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*OldPharm > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

what maintains serum calcium?

A

Parathyroid hormone

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2
Q

what organ does PTH act on to reabsorb calcium from the tubular filtrate?

A

kidney

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3
Q

PTH stimulates kidney to convert 25-OH-VitD to what?

A

1,25-(oh)2-VitD (calcitriol)

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4
Q

what is the endogenous (skin) form of vitamin D?

A

cholecalciferol (Vit D3)

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5
Q

What is the exogenous (diet) form of Vit D?

A

ergocalciferol (Vit D2)

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6
Q

this comes from the thyroid gland and is released in response to really high serum calcium levels.

A

Calcitonin

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7
Q

1 to 2.5 standard deviations below bone mass of a normal young adult

A

Osteopenia

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8
Q

It is 2.5 or more standard deviations below the bone mass of a normal young

A

Osteoporosis

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9
Q

What form of osteoporosis occurs in older people (usually >70), postmenopausal women

A

primary osteoporosis.

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10
Q

Type of osteoporosis that occurs in people with hyperthyroidism, steroid use, chronic kidney disease, smoking, excessive ETOH

A

secondary osteoporosis

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11
Q

does excess or too little protein in the diet lead to osteoporosis.

A

excess

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12
Q

what are some modifiable risk factors for osteoporosis

A 
Inadequate calcium and Vit D
Alochol use
sedentary
carbonated drinks
smoking
anorexia
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13
Q

what drugs used long term can lead to osteoporosis?

A 
heparin
lithium
anticonvulsants
thiazolidinediones 
aluminum
cytotoxic drugs
immunosuppressnats
TPN
GnRH agonists
progesterone
tamoxifen
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14
Q

What are Gonadotropin-releasing hormone agonist used for?

A

Polycystic Ovarian Syndrome

helps patients have normal cycles

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15
Q

who should be tested for osteoporosis?

A

All women >65 ( >60 w/ risk factors)

men >70 (>50 w/ risk factors)

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16
Q

Only calciums in IV preparation

A 
Calcium gluconate (replacement) 
Calcium chloride (code)
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17
Q

What calcium are available in PO form?

A

calcium gluconate
calcium carbonate (tums)
calcium lactate
calcium citrate

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18
Q

what type of calcium is also available in liquid form?

A

Calcium citrate

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19
Q

Indications for calcium

A

Hypocalcemia
calcium deficiency
osteoporosis or osteopenia

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20
Q

ADRs with calcium

A

GI problems
constipation
bradycardia
arrhythmias

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21
Q

what should be monitored anytime calcium is given IV?

A

monitor serum calcium levels every 6 hours

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22
Q

Inactive form of vit D (required liver and kidneys to convert)

A

ergocalciferol

23
Q

what is the active form of Vit D?

A

calcitriol

24
Q

MOA of Vit D?

A

acts on the gut to absorb calcium from the diet

25
Q

Routes available for Vit D?

A

Oral
IV
UV reaction in skin

26
Q

Indications for Vit D replacement

A

Hypocalcemia
Vit D deficiency
Postmenopausal osteoporosis
renal failure

27
Q

Expensive drug, recombinant paraythroid hormone that stimulates osteoblastic activity

A

Teriparatide

28
Q

When is teriparatide only used?

A

Hx of osteoporotic fractures

multiple risk factors and failed/ intolerant to other therapies

29
Q

ROA of teriparatide

A

20 mcg SubQ qday

30
Q

C/I with teriparatide

A

Paget’s dz
increased alkaline phosphatase
h/o radiation treatment

31
Q

ADRs w/ teriparatide

A

dizziness, leg cramps

Transient increase in serum calcium

32
Q

black box warning w/ teriparatide

A

osteosarcoma

33
Q

what are Structural analogs of pyrophosphate

A

bisphosphonates

34
Q

MOA of bisphosphonates?

A

MOA: works by inhibiting bone resorption via:
Inhibits osteoclastic proton pump necessary for dissolution of hydroxyapatite
Decreased osteoclastic formation/activation
Increased osteoclastic apoptosis

35
Q

bisphosphonates that are avaliable PO

A

alendronate (once a week)
risedronate (once a week)
ibadronate (once a month)

36
Q

What bisphosphonates are given IV?

A

zoledronic acid (hypercalcemia of malignancy)

37
Q

PO bisphosphonates should be administered how?

A

With a full glass of water
30 minutes before a meal
remain upright for 30 minutes

38
Q

C/I w/ bisphosphonates

A

renal impairment/ hypocalciemia

CrCl < 30-35 ml/min

39
Q

what is a potential problem w/ the PO form of bisphosphonates

A

esophageal erosion

40
Q

ADRs w/ IV form of bisphosphonates

A

Acute phase reactions (N/V, HA, myalgias, flue like symptoms)

41
Q

works to increase mineral stores in bone, decreases activity of osteoclasts (and number) and acts in kidney. Found in salmon. increases spine BMD, bone architecture

A

calcitonin

42
Q

ROA of calcitonin

A

intranasal

SubQ

43
Q

what is calcitonin used for?

A

Hypercalcemia
Paget’s dz of the bone
bone pain in metastatic dz
bone pain in osteoporosis

44
Q

ADRs of calcitonin

A

tingling in hands
N/V
flushing

45
Q

Advnatages of calcitonin nasal spray

A

don’t have to remain upright

don’t have to avoid eating

46
Q

disadvantages of calcitonin nasal spray

A

Is not as good at rebuilding bone
Must remember which nare medication was placed previous day.
Tolerance with continued use
Must keep refrigerated

47
Q

Acts like an estrogen in the bone, but estrogen antagonists in the breast and uterus. Decrease serum LDL and decreases vertebral fractures

A

Raloxifene

48
Q

When to use raloxifene

A

1st line if patient postmenopausal and contraindication to bisphosphonates

49
Q

ADRs with raloxifene

A

Chest pain and peripheral edema
3x risk for thromboembolism and PE
hot flashes, weight gain

50
Q

What is a 4th line treatment for osteoporosis

A

estrogen

51
Q

disadvantages of estrogen

A

increases risk of breast cancer
need to give w/ progesterone if intact uterus
increased risk of thromboembolitic events

52
Q

monoclonal antibody that slows bone breakdown and remodeling, is costly

A

Denosumab

53
Q

who is Denosumab approved for?

A

Postmenopausal women with osteoporosis and high risk of fracture
Patients with osteoporosis for whom other osteoporosis treatments have failed.
Patients who cannot tolerate other osteoporosis treatments

54
Q

ADRs of denosumab

A 
decrease Ca levels
back and extremity pain
muscle and bone pain
high cholesterol levels
bladder infections

*OldPharm (12 decks)

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