Osteoporosis

Question 1

When is teriparatide CI?

Answer 1

Increased Ca2+ in urine or blood

Osteosarcoma

Question 2

What is Denosumab NOT intended for

Answer 2

OP PVT

or in premeno women

Question 3

Risedronate

Answer 3

PO Bisphosphonates
PVT/TXT of OP postmeno
Increase BMD in men
TXT GCS induced OP
Pagets Disease

Question 4

What are adverse effects of bisphosphonates?

Answer 4

GI issues (do not lie down for 30-60m)
Osteonecrosis of the jaw
Esophagitis/Cancer
Atypical fractures

Question 5

MC SEs to denosumab

Answer 5

Msk pain
Hypercholestrolemia
Cystitis

Question 6

What the CI of bisphosphonates?

Answer 6

CrCl <30ml/min
Hypocalcemia
Esophageal D/Os

Question 7

If someone stops taking ERT will they still have the protective bone benefits?

Answer 7

NO

Question 8

Raloxifene

Answer 8

SERM - Estrogen ag/antag depending on tissue

Question 9

Calcitonin Salmon

Answer 9

PTH antagonist inhibiting OC esp at vertebrae (analgesic) and femur causes decreases Ca2+

Question 10

Which chemical promotes OC activity

Answer 10

Calcitrol

Question 11

What routes are available for calcitonin?

Answer 11

(IN)(SQ)(IM)

Question 12

Raloxifene DIs

Answer 12

Bile acid resins
Warfarin
Thyroid hormones

Question 13

Calcitonin has what type of serious adverse effects?

Answer 13

Increased cancer rates

Question 14

Which bisphonates come in an PO formulation?

Answer 14

Alendronate (Daily/Wkly dosing PVT/TXT)
Risedronate (Daily/Wkly/Monthly dosing)
Ibandronate (PO) - (Monthly dosing)

Question 15

What are the CI for ERT?

Answer 15

Hx of VTE
Breast/endometiral cancer
unDX genital bleeding

Question 16

Conjugated Estrogen/Bazedoxifene

Answer 16

SERM

Question 17

What is 2nd line OP drug for GCS induced OP after bisphosphonate?

Answer 17

Teriparatide

Question 18

Which bisphosphonate only reduces vertebral fractures?

Answer 18

Ibandronate

Question 19

What two drugs are reserved for high risk fractures past bisophosphantes?

Answer 19

Denosumab and Teriparatide

Question 20

Which bisphosphonate is indicated for metastatic bone disease

Answer 20

Zoledronic acid

Question 21

What lifestyle mods can someone with OP make?

Answer 21

Supplementation
Weight bearing exercise
No smoking/limit ETOH
Avoid excess GCS

Question 22

What should someone take with a bisphosphonate?

Answer 22

A 8oz glass of water

Question 23

MOA - intermittent admin of human PTH analog stimulates bone formation

Answer 23

Teriparatide (SQ)

Question 24

Ibandronate

Answer 24

(PO/IV) Bisphosphonates
PVT/TXT OP
Only reduces vertebral fxs

Question 25

MOA- selectively binds to anti-resoprtive surfaces incorporating into bone

Answer 25

Bisphosphonates (Decreased OC activity)

Question 26

What are 2 SERM drugs for OP

Answer 26

Raloxifene / Bazedoxifene/Conjugated Estg

Question 27

Serious SE's to denosumab

Answer 27

Hypocalcemia Jaw necrosis Infection due to supresses immune sys Dermtological issues

Question 28

Teriparatide

Answer 28

(SQ) PTH analog (1-34aa)

Question 29

How long is bisphosphonates T1/2?

Answer 29

Up to 10 year half life

Question 30

Which bisphonates come in an IV formulation?

Answer 30

``` Ibandronate (3 month dosing - postmeno) Zoledronic acid (yearly dose) ```

Question 31

What are the indicated uses for Raloxifene?

Answer 31

PVT/TXT OP in postmeno w/ high risk of breast cancer postmeno who cant take bisphosphonates or concerned about bisphosphonate safety

Question 32

Raloxifene CIs

Answer 32

Hx of VTE If hip fracture is primary concern Premeno women/pregnancy (teratogen)

Question 33

What should be corrected before initiating bisphosphonate therapy?

Answer 33

Vit-d and mineral deficits 1st

Question 34

Which is Calcitonin route is better for common side effects?

Answer 34

``` IN - less nausea/flushing Calcitonin Salmon (miacalcin) ```

Question 35

MOA - Monoclonal AB binds to RANK ligand inhibiting OC

Answer 35

Denosumab (SQ)

Question 36

How long should bisphosphonate TXT last at least?

Answer 36

5 years

Question 37

What is the primary actions of Calcitonin?

Answer 37

Vertebral and femoral sites

Question 38

Denosumab

Answer 38

Monoclonal antibody antibody binds RANK ligand inhibiting OC activity

Question 39

What is naturally secreted by the thyroid?

Answer 39

Calcitonin

Question 40

What are teriparatide use indications

Answer 40

High risk fractures CI bisphosphonates GCS induced OP

Question 41

Which bisphosphonate is not indicated for pagets disease?

Answer 41

Ibandronate

Question 42

Which OP drug is indicated for androgen depravation?

Answer 42

Denosumab

Question 43

What is 1st line in most OP pts?

Answer 43

Bisphosphonates

Question 44

Zoledronic acid

Answer 44

``` (IV) Bisphosphonates (Metastatic bone DZ) PVT/TXT of OP postmeno Increase BMD in men TXT GCS induced OP Pagets Disease ```

Question 45

When is Denosumab ok for initial therapy?

Answer 45

Pt is at high risk of fracture and Bisphosphonates are CI (renal dysfx/PO)

Question 46

What is the maximum timeframe to use teriparatide?

Answer 46

2 years max (cancer risk)

Question 47

Which drug may have an analgesic effect with vertebral fractures?

Answer 47

Calcitonin

Question 48

What are the FDA indications for calcionin?

Answer 48

TXT of OP >5yr postmeno Hypercalcemia Pagets disease

Question 49

What dosing should be considered for Estrogen replacement therapy in a postmenopausal woman?

Answer 49

Lowest dose possible-lowers vasomotor S/S

Question 50

How long should someone wait before taking meds, food, drink after taking bisphosphonate?

Answer 50

30m | Ibandronate - 60m

Question 51

Recommended dietary supplements for OP

Answer 51

Calcium - 1200mg/D | Vit-D 800IU/D

Question 52

Which OP drugs promote OB activity

Answer 52

Teriparatides

Question 53

Alendronate

Answer 53

``` (PO) Bisphosphonates PVT/TXT of OP postmeno Increase BMD in men TXT GCS induced OP Pagets Disease ```

Question 54

MOA - Inhibits OC by antag PTH

Answer 54

Calcitonin