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Pharm 3 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Osteoporosis Therapy Classes

A

Bisphosphonates
RANK Ligand Inhibitor
Sclerotin Inhibitor
Parathyroid Hormone Analogs
Calcitonin
Tissue-specific Estrogen Complex
Selective Estrogen Receptor Modulators/Estrogens (SERMs)

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2
Q

What are necessary for bone homeostasis

A

calcium and vitamin D
(Vitamin D increases calcium absorption)

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3
Q

Best way to manage osteoporosis

A

Prevention!

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4
Q

Can Ca and Vit D prevent fractures

A

not sure, controversial

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5
Q

What forms of Vit D should u recommend

A

D2 (ergocalciferol) or D3 (cholecalciferol)

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6
Q

How to get intake of Calcium

A

1 is dairy products; ingesting Ca foods or fortified foods

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7
Q

How to get intake of Vit D

A

Sunlight, diet, and supplements, Fish, eggs, and fortified dairy

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8
Q

AE of Calcium Supplements

A

constipation and kidney stone formation

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9
Q

Drug interactions of calcium supplementation

A

PPIs and Histamine Type 2 receptor antagonists

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10
Q

Ca dosing recommendations

A

Women <50yoa and men 50-70yoa à 1000mg calcium daily (food + supplements)

Women >51yoa and men >71yoa à 1200mg of calcium daily (food + supplements)

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11
Q

Options for Ca supplementation

A

Ca Carbonate or Calcium citrate

More detail:
Carbonate: 40% elemental calcium, less expensive, taken with meals- needs acid to be absorbed
Citrate: 21% elemental calcium, acid-independent absorption- does not need to be taken with meals

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12
Q

What options for Ca supplements do you want to avoid

A

Unrefined oyster shells or coral calcium –> can have high levels of lead and heavy metals

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13
Q

Tolerable Upper Intake Level (UL) for Ca and Vit D for ages 19-50

A

2,500 for Ca
4,000 for Vit D

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14
Q

Tolerable Upper Intake Level (UL) for Ca and Vit D for ages 51+

A

2,000 for Ca
4,000 for Vit D

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15
Q

What should you be careful of w dosing of Ca and Vit D and what is less of a concern?

A

hypercalcemia and kidney stones

Not as worried about MI

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16
Q

Best way to increase calcium and max limit

A

Dietary calcium
Not above 1500 mg/day

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17
Q

Women 51+ yo should consume how much Ca

A

1200 mg/day

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18
Q

What are we trying to balance w Osteoporosis

A

Inhibition of osteoclasts and increasing osteoblast activity

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19
Q

Big Meds as RF for Osteoporosis

A

PPI and Corticosteroids

**not on exam but figured good as quick refresher!

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20
Q

Bisphosphonates: Name Ending

A

-Onates

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21
Q

Bisphosphonates MOA

A

Bind to active sites of bone remodeling –> decrease bone resorption and inhibit osteoclasts

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22
Q

all Bisphosphonates have poor what?

A

Oral bioavailability

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23
Q

What Bisphosphonates can be given to both men and women

A

Alendronate (Fosamax, Binosto) Risedronate (Actonel), Zolendronic Acid (Reclast)

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24
Q

What Bisphosphonates can only be given to females?

A

Ibandronate (Boniva), Risedronate (Atelvia)

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25
Q

Which bisphosphonate has same generic name but different brand names that are different for sexes?

A

Risedronate

Risedronate (Atelvia) –> females only
Risedronate (Actonel) –> females and males

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26
Q

Which bisphosphonates are IV?

A

ibandronate and zoledronic acid

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27
Q

Bisphosphonates AE

A

Osteonecrosis of the Jaw**

Others: hypoCa, fragility fractures, esophageal cancer, atrial arrythmias

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28
Q

What pts can we not give Bisphosphonates

A

renal insufficiency (primary mode of elimination)
Hypocalcemia, oral prep in pts not upright or swallowing disorder

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29
Q

Patient Education for Bisphosphonates

A

Take first thing in the AM with PLAIN water

Remain upright for at least 30 min to reduce GI SE and acid reflux

30
Q

what happens if pt stops Bisphosphonates

A

drug(s) have residual benefits after discontinuation –> will continue to monitor pt bone density

31
Q

RANK ligand inhibitor name

A

Denosumab (Prolia)

32
Q

Denosumab (Prolia) MOA

A

Human monoclonal antibody that inhibits osteoclast formation and reduces bone resorption

33
Q

Denosumab (Prolia) Indications

A

tx of osteoporosis and bone mets in males AND females

34
Q

Denosumab (Prolia) is given how

A

subQ injection

35
Q

are Denosumab (Prolia) effects reversible?

A

Yes
Bone mineral density declines to pre-tx levels w/in 2 years of discontinuation and increases bone turnover w/in 3 m of discontinuation

36
Q

Denosumab (Prolia) AE

A

*Rash, dermatitis
*Infections
*Upper GI symptoms
*Hypocalcemia

37
Q

What pts should be not give Prolia to

A

hypocalcemic

38
Q

when should we give Prolia

A

Reserved for patients unresponsive to or unable to tolerate bisphosphonates
AND
*Patients receiving androgen deprivation therapy for prostate cancer
*Patients receiving aromatase inhibitor for breast cancer

39
Q

what tx for osteoporosis is no longer 1st line prevention

A

Estrogen Therapy

40
Q

what does estrogen therapy increase the risk of

A

*Increased risk of CVA, clots, and breast cancer
*Long-term estrogen increases risk of ovarian cancer

41
Q

what kind of formulations does estrogen therapy come in

A

*Many formulations and dosage forms approved for prevention
*Including estrogen + progestin products

42
Q

estrogen therapy stats that is helps w
(not sure how in depth we need to know so added it all!)

A

Treatment in 10k women for 1 year with estrogen + progestin prevents 6 hip and 6 vertebral fractures
*8 more cases of breast cancer
*9 more strokes
*12 more cases of DVT
Treatment in 10k women for 1 year with estrogen alone prevents 7 hip and 6 vertebral fractures
*11 more strokes
*7 more cases of DVT

43
Q

When to avoid estrogen therapy

A

*History of stroke
*History of coronary events
*History of thromboembolism
*Breast cancer

44
Q

When to consider estrogen therapy

A

prematurely menopausal women (<50 years old) or if symptomatic

45
Q

Selective Estrogen Receptor Modulator (SERMs): Name

A

*Raloxifene

46
Q

Raloxifene MOA

A

acts like estrogen on bone
AND
estrogen antagonist in uterus and breast

47
Q

Raloxifene is approved tx for what

A

osteoporosis

48
Q

Raloxifene AE

A

*Hot flashes
*Leg cramps
*Peripheral edema
*Thromboembolic events

49
Q

When to avoid Raloxifene

A

*History of stroke
History of thromboembolic events (Boxed warning)**
*Hypertriglyceridemia
*History of breast cancer
*High risk for hip fracture

50
Q

Raloxifene is contraindicated in what pt population? not indicated?

A

Contra: pregnancy and hx of or current thromboembolic disorde

Not indicated: Not indicated or recommended for for premenopausal women

51
Q

Raloxifene is useful in what pt population besides osteoporosis

A

women at high risk of breast cancer (but does not eliminate risk)

52
Q

*Extra Flashcard: Parathyroid Hormone Analogs Names

A

teriparatide (Forteo®) and abaloparatide (Tymlos®)

AND are $$$

53
Q

Calcitonin Drug Names

A

Miacalcin®, Fortical®

54
Q

Calcitonin MOA

A

Peptide hormone that binds to osteoclasts and inhibits bone resorption

May have analgesic effect

55
Q

Calcitonin is more derived from what source

A

Salmon; more potent than mammalian

56
Q

Calcitonin routes

A

IM, SQ, intranasal

57
Q

Calcitonin AE

A

*Nausea and flushing with injection
*Runny nose and epistaxis with nasal spray

58
Q

when to give calcitonin

A

Reserved for postmenopausal women who are postmenopausal by at least 5 years
*Who are unable to tolerate bisphosphonates
*AND have bone pain from compression fractures

59
Q

who not to give calcitonin to

A

High risk of hip fractures

60
Q

what does calcitonin reduce fracture risk of

A

small increase in vertebral bone mineral density with a slightly reduced risk of vertebral fractures

61
Q

Reminder to look at green table for fracture site prophylaxis (this was more for reference)

A

Reminder to look at green table for fracture site prophylaxis (this was more for reference)

62
Q

OTC supplements for bone health

A

*Glucosamine
*Chondroitin
*MSM (methylsulfonylmethane)
*SAMe (S-adenosy-L-methionine)
*Natural anti-inflammatory compounds
*Turmeric
*Ginger
*Boswellia

63
Q

how often do you assess BMD for osteoporotic pts

A

every 2-3 years

64
Q

Drug holiday timeline if not at high risk of fracture

A

3-5 years (found in notes of her pwpt)

65
Q

Duration of therapy guidelines for Osteoporosis drugs are set by

A

American Association of Clinical Endocrinologists (AACE)

66
Q

Drug Holiday time lines for bisphosphonates

A

*Bisphosphonate drug holidays (consider if condition stable)
*Moderate risk—5 years; (IV zoledronic acid - 3 annual doses)
*High risk— 6-10 years; (IV zoledronic acid - 6 annual doses)

67
Q

What osteoporosis drug should NOT have a drug holiday

A

Denosumab (Prolia)

68
Q

Reminder to Look at Duration of Therapy Flow Chart (slide 38)

A

Reminder to Look at Duration of Therapy Flow Chart (slide 38)

69
Q

What type of fracture are all mentioned osteoporosis drugs good at preventing

A

vertebral

70
Q

What drugs are good at preventing wrist fractures

A

Alendronate and Risendronate

Pharm 3 (10 decks)

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