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Pharm > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

osteoporosis

A

reduced bone mass and altered microarchitecture

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2
Q

types of osteoporosis

A

primary

secondary

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3
Q

primary osteoporosis type I

A

loss of trabecular bone with estrogen loss

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4
Q

primary osteoporosis type II

A

loss of trabecular and cortical bone with inefficient remodeling

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5
Q

secondary osteroporosis

A

due to systemic illness or medication

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6
Q

therapy goals of osteoporosis (4)

A

limit bone mass
delay prevention
recent fracture
balance osteoclastic and plastic activity

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7
Q

osteoclastic

A

resoprtion

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8
Q

osteoblastic

A

deposition

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9
Q

bone healthy lifestyle consists of

A

calcium and vitamin D

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10
Q

1st line osteoporosis treatment

A

bisphosphonates

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11
Q

second line osteoporosis tx

2

A

teriparatide

raloxifene

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12
Q

3rd line osteoporosis tx

2

A

raloxifene

calcitonin

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13
Q

nutrients as tx

uses

A

prevention

treatment

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14
Q

biphosphonates as tx

uses

A

prevention

treatment

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15
Q

calcitonin as tx

uses

A

treatment

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16
Q

estrogen tx

uses

A

prevention

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17
Q

selective estrogen receptor modulators as tx

use

A

prevention

treatment

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18
Q

PTH analogs like teriparatide

use

A

treatment

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19
Q

calcium products: elemental dosages

A

vary with age

1000mg/day to 1500mg/day with vit D

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20
Q

calcium ____ or _____ is preferred to salts

A

carbonate

citrate

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21
Q

supplements <500mg should be

A

taken with meals

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22
Q

calcium product elimination

A

eliminated unabsorbed by GI tract

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23
Q

AE of calcium product

A

nausea

constipation

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24
Q

calcium products may interact with

A

FQs

tetracyclines

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25
Q

ways to get vitamin D

A

diet
UV exposure
supplements

26
Q

vit D supplement examples

A

cholecalciferol
calcitriol
ergocalciferol

27
Q

normal serum vitamin D levels

A

~32 ng/mL

28
Q

adverse effects of vit D

A

hypercalcemia bc of promoted absorption from small intestine, thereby increasing serum Ca.

29
Q

hypercalcemia causes

A

decreased PTH

bone resorption

30
Q

bisphosphonates

A

first line therapy

prevention and treatment

31
Q

biphosphonates MoA

A

inhibits breakage.

binds to bone and inhibits osteoclast activity

32
Q

pt education for bisphosphonates

A

take at least 30 min before meal with full glass of water

33
Q

excretion of bisphosphonates

A

renal

34
Q

AEs of bisphosphonates

A

nausea

abdominal discomfort

35
Q

when to avoid bisphosphonates?

A

severe renal impairment

hx esophageal obstruction

36
Q

bisphosphonates will interact with

A

antacids

divalent cations

37
Q

bisphosphonate examples

A

alendronate
risedronate
ibandronate
zoledronic acid

38
Q

zoledronic acid is given how often

A

yearly as an injection

39
Q

bisphosphonates can be given

A

daily, weekly, orally, injected.

40
Q

bone demineralization with bisphosphonates

A

rare: jaw necrosis

potential for femur fracture.

41
Q

PTH analog drug

A

teriparatide

42
Q

MoA teriparatide

A

PTH analog
stimulates osteoblast function
also increases renal tubular reabsorption of calcium, leading to inc bone mass/density

43
Q

dosing of teriparatide

A

SQ for 18-24 months

44
Q

excretion of teriparatide

A

renal

45
Q

when to avoid teriparatide

A

hypercalcemia
skeletal malignancy
bone mets

46
Q

AE teriparatide

A 
HA
lightheaded
hypoTN
palpitations
transient hypercalcemia
47
Q

SERMS: raloxifene

use

A

prevention and treatment

48
Q

MoA SERM: raloxifene

A

estrogen receptor agonist (bone) and antagonist (breast, uterus) to slow the rate of bone loss

49
Q

SERMS: raloxifine

protein binding

A

highly protein bound

50
Q

ADR of SERM: Raloxifene

A 
HA
hot flash
flushing
leg cramp
thromboembolism
51
Q

when to avoid SERM: Raloxifene

A

hx venous thrombosis

women of childbearing age (estrogen related)

52
Q

SERM: raloxifene interaction

A

cholestyramine

estrogens

53
Q

Calcitonin

A

treatment only

strictly 3rd line

54
Q

MoA Calcitonin

A

inhibits osteoclasts

55
Q

estrogen products for tx

A

used to alleviate peri menopausal symptoms or to prevent osteoporosis in high risk patients. recommended to be used for short term symptom management.

56
Q

AEs estrogen

A 
HA 
depression
N/V
cramps
HTN
thrombosis
bleeding
edema
breast tenderness
breast cancer
57
Q

absolute contraindications to estrogen

A 
cancers
thromboembolic disease
acute liver disease
pregnancy
tobacco use
58
Q

osteoporosis tx that increases deposition

A

nutrient

teriparatide

59
Q

osteoporosis tx that decreases resorption

A

bisphosphonates
calcitonin
estrogen
SERMs

60
Q

monitoring osteoporosis pt newly started on meds

A

followup in 1-2 months, then 3-6

DEXA q2 years

61
Q

if pt is using estrogen for osteoporosis

A

do a full annual workup and discuss with patient before renewing Rx

Pharm (31 decks)

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