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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
Q

Calcitriol
Characteristic

A

activated Vitamin D3
Available by prescription
Drug choice for osteoporosis
Expensive

26
Q

Ergocalciferol
Doxercalciferol

Characteristic
a) activated by?
b) frequency?

A

Vitamin D2
Prescription-only
Derived from fungi

kidney/liver
per week

27
Q

Bisphosphonates
Agents

A

Alendronate
Risedronate
Ibandronate
AIR “drontate”

28
Q

Bisphosphonates
Actions

A

Mimic endogenous pyrophosphate
-Bind to hydroxyapatite in bone
-Inhibit osteoclast adherence to bone surfaces
-Decrease resorption

29
Q

Bisphosphonates
a) All tablets should be taken with at least?
b) take when?

A

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
Q

Bisphosphonates
How often take this?

A

Once weekly dosing
poor absorbed
Bioavailability 1-5%

31
Q

Bisphosphonates
dosage
a) Alendronate
b) Risedronate
c) Ibandronate

A

a) PO daily, tablet/oral solution weekly
b) tablet daily, weekly, or monthly
c) tablet monthly, IV inj every 3 months

32
Q

Denosumab
action

A

a human monoclonal antibody
binds to RANKL
inhibits osteoclasts

33
Q

Denosumab
Administered
a) Xgeva
b) Prolia
c) Must take with what?

A

a) every month
b) every 6 months
c) calcium supplement!!!!
This is not even an option.

34
Q

Denosumab
ADRs

A

Hypocalcemia – supplementation important
Dermatologic – dermatitis, eczema and rashes

35
Q

Selective Estrogen Receptor Modulators
agent

A

Raloxifene

36
Q

Raloxifene
action

A

Estrogen agonist in bone tissue and
antagonist in the breast and uterus

37
Q

Raloxifene
Administration
dosage
ADRs

A

60 mg once daily
Hot flashes often result in discontinuation
3x increased risk of venous
thromboembolism

38
Q

Calcitonin

A

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
Q

Estrogen Therapy
ADR

A

PE
Breast cancer
strokes
coronary heart disease

40
Q

Adequate Vitamin D
which food?

A

Sun-induced skin conversion
Fatty fish
Fortified foods
Milk and orange juice

41
Q

Teriparatide

A

human parathyroid hormone
The only FDA approved agent

42
Q

Teriparatide
how to administer?

A

laying down d/t orthostatic
hypotension

43
Q

Teriparatide
a) route
b) do not administer with?

A

a) pen type injection
SUQ
b) alendronate

44
Q

Dietary change
which one is improve BMD?
a) Calcium
b) Vitamin A
c) Vitamin D
d) Vitamin C

A

a, c, d
vitamin A is clast

45
Q

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

A

b

46
Q

For elderly hypophosspatemia?

A

Posture
Dical-D

47
Q

Vitamin D
a) __________ are prescription only and take b)________________.
b) __________ is available OTC and taken_________.

A

Ergocalciferol
Doxercalciferol
week

Cholecalciferol
daily

48
Q

Xgeva, which one is correct?
a) Hot flashes
b) Require Ca supplement
c) causes VE
e) must be on empty stomach

A

take with Ca

49
Q

Pt with active thromboembolic disease, which one is contraindication?
a) Xgeva
b) Raloxifene
c) Risedronate
d) Alendronate

A

b

50
Q

Calcitonin
route

A

Intranasal spray
-spray in alternating nares every
other day
SQ injection
-100 units per day

51
Q

FDA approved stimulating bone formation, agent?

A

Teriparatide

52
Q

Which are the medication for osteoporosis?
a) calcium citrate
b) Calcitriol
c) Calcium phosphate tribasic
d) Alendronate

A

b Vitamin D3(Rx)
a highest amount 40%

Pharmacology (34 decks)

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