OSTEOPOROSIS

Question 1

EViSTA

Answer 1

Raloxifene (SERM)

60mg QD

Use: usually osteoporosis w/ need for breast cancer ppx

SE: hot flashes, leg cramps, VTE, > TGC

Question 2

Bisphosphonates

Answer 2

MOA: inhibit osteoclast bone resorption

Notes: stay in bones for years. Recommend drug holiday

PO- 5 yrs
IV - 3 yrs

SE: GI, GERD, ULCERS, HYPOCALCEMIA**

• OSTEONECROSIS OF JAW*
  
  • chlorhexidine rinse

STAND UP RIGHT, MAJORITY TAKEN ON AN EMPTY STOMAHE

CAUTION: ** < Ca+, CKD, inability to sit upright

Question 3

FosaMAX

Answer 3

ALENdronate

5-10mg QD & 35-70mg WEEKLY

1) Osteoporosis in post-men females (ppx $ trtment)
2) Osteoporosis in males
3) Osteoporosis 2nd to glucocorticoids
4) Paget’s disease

Caution: CrCl < 35 : NO

Question 4

BiNOSTO

Answer 4

ALENdronate 70mg

EFFERVESCENT TABS

Dissolve in water

Question 5

AcTONEL

Answer 5

RISEdronate

Forms: QD - WEEKLY- MONTHLY

Indications: same as AlenDronate

Question 6

AtelVIA

Answer 6

RISEdronate DELAYED RELEASE

ONLY ONE THAT CAN BE TAKEN W/ FOOD

QWEEKLY ONLY

AFTER BREAKFAST

Question 7

Boniva

Answer 7

iBandronate

Forms: ORAL (150mg Q MONTHLY) upright for 60 minutes. SEPERATE FROM CA2+

          IV - Q 3 MONTHS

Caution: CrCl < 30
HYPOCALCEMIA

SE: GI, muscle & joint pain,< Ca2+

Question 8

Reclast

Answer 8

Zoledronic acid (IV ONLY)

5mg
Indicated: Osteoporosis TREATMENT
One IV infusion YEARLY

              Osteoporosis PREVENTION
                ONE IV infusion BI-YEARLY

Caution CrCl < 30

Question 9

ZOMETA

Answer 9

Zoledronic acid (4mg)

• Hypercalcemia of malignancy
• Multiple myeloma

Dose:

1) Hypercalcemia 4mg
2) Multiple myeloma and metastatic bone lesions
4mg IV over 15 minutes every 3-4 weeks

CrCl > 60mL/min 4mg
CrCl < 60mL/min Dose adjust
CrCl < 30mL/min

Question 10

AreDIA

Answer 10

Pamidronate IV ONLY

• Hypercalcemia
• Osteolytic bone lesions assoc w/ breast cancer
• Paget’s disease

Dose: IV 30-90mg Q3-4 weeks

Side effects: fever, electrolyte depletion, a-fib, tahycardia, HTN, ONJ

Question 11

Prolia, Xgeva (SQ)

Answer 11

DenosUMAB (SQ)

MOA: Human igG2 monoclonal AB which inhibits or rather binds to RANK ligand (RANKL), and prevents osteoclast formation

Contraindications: hypocalcemia**

Precautions: HypocalcemiA
Serious infections
Dermatological rxns
Osteonecrosis of the jaw**

SE: back, extremity, musculoskeletal pain, hypercholesterolemia, HTN.

Question 12

Prolia

Answer 12

Denosumab

Indication: treatment of postmenopausal women and men with osteoporosis at high risk of fractures

Prefilled 60mg/mL syringe

Dosage: 60mg SQ once every 6 MONTHS

REFRIGERATED

Question 13

Xgeva

Answer 13

Denosumab

IndicAtion:

• skeletal events in cancer patients with BONE METASTASES
• Hypercalcemia of malignancy

Dosage form: SQ 120mg/1.7 mL

120mg Q 4 WEEKS