with estrogens and raloxifene

100
Q

treatment of osteo in pts with renal impairment

A

vitamin D, estrogens, calcitonin, caution with bisphosphonates (may be vit D deficient)

101
Q

treatment of males with osteo

A

bisphosphonate, calcitonin, caution with estrogens (androgen replacement?)

102
Q

treatment of osteo. In pts with painful fx

A

calcitonin

Pharmacology quiz 5 (6 decks)

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