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Pharmacology-Exam #1 (Summer) > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Age-Related osteoporosis results from deficiencies in what? Overall result?

A

Deficiency in:

  1. Hormone (estrogen)
  2. Calcium
  3. Vitamin D

*Leads to accelerated bone turnover and reduced osteoblast formation

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2
Q

List the Drugs Induced Osteoporosis

A
  1. Steroids
  2. Antiseizure: Phenytoin, Phenobarbital
  3. Thyroid hormone replacement
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3
Q

RF’s for Osteoporosis

A
  1. Advancing age
  2. Previous Fx
  3. Glucocorticoid therapy
  4. Low body weight
  5. Current Cigarette smoking
  6. Excessive alcohol
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4
Q

What is the diagnostic standard for Osteoporosis?

A

DXA: Dual Energy X-ray Absorptiometry

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5
Q

The dx of osteoporosis is based on what?

A
  • Low trauma fracture

- Central hip/spine DXA using WHO T-score thresholds

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6
Q

Dx of osteoporosis in postmenopausal women, perimenopausal women, and men >50 is based off what?

A

T score at or below -2.5

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7
Q

Dx of osteoporosis in children, premenopausal women, and men under 50 is based off what?

A

Z score at or below -2.0 + other RF’s or Fx’s

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8
Q

Define Osteopenia

A

Low bone mass

T score between -1 and -2.5

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9
Q

List the antiresorptive therapies of choice

A
  1. Calcium
  2. Vitamin D
  3. Biophosphonates
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10
Q

What age group is the recommended dietary allowances (RDA) the highest for calcium? Amount recommended?

A

9-18 y.o

1,300-3,000 mg

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11
Q

What age group is the recommended dietary allowances (RDA) the SECOND highest for calcium? Amount recommended?

A

51-70 y.o.
1,000-2,000: Men
1,200-2,000: Women

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12
Q

What are the two basic forms of calcium?

A
  1. Calcium Carbonate

2. Calcium Citrate

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13
Q

ADE’s of BOTH Calcium forms

A
  1. Hypophosphatemia

2. Hypercalciumia

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14
Q

Calcium Carbonate ADE’s

A
  1. GI upset
  2. Gas/Bloating
  3. Constipation
  4. Kidney stones (rare)
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15
Q

Vitamin D3: Cholecalciferol ADE’s

A
  1. Hypercalcemia: Cardiac rhythm disturbances, HA, weakness

2. Hypercalcuria

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16
Q

When would you increase the dose of Vitamin D3: Cholecalciferol?

A
  1. Malabsorption

2. Anticonvulsants: Carbamazepine, Phenobarbital, Phenytoin

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17
Q

What is Cholecalciferol converted to in the liver?

A

25 (OH) Vitamin D

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18
Q

What is Cholecalciferol converted to in the kidneys?

A

1, 25 (OH) Vitamin D

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19
Q

Indications ofr Vitamin D2: Ergocalciferol?

A

Vitamin D deficiency

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20
Q

Indications for 1, 25 (OH) Vitamin D: Calcitrol

A
  1. Renal osteodystrophy
  2. Hypoparathyroidism
  3. Refractory Rickets
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21
Q

Biophosphonates have been FDA indicated in what groups?

A
  1. Postmenopausal females
  2. Males
  3. Glucocorticoid-induced osteoporosis
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22
Q

What Biophosphonate is indicated ONLY for postmenopausal osteoporosis?

A

Ibandronate: IV or Oral

23
Q

Which Biophosphonate is 1st line treatment?

A

Alendronate

24
Q

Which is the only Biophosphonates you must you drink 6 oz. of plan water 60 minutes (others are 30 minutes) prior to any food/meds?

A

Ibandronate

25
Q

Which Biophosphonates must you remain upright for 30 minutes after administration?

A

Alendronate

Risedronate

26
Q

Which Biophosphonate must you remain upright for 1 hour after administration?

A

Ibandronate

27
Q

What are common Biophosphonate ADE’s (Oral)?

A

Nausea

Dyspepsia

28
Q

What are common Biophosphonate ADE’s (IV)?

A

Transient flu-like illness

29
Q

What are RARE Biophosphonate ADE’s

A
  1. Perforation
  2. Ulceration
  3. GI bleeding
  4. Musculoskeletal pain
30
Q

Biophosphonate CI’s?

A
  1. Creatinine clearance < 30-35ml/min
  2. Serious GI conditions: esophagus abnormalities, delaying emptying-stricture or achalasia, esophageal varices, Barrett’s esophagus
  3. Pregnancy
31
Q

Biophosphonate Black Box warnings

A
  1. Osteonecrosis of jaw: ONJ

2. Subtrochanteric femoral fx’s: Atypical fx’s

32
Q

Who does ONJ and Atpical Fx’s MCly occur in?

A
  1. CA pt’s
  2. Chemotherapy/Radiation
  3. Glucocorticoid therapy

Receiving higher doses IV biophosphonate therapy

33
Q

Define “Drug Holiday”

A
  • Pt’s are taken off their bisphosphonate therapy

- Followed serially w/ bone turnover markers and central DXA BMD

34
Q

Who can be considered for “Drug Holiday” therapy?

A
  1. No hx of low-trauma fracture 2. Have responded well to Bisphosphonate therapy (approx. 5 years)
  2. T-score > –2
35
Q

When would you consider using Calcitonin?

A

For possible pain relief in acute vertebral fx’s in women are @ least 5 years postmenopausal
Administered nasally
Last resort treatment

36
Q

List the Mixed Estrogen Agonist/Antagonists (SERMs)

A

Raloxifene and Bazedoxifene

37
Q

MOA/Result of Raloxifene and Bazedoxifene

A
  • Decreases bone resorption
  • Increasing bone mineral density
  • Decreasing fracture incidence
38
Q

Estrogen therapy indication

A

Short-term therapy

Management of menopausal sx’s

39
Q

What does testosterone replacement increase?

A

BMD

BUT no date on fx prevention

40
Q

List Anabolic therapy

A

Teriparatide

41
Q

Teriparatide (anabolic therapy) MOA. How is it administered?

A

Recombinant product representing the first 34 amino acids in human PTH
SubQ injection

42
Q

Teriparatide (anabolic therapy) Clinical Indications

A

Very low bone density T score < -3.5 in:

  1. Postmenopausal women
  2. Men
  3. Patients on glucocorticoids at high risk
43
Q

What drug was FDA approved in June 2017 for the treatment of high risk postmenopausal osteoporosis? What is it?

A

Abaloparatide (Tymols): Synthetic Anaol of PTH, Anabolic Agent

44
Q

What have been the active trial results of Abaloparatide?

A
  • Decreased new vertebral & non vertebral fx’s

- Increased BMD

45
Q

What should you consider starting when you discontinue Abaloparatide?

A

Antiresorptive tx to protect against bone loss

46
Q

RANKL inhibitor: Denosumab MOA

A

Inhibits osteoclatogenesis

Increases osteoclast apoptosis

47
Q

RANKL inhibitor: Denosumab ADE’s

A
  1. Back, extremity, and musculoskeletal pain
  2. Increased cholesterol
  3. Cystitis
  4. Decreased serum Ca++
48
Q

In general, what is considered 1st line Osteoporosis Tx? Why?

A 
1. Biophosphonates:
Alendronate
Risedronate
Zoledronic acid
2. Denosumab: RANKL Inhibitor

Decrease vertebral, nonvertebral fractures and hip fx’s

49
Q

What is a vertebroplasty & Kyphoplasty? Results?

A

Bone cement injected into fractured vertebral space

Reduces pain in 70-95%

50
Q

Concerns with vertebroplasty & Kyphoplasty?

A

Cement leakage into spinal column: Nerve damage and vertebral fracturing around cement

51
Q

Define Osteomalacia

A

“Soft bones”

Significant under mineralized bones seen in adults

52
Q

What is the MC cause of Osteomalacia

A

Long-standing Vitamin D deficiency

53
Q

Osteomalacia presentation

A
  1. Pathologic fx’s
  2. Deep bone pain
  3. Proximal muscle weakness
  4. Low BMD
54
Q

Osteomalacia Treatment

A

High dose Vitamin D replacement therapy: oral ergocalciferol + Chronic Vitamin D maintenance

Pharmacology-Exam #1 (Summer) (6 decks)

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