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Naplex Drug Card > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Recommended calcium dose

A

1000-1500mg elemental calcium daily

(Take in two divided doses)

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2
Q

Why should a single dose of elemental calcium not exceed 500-600mg?

A

To reduce the risk:

Kidney stone

CVD

Stroke

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3
Q

Types of calcium formulation

A

Carbonate

Citrate

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4
Q

Os-Cal
Tums
Caltrate
Maalox
Oysco

A

Calcium Carbonate

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5
Q

40% elemental calcium

Requires acid for absorption

Take with food

A

Calcium Carbonate

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6
Q

Calcitrate

Citracal

A

Calcium Citrate

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7
Q

21% elemental calcium

Good with elderly and PPI (increased gastric absorption at high pH)

+/- food

A

Calcium citrate

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8
Q

ADR calcium supplements

A

Constipation

Hypercalcemia

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9
Q

Vit. D recommended daily dose

A

20-25 mcg/day (800-1000 IU)

Osteoporosis dose

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10
Q

Vit D deficiency treatment dose

A

125 - 175 mcg (5000-7000 IU) daily or 1250mcg (50000 IU) weekly for 8-12 weeks

Then maintenance dose:
25-50 mcg (1000-2000 IU) daily

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11
Q

Vit. D level for deficiency

A

< 30 ng/ml

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12
Q

Cholecalciferol

A

D3

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13
Q

Ergocalciferol

A

D2

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14
Q

Medications for Osteoporosis prophylaxis

A

Bisphosphonate

Estrogen based therapy (Raloxifene, Duavee)

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15
Q

Medications for osteoporosis treatment

A

Bisphosphonate

Denosumab

Parathyroid hormone analogs

Calcitonin

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16
Q

Levels must be adequate prior to treatment initiation

A

Vit. D

Calcium

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17
Q

Criteria for initiating treatment if osteoporosis

A

T score <= -2.5 in the spine, fermoral neck, total hip or 1/3 radius

Or

Any osteoporosis related fracture regardless of BMD

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18
Q

Criteria for initiating treatment if osteopenia

A

T score of -2.5 — -1 and 10 yrs risk of 20% or greater osteoporosis major fracture or 3% or greater hip fracture

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19
Q

Inhibits osteoclast and bone resorption

A

Bisphosphonate

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20
Q

Vertebral and hip fx risk reduction

A

All Bisphosphonate except ibandronate (verterbal only)

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21
Q

Bisphosphonate drug holiday timeframe

A

After 3-5 years of treatment

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22
Q

Other Bisphosphonate indications

A

Paget disease

Glucocorticoid induced osteoporosis

Hypercalcemia o f malignancy

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23
Q

Fosamax

Binosto

A

Alendronate

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24
Q

Alendronate dose:

Prophylaxis postmenopausal women

Glucocorticoid induced osteoporosis

A

5 mg daily

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25
Q

Alendronate dose:

Treatment (male and female)

A

10mg daily or 70mg weekly

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26
Q

Actonel

Atelvia (DR)

A

Risedronate

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27
Q

Risedronate dose:

Prophylaxis

A

5 mg daily or 35mg weekly or 150mg monthly

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28
Q

Risedronate dose:

Treatment (male and female)

A

35mg weekly

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29
Q

Risedronate dose:

GIO

A

5 mg daily

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30
Q

Boniva

A

Ibandronate

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31
Q

Ibandronate prophylaxis formulation

A

PO option only

32
Q

Ibandronate treatment formulation

A

IV and PO

33
Q

Ibandronate IV dose (male and female)

A

3mg IV every 3 months

34
Q

Reclast

Zometa

A

Zoledronic acid

35
Q

Zoledronic acid dose:

Treatment and GIO

A

5mg IV yearly

36
Q

Zoledronic acid prophylaxis

A

5mg IV every 2 years

37
Q

Bisphosphonate contraindications

A

Hypocalcemia

Inability to stand upright for 30 mins or more

38
Q

Bisphosphonate warnings

A

ONJ
Esophagitis
Atypical femur fracture
Hypocalcemia
GI2

39
Q

Bisphosphonate renal contraindications

A

< 30 ml/min: risedronate and ibandronate

< 35 ml/min: alendronate and zoledronic acid

40
Q

Bisphosphonate and polyvalent ions

A

Separate by 2 hours

41
Q

Bisphosphonate and food and beverage except water

A

Seperate by 30 mins

42
Q

Bisphosphonate requires acid for absorption

Avoid PPI and H2RA

A

Atelvia DR (Risedronate)

43
Q

Caution in aspirin induced asthma patient (bronchoconstriction)

Teratogenic

A

Zoledronic acid

44
Q

Preferred formulation for esophagitis to reduce risk of esophageal cancer

A

IV Bisphosphonate

45
Q

Estrogen based products

A

Raloxifene

Duavee

46
Q

Evista

A

Raloxifene

47
Q

Duavee

A

Conjugated estrogen + Bazedoxifene

48
Q

Increased risk of VTE

Avoid if Hx/current VTE or pregnant

A

Raloxifene

49
Q

Seperate from levothyroxine

A

Raloxifene

50
Q

Hot flash
Peripheral edema
Arthralgia
Leg cramp

A

Raloxifene

51
Q

Risk of endometrial, breast and ovarian cancer and VTE

Avoid if: breast cancer, pregnancy, uterine bleeding, hx/active VTE

A

Duavee

52
Q

Indicated if > 5 yrs post-menopausal

A

Calcitonin

53
Q

Nasal spray (200 units) or injection (100 units)

A

Calcitonin

54
Q

Hypocalcemia

Risk of malignancy

Hypersensitivity to salmon products

A

Calcitonin

55
Q

Injections and unopened nasal spray refridgerated

A

Calcitonin

56
Q

Parathyroid hormone agonists (increases osteoblast)

Injection only

A

Teriparatide
Abaloparatide

57
Q

Forteo

A

Teriparatide

58
Q

Tymlos

A

Abaloparatide

59
Q

High risk fx

Use 2yrs or less

A

Parathyroid agonists

60
Q

Increased risk of osteosarcoma

A

Parathyroid agonists

61
Q

Hypercalcemia

Arthralgia

Leg cramp

Nausea

Orthostasis/Dizziness

A

Parathyroid

62
Q

Parathyroid injection storage

A

Keep refrigerated

63
Q

Parathyroid hormone requires light protection

A

Teriparatide (Forteo)

64
Q

SC prefilled pens

A

Parathyroid agonists

65
Q

Monoclonal antibody blocks RANKL and RANK interactions preventing osteoclast formation

A

Denosumab

66
Q

Prolia

Xgeva

A

Denosumab

67
Q

Denosumab dose

A

60mg SC q6 months

68
Q

Denosumab CI

A

Hypocalcemia

69
Q

Denosumab warnings

A

ONJ
Atypical femur fracture
Hypocalcemia

70
Q

Denosumab ADR

A

Hypertension
Fatigue
Edema
Dyspnea
Headache
GI2
Hypophosphotemia

71
Q

Inhibits sclerostin (protein which inhibits bone formation)

A

Romosozumab

72
Q

Evenity

A

Romosozumab

73
Q

Duration limited to 12 months

A

Romosozumab

74
Q

Treatment option if high risk of fracture

A

Parathyroid analogs

Denosumab

Romosozumab

75
Q

Increased risk of MI, stroke and death

A

Romosozumab

Naplex Drug Card (6 decks)

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