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Pharm 2 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

t score

A

T -1 or higher = Normal

T -2.5 to -1 = Osteopenia

T below -2.5 = Osteoporosis

T below -2.5 + bone fragility/ fracture risks = Severe osteoporosis

  • t score shows where the patient is compared to the population
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2
Q

osteoporosis prevention considerations

A 
Calcium
Vitamin D
Magnesium
Strontium
Bisphosphonates
SERMs - selective estrogen-receptor modulators
Synthetic calcitonin hormone 
PTH analogs 
Estrogen
Monoclonal antibodies/Anti-RANK Ab
Calcium Supplementation
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3
Q

vitamin D

A
  • nec, for absorption of ca2+ in the GI tract and maintaining adequate ca2+ and phos livels in serum= normal bone mineralization
  • must undergo 2 hydroxylatios inthe body for activation
    1. liver converts D to 5-hydroxyvit d( calcidiol)
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4
Q

Calcitriol

A

prescription form of vitamin D that can increase bone mass and decrease rate of spinal fracture

however it increases serum calcium therefor this needs to be monitored

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5
Q

magnesium

A

can assist with diminished bone loss when taken in conjunction with vit D and calcium

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6
Q

strontium

A

body absorbs as if it where calcium and acts to improve osteoblastic activity

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7
Q

strontium and ranelic acid

A

aid bone growth increase bone density and lessen vertebral, peripheral, and hip fractures

generally safe and free of SE

Excess intake can cause bone weakening

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8
Q

what are the two different effects strontium has on bone?

A
  1. it is incorportated in small amount into the hydroxyapatite crystal lattice, where it remains bound for years or decades
  2. absorbed into the surface of hydroxyapatite crystals, the probable site at which they stimulate bone formation, inhibit resorption and increase BMD
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9
Q

what 2 drugs are approved for tx in both men and women with glucocorticoid induced osteoporosis

A

Alendronate

Risedronate

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10
Q

raloxifene (evista)

A

selective estrogen receptor modulator which has been approved for both the prevention and treatment

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11
Q

calcitonin ( mialcin)

A

used for tx but not yet approved for prevention

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12
Q

teriparatide

A

synthetic PTH analogue

tx of postmenopausal osteoporosis and in high risk men

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13
Q

Estorgen/hormone replacement therapy

A

approved for prevention of porstmenopausal osteoporosis

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14
Q

denosumab

A

human monoclonal antibodiy used for TX

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15
Q

Bisphosphonates

A
  • inhibit osteoclasts- induces apoptosis
  • have 2 phosphonare groups symilar to pyrophosphate

-reduce fractures in those who have had fractures in the past ( not those who have not)

Se: upset stomach, inflammation and erosion of esophagus 9 prevent by remaining standing)

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16
Q

what are the uses of bisphosphonates

A

osteoporosis

osteitis deformans ( paget's)
bone metastasis

multiple myloma
primary hyperparathyroidism

osteogenisis imperfecta

17
Q

Alendronatw/ fosamax

A

Class: Bisphosphonates

Indication: Prevention and treatment of osteoporosis

MOA: Inhibition of osteoclast activity

Char: PO. Once daily. Instructions for taking Alendronate are noted under side effects.

18
Q

Raloxifene/ Evista

A
  • SERM (selective estrogen-receptor modulator)
  • moa:Binds select estrogen R sites – maintains beneficial estrogenic activity on bone & lipids, & anti-estrogenic activity on endometrial & breast tissue
  • se:Hot flashes, arthralgia, myalgia, edema, pruritis, small but definite increased risk for DVT

I: Increases bone mass & reduces risk of vertebral fx
Significantly reduces incidence of breast CA

PO, 1x/day

CI: pregnancy/lactation, active/past hx DVT/PE/retinal vein thrombosis

19
Q

Calcitonin/ Miacalcin

A
  • Synthetic hormone
  • Inhibits osteoclastic activity

SE:Nasal spray: nose bleeds, sinusitis

HA, dizziness, edema, anorexia, diarrhea, skin rash

I: Osteoporosis tx (not prevention)

Nasal spray, IV

20
Q

Teraparatide/ Forteo

A
  • PTH analog
  • Activates bone turnover w/ osteoblasts activated much more than osteoclasts
    Stimulates bone formation in both spine & hip

-Se:Nausea, leg cramps, dizziness

I: postmenopausal women & men with osteoporosis at high risk for having fx – reduces risk of vertebral & non-vertebral fx in postmenopausal women

SQ, 1x/day – can be used for up to 24 months

21
Q

Denosumab/ Prolia

A
  • Human mAb ,Alpha-TNF agent
  • Targets RANKL (protein that acts as primary signal to promote bone removal) – inhibits maturation of osteoclasts, protecting bone from degradation

Se:Increased susceptibility to infection
URI, UTI, cataracts, constipation, rash, joint pain

One study: slight increased risk of CA & severe infections, but not statistically significant

I: osteoporosis (tx), bone mets, RA, multiple myeloma, giant cell tumors of bone

SQ, 1x/6 months

Pharm 2 (16 decks)

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