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Pharmacology > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Bone Physiology
Two main types of bone

A

Trabecular bone
Cortical bone

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2
Q

Trabecular bone?

A

Maintained Ca normal
Meshwork of struts
Metabolically active
Large surface area

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3
Q

Cortical bone?

A

Formed in layers
80-90% calcified
Structurally strong and protective

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4
Q

Bone remodel
Peak bone mass achieved by age??

A

age 20-30
Maximum bone length achieved much earlier

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5
Q

Bone remodel
For a)_____ year after menopause, women lose by at a rate of b) ____ per year

A

a) 5-10
b) 3%

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6
Q

Bone remodel
The majority of the skeleton is replaced every a)______ years

A

7-10 years

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7
Q

a)_______and b)_______ maintain calcium homeostasis

A

a) Vitamin D
b) parathyroid hormone
Vitamin D and PTH work together to release calcium from bone

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8
Q

Postmenopausal OP
rate of bone resorption accelerated
(Men resorption slower)
Accelerated by?

A

Insufficient dietary calcium
Cigarette smoking,
Concurrent hypothyroidism

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9
Q

BMD Testing
TEST! recommendation

A

All women ≥ 40 who have had a fracture should have screen
All women need to be screened ≥ 65 years old
Adult women with symptomatic
hyperparathyroidism
Women receiving long-term glucocorticoid therapy

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10
Q

WHO Diagnostic Criteria
a) Normal
b) Osteopenia
c) Osteoporosis

A

a)
BMD within 1 SD of young adult mean
b)
BMD -1 to -2.5 SD below young adult mean
c)
BMD at least -2.5 SD below young adult mean

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11
Q

Vitamin A
considerations

A

Increased amounts promote osteoclast activity
osteoclast=breaking bone down

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12
Q

Vitamin C
considerations

A

Promotes collagen production and increases osteoblast activity
osteoblast=build bone

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13
Q

smoking cause?

A

bone loss and fractures
causes early menopause
decreases body weight
enhances estrogen metabolism
increases PTH concentrations
decreases Vitamin D concentrations

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14
Q

Increase BMD and decrease fractures
what combination is this?

A

Calcium + Vitamin D + exercise

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15
Q

Calcium Options 3

A

Calcium carbonate
Calcium citrate
Calcium phosphate tribasic

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16
Q

Calcium carbonate
agent

A

Os-Cal
Tums,
Titralac
Caltrate

40% elemental calcium

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17
Q

Calcium carbonate
a) drug choice
b) Maximum single doses
c) take with what?

A

a)
the highest amount of elemental calcium and least expensive
b)
600 mg
c)
Take with food for maximum absorption(Gastric acid converts to absorbable calcium)

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18
Q

Calcium citrate
agent

A

Citrical

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19
Q

Calcium citrate
a) how much % of elemental ca?
b) Take with?

A

a) 24%
b) take with nothing

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20
Q

Calcium phosphate tribasic
agents

A

Posture
Dical-D

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21
Q

Calcium phosphate tribasic
a) how much % of elemental ca?
b) For who?

A

a) 39% elemental calcium
b) elderly with concurrent
hypophosphatemia

22
Q

Which are the V D3?
agent

A

Cholecalciferol
Calcitriol

23
Q

Which are the V D2?
agent

A

Ergocalciferol
Doxercalciferol

24
Q

Cholecalciferol
a) Characteristic
b) Needs to be activated by?
c) take how many times?

A

a)
Available OTC
The form your body makes when exposed to sunlight
b)
liver/kidney
c)
daily

25
Calcitriol Characteristic
activated Vitamin D3 Available by prescription Drug choice for osteoporosis Expensive
26
Ergocalciferol Doxercalciferol Characteristic a) activated by? b) frequency?
Vitamin D2 Prescription-only Derived from fungi kidney/liver per week
27
Bisphosphonates Agents
Alendronate Risedronate Ibandronate AIR "drontate"
28
Bisphosphonates Actions
Mimic endogenous pyrophosphate -Bind to hydroxyapatite in bone -Inhibit osteoclast adherence to bone surfaces -Decrease resorption
29
Bisphosphonates a) All tablets should be taken with at least? b) take when?
a) 4 oz of plain tap water Not coffee, juice, mineral water or milk b) Take first thing in the morning and at least 30 minutes before any food, medication, or dietary supplement
30
Bisphosphonates How often take this?
Once weekly dosing poor absorbed Bioavailability 1-5%
31
Bisphosphonates dosage a) Alendronate b) Risedronate c) Ibandronate
a) PO daily, tablet/oral solution weekly b) tablet daily, weekly, or monthly c) tablet monthly, IV inj every 3 months
32
Denosumab action
a human monoclonal antibody binds to RANKL inhibits osteoclasts
33
Denosumab Administered a) Xgeva b) Prolia c) Must take with what?
a) every month b) every 6 months c) calcium supplement!!!! This is not even an option.
34
Denosumab ADRs
Hypocalcemia – supplementation important Dermatologic – dermatitis, eczema and rashes
35
Selective Estrogen Receptor Modulators agent
Raloxifene
36
Raloxifene action
Estrogen agonist in bone tissue and antagonist in the breast and uterus
37
Raloxifene Administration dosage ADRs
60 mg once daily Hot flashes often result in discontinuation 3x increased risk of venous thromboembolism
38
Calcitonin
Naturally occurring substance that decreases bone resorption Released from the thyroid gland lndicated for women at least 5 years past menopause 甲状腺から分泌されるホルモン。骨のカルシウム放出を抑制
39
Estrogen Therapy ADR
PE Breast cancer strokes coronary heart disease
40
Adequate Vitamin D which food?
Sun-induced skin conversion Fatty fish Fortified foods Milk and orange juice
41
Teriparatide
human parathyroid hormone The only FDA approved agent
42
Teriparatide how to administer?
laying down d/t orthostatic hypotension
43
Teriparatide a) route b) do not administer with?
a) pen type injection SUQ b) alendronate
44
Dietary change which one is improve BMD? a) Calcium b) Vitamin A c) Vitamin D d) Vitamin C
a, c, d vitamin A is clast
45
Which one is not true about calcium carbonate? a) Can be take with or without VD b) Must be taken grater than 600mg c) Should take with food d) contains 40% element calcium
b
46
For elderly hypophosspatemia?
Posture Dical-D
47
Vitamin D a) __________ are prescription only and take b)________________. b) __________ is available OTC and taken_________.
Ergocalciferol Doxercalciferol week Cholecalciferol daily
48
Xgeva, which one is correct? a) Hot flashes b) Require Ca supplement c) causes VE e) must be on empty stomach
take with Ca
49
Pt with active thromboembolic disease, which one is contraindication? a) Xgeva b) Raloxifene c) Risedronate d) Alendronate
b
50
Calcitonin route
Intranasal spray -spray in alternating nares every other day SQ injection -100 units per day
51
FDA approved stimulating bone formation, agent?
Teriparatide
52
Which are the medication for osteoporosis? a) calcium citrate b) Calcitriol c) Calcium phosphate tribasic d) Alendronate
b Vitamin D3(Rx) a highest amount 40%

Pharmacology (34 decks)

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