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Kol- Pharm 323 Spring > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

3 classes of drugs for Osteoporosis

A

1.Vitamin supplementation
Calcium, Vitamin D

2.Drugs that decrease bone resorption (osteoclast activity = bone breakdown)
Calcitionin-Salmon
Biphosphonates:alendronate (Fosamax) 
Estrogen replacement (Premarin)
SERMs
Denosumab (Prolia)
3.Drugs that increases bone formation
Parathyroid Hormone (Forteo)
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2
Q

Osteopenia vs osteoporosis T score

A

Osteopenia- low bone mass T-score -1 to -2.5

Osteoporosis- T score -2.5 or more

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3
Q

what is a fraxx score?

what is a fraxxx score?

A
  • FRAXX score: 10-year risk of experiencing a fracture

- FRAXXX score: 10 year risk of experiencing awesome sex

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4
Q

Vitamins for OP?

A

Calcium, Vitamin D

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5
Q

Drugs that decrease bone RESORPTION

A

(resorption = osteoclast activity = bone breakdown)

Calcitionin-Salmon
Biphosphonates:alendronate (Fosamax) 
Estrogen replacement (Premarin)
SERMs
Denosumab (Prolia)
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6
Q

Drug that increases bone formation?

A

Parathyroid Hormone (Forteo)

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7
Q

Vitamin supplementation for prevention or treatment of OP?

A

both!

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8
Q

Ca dose?

A

At least 1200mg/day

–> Divided doses b/c only absorb so much @ 1 time - only absorb 600 mg @ one time

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9
Q

Ca food interactions? what we gonna do about it?

A

(oxalic acid) spinach, rhubarb, swiss chard, beets, (phytic acid) bran, whole grain cereals
–>separate 1 hour from Ca supplement

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10
Q

Vitamin D dose?

A

Oral supplementation : 800mg-1000mg daily

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11
Q

How does vitamin D help OP?

A

increases plasma Ca level by increase absorption from bone, kidney, intestine

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12
Q

This OP treatment has characteristics of a hormone

A

vitamin D

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13
Q

drug that Keeps calcium in the bone and prevents pulling calcium into the bloodstream

A

Calcitonin-Salmon

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14
Q

Calcitonin-Salmon route?

A

Intranasal or SQ forms

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15
Q

SE of calcitonin salmon

A

nausea, nasal drying, increased malignancies? (Canada)

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16
Q

drug that Undergoes incorporation into the bone & decrease osteoclast activity

A

Biphosphonates –> Prototype: alendronate (Fosamax)

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17
Q

biophosphonates end in

A

onate!

18
Q

How do we give biophosphonates/alendronate (Fosamax) ? what do you do after you take it?

A
  • take it first thing in morning before eaten or drink anything for 30 minutes
  • remain upright for 30 minutes to prevent esophagitis
19
Q

once in the bone this drug stays there for decades

A

biophosphonate/alendronate (Fosamax)

20
Q

side effects of alendronate (Fosamax)

A

-Esophagitis*, atypical fractures of the femur, musculoskeletal pain, ocular inflammation and osteonecrosis of the jaw

21
Q

patient teaching for alendronate?

A
  • Take on empty stomach 1st thing in morning
  • Nothing to eat or drink for 30 min
  • Remain upright for 30 min
  • Take with full glass of water
  • Don’t chew or suck tablets
  • take with Ca and Vit D
22
Q

how does estrogen replacement therapy work for OP?

A

Suppress osteoclast proliferation

23
Q

prototype for estrogen replacement for OP?

A

conjugated equine estrogens (Premarin)

24
Q

side effects of conjugated equine estrogens (Premarin)

A

Increased risk of breast cancer and endometrial cancer, cholecystitis, myocardial infarction and stroke

25
Q

What does SERM stand for? - 10 points if you get it!

A

Selective estrogen-receptor modifiers (SERM)

26
Q

SERM prototype

A

raloxifene (Evista)

27
Q

How does raloxifene fxn?

A

(SERM)

Block estrogen receptors on breast cancer cells, but have estrogen effects on non-breast cells

28
Q

side effect of raloxifene?

A

DVT and PE risk (stroke)

29
Q

raloxifene and pregnancy?

A

preg category X

30
Q

other uses for raloxifene?

A

(SERM)

breast cancer

  • Improve bone density
  • Reduces spinal fractures
  • Improve lipid profiles and improves cardiovascular risk
31
Q

what kind of drug is Denosumab (Prolia)?

A

Monoclonal Antibody

32
Q

how does Denosumab fxn?

A

-RANKL inhibitor
–>RANK= receptor stimulates formation of osteoclasts
-this drug prevents receptor activation and inhibits osteoclast formation
Receptor activation of nuclear factor kappa-B ligand

33
Q

route for denosumab?

A

SQ / 6 months

34
Q

Side effects and rare side effects of denosumab?

A

SE: back pain, MS pain, pain in extremities, UTI, hypercholesterolemia

Rare/serious SE: serious infections, derm reactions, osteonecrosis of the jaw

35
Q

before taking denosumab you need to correct …..

A

hypocalcemia

36
Q

how does teriparatide fxn?

A

Increases bone deposits by osteoblasts

37
Q

route for teriparatide?

A

SQ monthly

38
Q

teriparatide costs _____

A

$1500/month

39
Q

side effects of teriparatide?

A

Generally well tolerated
Nausea, headache, back pain, leg cramps
Orthostatic hypotension-initially
Increased risk of osteosarcoma

40
Q

which OP drug causes orthostatic hypotension initially?

A

teriparatide

41
Q

which OP drug has risk of osteonecrosis pf jaw

A

denosumab

42
Q

SQ route for OP

A
  1. Calcitonin-Salmon
  2. Denosumab (Prolia) : Monoclonal Antibody (ever 6 mo)
  3. teriparatide (Forteo) (1/month)

Kol- Pharm 323 Spring (41 decks)

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