osteo

Question 1

osteoporosis pharm

Answer 1

calcium, bisphosophonates, estrogen, raloxifene, calcitonin, pth, denosumoab, hrt

Question 2

calcium

Answer 2

Calcium Carbonate vs. Calcium Citrate•

Calcium carbonate is the most efficient source of calcium and is the least expensive (Tums)•

Should be given with meals (enhanced absorption)•

Bones don’t care if the calcium came from food, fortified food, or supplements •

Possibly calcium taken at bedtime can stop bone loss that occurs at night, so one dose of the calcium should be taken late in the day •

Can inhibit iron absorption •

Can inhibit absorption of thyroid medication

Question 3

intake recs

Answer 3

infants upper level 1000mg

9-13 3,000

31 - 50. 2,500

over 7- 2,000

Question 4

vit d

Answer 4

when supplementing - cholecalfercol generally preffered

calcium and vit d is main treatment for bone loss.

recs: upller limit for infants is 1000 and then by teenager years its 4,000 but should take btween 400 and 600

Question 5

pharm

Answer 5

Antiresorptive (anti-catabolic)
• Decrease bone resorption
• Most treatment agents
• Examples: Bisphosphonates, SERMs, calcitonin,
estrogen, denosumab
- atypical fractures of femur can occur in long term treatment.

• Anabolic
• Stimulate bone formation
• Example: teriparatide
Osteoporosis Pharmacology

Question 6

bisphosphonate

Answer 6

alendronate

risedronate

ibandronate

z acid

intrusction: 
not with food 
not with tea water only 
not before bed 
dont lie down 

Increased bone density in the spine by 5% to 8% and at
the hip by 3% to 6% after 3 years
• Reduced incidence of vertebral fractures by 40% to 70%
• Alendronate, risedronate and zoledronic acid reduced
non-vertebral fractures (25% to 40%), including hip
fractures (40% to 60%), in women with osteoporosis
• Ibandronate: Overall, no effect observed on non-vertebral
or hip fractures. In a post-hoc analysis, non-vertebral
fracture reduction was seen in a high-risk subgroup with
a baseline femoral neck T-score less than -3.0

Contradictions /warnings

Hypocalcemia
– Creatinine clearance <30 cc/min (<35 cc/min for
zoledronic acid)
– For oral dosing: Esophageal stricture or impaired
esophageal motility (alendronate); inability to
stand or sit for at least 30 minutes
(alendronate/risedronate) or 60 minutes
(ibandronate)
Bisphosphonates:

adverse ractions
- GI – abd. pain, flatulence, diarrhea, esophagitis
•Risindronate (Actonel) - constipation
•Bone pain – in patients with Paget’s Disease
•Osteonecrosis of the jaw
•Long bone (femur) fracture with long term use

drug interactions
- ranitidine might go up, aspiring might go up, calcium and andtacids go down

Question 7

osteronecrosis of the jaw

Question 8

calcitonin

Answer 8

nasal spray
- small effect on bone density in spine
reduced incidence of vertebral fracturs in women with pre existing fractures
no effect on nonvertebral or hip fractures

can cuase nasal stuffiness and possible cancer risk

Question 9

raloxifene

Answer 9

SERM
estrogenic
no effect on non vertebral fracture risk

for post menopausal osterpersosi
women with hgh risk for breast cancer

dont give with dvt stuff
lactating wmn or pregnancy

Question 10

denosumab

Answer 10

a rank ligand inhibitor
binds to rank - inhibiting formation of osteoclasts
every six months injection

Question 11

PTH

teriparatide forteo

Answer 11

PTH regulated calcium and phosphtate in bone and kidney

increases serum ca levels
stimulates bone formation
sq qd times 2 years

start an atireporptive after stopping PTH

contradicted in patients at risk for ostteosarcoma

precuations

• hypercalcemia
• urolithiasis
• cv
• pregnancy
• severe renal issues
• digoxin therapy

can cause neasur, leg cramps, dizzy, transiesnt hypercalcemia