osteo Flashcards
risedronate po dosage
35 mg per week
administration instructions for po bisph
30min before breakfast with a full glass of water. maintain upright for at least 30 mins
alendronate po dosage
70 mg per week
contraindications for po bisp
crcl <30ml/min
hypocalcemia
oesophageal/gastric/gi abnormalities
inability to sit upright ≥30 mins
aspiration risk (eg difficulty swallowing liquids)
se of iv bisp
Flu-like symptoms, worsened renal function
se of po bisp
Nausea, ab pain, heartburn, upper GI irritation
side effects of bisphosphonates /mabs
ONJ, atypical femoral fracture, muscle pain
how long can you take po bisph
5 yr
how long can you take iv bisph
3 yr
how often to repeat BMD
every 2 years
how much serum 25(OH) vit d should be present before initiating therapy
≥ 20-30 ng/ml
zoledronic acid (iv) dosing
5 mg per year as 30 min infusion
zoledronic acid (iv) ci in
crcl <35 ml/min
hypocalcaemia
drugs ci in hypocalcaemia
iv, po bisphosphonates
denosumab
calcitonins
drugs causing hypercalcaemia
teriparatide
first line for osteo
po bisphosphonates
how long can you use romosozumab for
max 1 year
ci for romosozumab
hx of cvs event/stroke, uncorrected hypocalcemia
administration of romo
once a month
administration of denosumab + concurrent suppl?
once every 6 months, 1000mg Ca + 400 IU Vit D (OD)
teriparatide sc
20 mcg OD
teriparatide ci in
crcl<30
any hx of bone issues: paget’s disease/ hx of bone radiation
hypercalcemia
severe renal impairment
pregnancy
teriparatide se
serious calciphylaxis, postural hypotension, transient hypocalcemia
teriparatide can treat for how long
max 2 years
raloxifene po dosage
50mg OD
raloxifene ci
crcl <30
hx/current VTE
hepatic / severe renal impairment
hx of breast cancer
se of raloxifene
vte, stroke risk
moa of romo
scelerostin inhibitor. Removes sclerostin inhibition of signalling pathway that regulates bone growth, increasing bone formation and decrease bone resorption
moa of denosumab
rankl inhibitor, prevents development of osteoclasts
moa of teriparatide
recombinant parathyroid hormone, stimulates new bone formation, increases bone strength
raloxifene moa
selective estrogen receptor modulator, mimics effects of oestrogen to maintain bone density
ibandronate po dosage
150mg per month
raloxifene preferred in
women without hot flushes
list 3 non pharm for osteo
exercises - weight bearing, muscle strengthening
smoking cessation
limit alcohol intake
adequate calcium intake
vit d supplementation
medications inducing osteo
glucocorticoids
immunosuppressants
ASM
GnRH agonists
heparin
chemotherapy
thyroid hormones
avoid concurrent administration of calcium with
ppi, fibre, iron, tetracyclines, FQLs, bisphosphonates, thyroid supplements
osteopenia bmd
-1 to -2.4
osteoporosis
-2.5 and worse
examples of anabolic agents
PTH therapies - teriparatide
sclerostin inhibitors - romo
examples of antiresorptive agents
bisphosphonates
moa bisph
increases osteoclast cell death, slowing bone loss
what to screen for bisp before initiation
calcium, vit d deficiency
se of denosumab
muscle, back, bone pain and aches
NVD
increased cholesterol
hypocalcaemia
cellulitis
eczema
ci of deno
hypocalcemia, pregnancy, crcl <10
screen prior to deno
scr, 25 OH vitD
denosumab do not discontinue because?
increased risk of spinal column fractures
raloxifene preferred in
younger women or women whose menopausal sx require concurrent tx
raloxifene se
increased risk of breast cancer, blood clots, stroke/vte, hot flushes
calcitonin moa
reduces blood calcium, opposes effects of PTH, inhibiting osteoclastic bone resorption
calcitonins ae
red streaks on skin, injection site rxn, warm feeling, redness
calcitonins ci
hypersensitivity, hypocalcemia
romosuzumab ae
MI/cvs/stroke
hypocalcaemia
