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Pharm II- Exam 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Osteoporosis is a bone disorder of….

A

low bone density

impaired bone architecture

compromised bone strength

increased fracture risk

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2
Q

Describe the progression of osteoporosis?

A

normal bone >

osteopenia >

osteoporosis >

severe osteoporosis

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3
Q

When to men and women start losing bone mass?

A

3rd or 4th decade because of reduce bone formation

men are at lower risk

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4
Q

Prevention of osteoporosis

A

bone healthy lifestyle

regular exercise, nutritious diet, tobacco avoidance, minimal alcohol use

fall prevention

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5
Q

Risk factors for osteoporosis ?

A

advancing age, previous fx, glucocorticoid therapy, family hx of hip fx, low body weight, smoking, excessive alcohol consumption, RA

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6
Q

What tools can you use to determine pts at high risk for fx?

A

FRAX tool

Garvan calculator

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7
Q

Dx standard for osteoporosis?

A

DXA (dual energy x-ray absorptiometry)

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8
Q

Dx of of osteoporosis is based on….

A

low trauma fx or

DXA using WHO T score thresholds

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9
Q

T score for osteopenia?

for osteoporosis?

A

-1 and -2.5

below -2.5

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10
Q

What are some antiresorptive therapies?

A
  • Ca
  • Vit D**
  • biphosphonates**
  • calcitonin
  • Estrogen agonists-antagonists
  • Estrogen
  • Testosterone
  • Teriparatide
  • Denosumab
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11
Q

At what age range do we need to most Ca and Vitamin D?

A

9-18 y/o

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12
Q

What are the 2 forms of calcium?

A

Calcium carbonate

Calcium citrate

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13
Q

ADEs of calcium carbonate?

A

Gas, upset stomach, bloating, constipation

Rare kidney stones

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14
Q

ADEs for both calcium carbonate and calcium citrate?

A

Hypophosphotemia

Hypercalciumia

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15
Q

When should you increase dose of Vit D3?

A

malabsorption

if also taking anticonvulsants

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16
Q

ADEs of Vit D3?

A

Hypercalcemia: cardiac rhythm disturbance, HA, weakness

Hypercalciuria

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17
Q

When is vitamin D2 (ergocalciferol) indicated?

A

for vitamin D deficiency

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18
Q

When is Vitamin D (calcitrol) indicated?

A

Renal osteodystrophy

Hypoparathyroidism

Refractory rickets

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19
Q

Examples of biphosphonates?

A

Alendronate

Ibandronate

Risedronate

IV Zoledronic Acid

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20
Q

IV and oral Ibandronate is indicated only for….

A

postmenopausal osteoporosis

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21
Q

MOA of biphosphonates?

A

Decreased osteoclast maturation, number, recruitment, bone adhesion and life span

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22
Q

What is the half life of biphosphonates?

A

up to 10 yrs, becomes incorporated in bones

23
Q

What is important about the admin of biphosphonates?

A

Administered in the morning on an empty stomach with 6–8 ounces of plain water. Do not eat and remain upright for at least 30 minutes following administration

(prevents esophageal damage)

24
Q

Which biphosphonate has a delayed release product that can be taken immediately after breakfast?

A

Risedronate

25
Q

Which biphosphonate is administered IV yearly?

A

Zoledronic acid

26
Q

Monitoring for pt taking biphosphonate?

A

generally 1-2 yrs after initiation then every 2+ yrs

27
Q

ADEs of biphosphonate?

A

PO: nausea, dyspepsia

IV: transient flu like sxs

rare: perforation, ulceration, GI bleeding, musculoskeletal pain, fx, ONJ

28
Q

What are some bone turnover markers?

A

Resorption markers: Type I collage degradation products, enzymes

Formation markers: matric proteins, enzymes

29
Q

Contraindications for biphosphonates?

A

Cr clearance < 30-35

Serous GI conditions: ex. achlasia, barrett’s esophagus

pregnancy

30
Q

What is ONJ?

A

osteonecrosis of the jaw
Subtrochanteric femoral fracture

BB warning: MC in pts with CA, chemo, radiation or high dose glucocorticoid therapy

31
Q

What is a “drug holiday”?

A

can stop drug therapy in women without evidence of low trauma fx, who have responded well to bisphophonate therapy and those with increasing T BMD

32
Q

What is calcitonin? Use?

A

Endogenous hormone released from the thyroid gland when serum calcium is elevated

3rd line tx for women who are at least 5 yrs past menopause, may help with bone pain

33
Q

How is calcitonin usually administered?

A

intranasally

34
Q

Examples of Estrogen Agonist/Antagonist and tissue selective estrogen complex? MOA?

A

Raloxifene

Bazedoxidene

decreases bone resorption, increasing bone mineral density and decreasing fracture incidence

35
Q

Bazedoxifene can be used in…

A

postmenopausal women with a uterus, no progestogen needed

36
Q

When is estrogen therapy used?

A

Short-term in women who need estrogen therapy for the management of menopausal symptoms as the risks of estrogen therapy outweigh the bone benefits.

37
Q

When is testosterone used?

A

Replacement of testosterone (male) or methyltestosterone (female) have demonstrated increases in BMD

38
Q

What is Teriparatide? Use?

A

Anabolic therapy, recombinant produce representing first 34 aa in human PTH

increase bone formation, remodeling rate and osteoblast number and activity

39
Q

Teriparatide may be indicated in….

A

postmenopausal women, men, and patients on glucocorticoids at high risk
Very low bone density T score < -3.5

40
Q

How is Teriparatide available?

A

as a prefilled “pen” delivery device

41
Q

What is Abaloparatide?

A

Synthetic analog of human parathyroid hormone (PTH) related peptide acting as an anabolic agent to stimulate bone formation

used for high risk postmenopausal osteoporosis

42
Q

MOA of Denosumab (RANKL Inhibitor)?

A

binds to RANKL on the surface of osteoclast precursor cells and mature osteoclasts

Inhibits osteoclatogenesis and increases osteoclast apoptosis

43
Q

ADEs of Denosumab?

A

back, extremity, and musculoskeletal pain

increased cholesterol, cystitis, decreased serum calcium, skin problems

44
Q

What are the 1st line osteoporosis treatments?

A

Alendronate

risedronate

zoledronic acid

denosumab

45
Q

Alternatives to first line therapy for osteoporosis?

A

Ibandronate, raloxifene, and teriparatide

46
Q

Last resort for osteoporosis?

A

Calcitonin

47
Q

What is a vertebroplasty/Kyphoplasty?

A

bone cement is injected into the fractured vertebral space

stablized damaged vertebrae and reduces pain

used in pts with debilitating pain after vertebral fracture

48
Q

ADEs of vertebroplasty/Kyphoplasty

A

cement leakage into the spinal column, which can result in complicating nerve damage, and vertebral fracturing around the cement

49
Q

What is osteomalacia?

A

“soft bones”

a condition seen in adults in which the bone is significantly undermineralized

50
Q

What is the childhood equivalent of osteomalacia?

A

rickets

51
Q

Causes of osteomalacia?

A

MCC = prolonged vitamin D deficiency

disorders that cause hypophosphatemia, rarely meds such as anticonvulsant therapy

52
Q

Consequences of osteomalacia?

A

pathologic fx and/or deep bone pain, proximal muscle weakness, low BMD

53
Q

Labs findings in pt with osteomalacia?

A

extremely low 25 (OH) vit D <10ml

+/- elevated bone specific alkaline phosphate and hypocalcemia

54
Q

Tx for osteomalacia?

A

high dose Vit D replacement therapy

-oral ergocalciferol

Pharm II- Exam 1 (6 decks)

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