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My own Naplex > Osteoperosis > Flashcards

Osteoperosis Flashcards

1
Q

Osteoblasts

A

bone formation

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2
Q

Osteoclasts

A

bone resorption (break down bone)

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3
Q

how bone mineral density is measured and diagnosed

A

DEXA/DXA scan which spits out a T or Z score

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4
Q

What age should BMD be measured?

A

All women> 65 or men > 70

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5
Q

what is the FRAX tool

A

estimates the risk of osteoperotic fracture in the next 10 years

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6
Q

how do you interpret a T score

A

normal is > -1, -1–2.4 is low bone mass, and less than 2.5 is osteoperosis

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7
Q

what are medications that can cause sedation or orthostasis

A

sedatives, narcotic analgesics, hypnotics

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8
Q

what are the exercise people with osteoporosis should do

A

weight bearing exercise and muscle strengthening exercise

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9
Q

when is it important calcium be adequare

A

in pregnancy, children, years around menopause

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10
Q

what is required for calcium absorption

A

vitamin D

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11
Q

what does vitamin D deficiency cause in kids and adults

A

in children, it can cause rickets and in adults, it can cause osteomalacia

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12
Q

recommended calcium

A

800-2000 IU daily

  • 1000-1200 elemental caldium

carbonate 40% elemental

citrate 21% elemental

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13
Q

which calcium is acid dependant must be taken with meals

A

calcium carbonate

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14
Q

cholcalciferol

A

d3

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15
Q

ergocalciferol

A

d2

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16
Q

dosing of vitamin d

A

daily: 5000-7000 IU or weekly 50,000 IU for 8-12 weeks

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17
Q

max daily elemental calcium

A

500 units

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18
Q

oscal

A

calcium carbonate

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19
Q

tums

A

calcium carbonate

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20
Q

what is indicated for treatment of osteoporosis

A

bisphosphonates (also prevention) desomab (RANKL), teriparatide (parathyroid), calcitonin

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21
Q

what is indicated for prevention of osteoporosis

A

bisphosphonates (except IV alendronate, also used for tx), estrogen-based therapies (raloxifene)

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22
Q

What is the criteria for tx osteoperosis

A

Either:

1) presence of a fragility fracture
2) post-menopausal people with a BMD score of less than -2.5

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23
Q

1st line for osteoperosis

A

bisphosphonates

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24
Q

PO administration of bisphosphenates

A

must stay upright for 30 minutes and drink water, usually given weekly or monthly

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25
Q

Side effects of bisphosphentes

A

esophagitis, hypocalcemia, GI

serious: atypical femur fractures, osteonecrosis of the jaw

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26
Q

Treatment duration with bisphosphenates

A

3-5 years in patients with a low risk of fracture

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27
Q

fosamax

A

alendronate (oral bisphosphonate, given daily or weekly)

28
Q

Boniva

A

Ibandronate (IV bisphosphonates every 3 months and oral given every month)

29
Q

Reclast

A

Zoledronic Acid (IV, once yearly)

30
Q

What is Zometa

A

an injectable bisphosphonates

31
Q

risendronate is given how often

A

daily, weekly, or monthly

32
Q

Are bisphosphonates indicated in renal impairment?

A

no - they deplete calcium

33
Q

which form of bisphosphonate is preferred in esophogitis

A

IV

34
Q

what is raloxifene, SE, boxed warning/contraindications

A

a SERM that decreases bone resorption

increases risk of VTA and death due to stroke (do not use in VTA)

contraindicated in pregnancy

side effects think estrogen hot flashes, peripheral edema, arthralgia, leg cramps

35
Q

boxed warning for conjugated estrogen/Serm combo

A

also increases risk of VTA and stroke (do not use in VTA) just like raloxifene

but additionally endometrial cancer due to the unopposed estrogen

also contraindicated in pregnancy just like raloxifene but additionally breast cancer

36
Q

how does calcitonin (miacalcin) work?

A

by inhibiting osteoclasts which break down bone

37
Q

Miacalcin

A

Calcitonin

38
Q

Warnings for calcitonin

A

hypersensitivity to salmon derived products, increased risk of malignancy with long-term use, hypocalcemia

39
Q

What is teraperatide and abaloparatide moa

A

analogs of PTH which stimulates osteoblasts and increases bone formation

40
Q

what is teraperatide and abaloparatide used for

A

high risk of fractures but has cumulative lifetime duration of two years or less

41
Q

What is the boxed warning for the PTH analaogs (teraperatide and abaloperatide) and how do you store

A

osteosarcoma

other warnings include hypercalcemia

side effects: arthralgias, leg cramps,nausea/orthostasis

Notes: Keep refrigerated, protect from light

42
Q

What is denosumab (prolia)

A

a monocolonial antibody injection that binds to RANKL and prevents osteoclast activity which is given every 6 months via IV

Don’t confuse with Xgeva which is used to treat hypercalcemia of malignancy but has same MOA

43
Q

anything that prevents osteoclast formation has what effect on calcium

A

hypocalcemia because you aren’t breaking bone to make calcium

44
Q

anything that stimulates osteoblasts cause what

A

hypercalcemia

45
Q

which two medication classes can cause ONJ?

A

bisphosphonates and denosumab (a rankl)

46
Q

when is menopause reached? What causes it?

A

When last period was 1 year ago, caused by a decrease in estrogen and progesterone

47
Q

what are the vasomotor symptoms in perimenopause

A

hot flashes, night sweats, vaginal dryness

48
Q

most effective tx for menopause and how it works

A

estrogen therapy which causes a decrease in LH

49
Q

why is estrogen combined with progestin in women with a uterus

A

because unopposed estrogen can cause endometrial cancer

50
Q

when are local estrogen products used

A

dry vagina only

51
Q

17 beta estradiol formulations

A

estrace (cream), vaginal ring (estring), vaginal tablet (vagifem),

52
Q

premarin

A

conjugated equine estrogens (comes in tablet, cream, injection)

53
Q

alora

A

estradiol

54
Q

climera

A

estradiol

55
Q

vivelle-dot

A

estradiol

56
Q

what is conjugated equine estrogens with medroxyprogesterone

A

a systemic hormone therapy

57
Q

provera

A

medroxyprojesterone

58
Q

prometrium

A

micronized progesterone

59
Q

how often is vivelle dot and olora applied

A

twice weekly

60
Q

how often is climera applied

A

once weekly

61
Q

what natural products are used for vasomotor sx

A

black cohash, evening primrose oil, soy, red clover

62
Q

What is paroxetine for and what is the major DDI?

A

for vasomotor, a CYPP450 2D6 inhibitor therefore blocks effectiveness of tamoxifen and increases risk of bleeding in warfarin

63
Q

what is used to treat dyspareunia (painful intercourse

A

Ospemifene is a oral estrogen agonist/antagonist for severe (not mild) dyspareunia. Astroglide is a lubricant marketed for dyspareunia.

64
Q

What medications can lower testosterone and cause hypogonadism

A

methadone, chemo, cimetitidne, spironolactone

65
Q

what does testosterone increase

A

hematocrit (clotting risk)

66
Q

what are the risks and boxed warnings of testosterone

A

can cause prostate growth and restricted in severe BPH, baldness, acne, gynocomastia, increased appetite, reduced sperm count

boxed warning do not exposekids

67
Q

what control is testosterone

A

A CII

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