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MJ- Pharm II Exam 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Define the following:

Bone disorder of…

  • low bone density
  • impaired bone architecture
  • compromised bone strength
  • increased fracture risk
A

Osteoporosis

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2
Q

At what age do men and women begin to lose bone mass due to reduced bone formation?

A

30s-40s

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3
Q

____________ deficiency during menopause increases _________ activity, increasing bone _________ more than ___________.

A

Estrogen deficiency during menopause increases osteoclast activity, increasing bone resorption more than formation.

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4
Q

Why are men at a lower risk for developing osteoporosis and osteoporotic fractures?

A

They have

  • larger bone size
  • greater peak bone mass
  • increase in bone width with aging
  • fewer falls
  • shorter life expectancy
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5
Q

What does male osteoporosis result from?

A

aging or secondary causes

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6
Q
  • incorporate a bone-healthy lifestyle beginning at birth and continuing throughout life
  • emphasize regular exercise, nutritious diet, tobacco avoidance, minimal alcohol use
  • fall prevention to prevent and treat osteoporosis

The following are…

A

prevention techniques that should be used at all ages

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7
Q

What 3 deficiencies lead to accelerated bone turnover and reduced ostoblast formation that causes age related osteoporosis?

A
  • VItamin D
  • Calcium
  • Hormones
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8
Q

What results from systemic corticosteroids, thyroid hormone replacement, antiepileptic drugs (phytoin, phenobarbital), depot medroxyprogesterone acetate?

A

Drug incuded osteoporosis

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9
Q

What are the two predictive tools?

A

FRAX tool & Garvan calculator

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10
Q

World Health Organization (WHO) created tool which uses risk factors to predict the percent probability of fracture in the next 10 years

Which predictive tool?

A

FRAX tool

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11
Q

Which predictive tool?

  • uses four risk factors (age, sex, low-trauma fracture, and falls) with the option to also use BMD.
  • Calculates 5- and 10-year risk estimates of any major osteoporotic and hip fracture.
A

Garvan Calculator

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12
Q

Which predictive tool?

  • Tool corrects some disadvantages of FRAX
  • includes falls and number of previous fractures
A

Garvan calculator

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13
Q

What is the diagnostic standard for osteoporosis/ bone mineral density?

A

dual-energy x-ray absorptiometry (DXA)

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14
Q

Diagnosis of osteoporosis is based on what 3 things?

A

low trauma fracture

OR

central hip

and/or

spine DXA using WHO-T score thresholds

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15
Q

What is the T-score range for Osteopenia?

A

-1 and -2.5

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16
Q

What is the T score range for Osteoporosis?

A

< or equal to -2.5

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17
Q

Dx of osteoporosis in children, premenopausal women and men < 50 y/o should be based on a Z score at or below what?

A

-2.0

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18
Q

What are the medications of choice for osteoporosis?

A

biphosphonates with calcium and Vit D

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19
Q

What are the 2 basic forms of Calcium?

A

calcium carbonate

calcium citrate

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20
Q

Which type of calcium is indicated on the label of calcium supplements?

A

elemental calcium

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21
Q

What are the adverse effects of carbonate?

A

gas, upset stomach, bloating, constipation

rare kidney stones

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22
Q

What are the 2 adverse effects for both types of calcium?

A

hypophosphotemia

hypercalciumia

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23
Q

Metabolism of which drug?

*Hepatic metabolism to 25 (OH) Vit D and then renal metabolism to 1,25 (OH) Vit D

A
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24
Q

Adverse effects of Vitamin D3 (Cholecalciferol- natural form)

A

Hypercalcemia: cardiac rhythm disturbance

HA

weakness

Hypercalcuria

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25
Q

Which drug is indicated for VItamin D deficiency?

A

Vitamin D₂ (ergocalciferol) plant-derived form

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26
Q

What is the plant-derived form of Vitamin D?

A

Vitamin D2 (ergocalcifereol)

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27
Q

Where is Vitamin D first hydroxylated and what does it form?

A

Liver, forms 25(OH)D (calcifediol)

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28
Q

When should you use Vitamin D (calcitriol: 1, 25, (OH))?

3 instances

A
  1. Renal osteodystrophy
  2. Hypoparathyroidism
  3. Refractory rickets
29
Q

Which biophosphonate is indicated only for postmenopausal osteoporosis?

A

ibandronate (IV and oral)

“you get stretch marks (bands) after menopause”

30
Q

MOA of biphosphonates

A

Mimic pyrophosphate: an endogenous bone resorption inhibitor

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

31
Q

What is the half-life of biphosphonates?

A

10 yrs: becomes incorporated into the bone

32
Q

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.

Do not coadminister with any other medication or supplements, including calcium and vitamin D.

Which drug?

A

Alendronate

33
Q

Administration instructions same as for alendronate, except must delay eating and remain upright for at least 60 minutes.

Which drug?

A

Ibandronate

34
Q

Administration instructions same as for alendronate, except delayed-release product is taken immediately following breakfast.

Which drug?

A

RIsedronate

35
Q

Can premedicate with acetaminophen to decrease infusion reactions.

_Contraindicated if CrCl <35 mL/min**_

Which drug?

A

Zoledronic Acid

36
Q

Monitoring for biphosphonates

A

bone turnover markers

37
Q

ADEs of biphosphonates

A

nausea, dyspepsia, transient flu-like illess (IV)

38
Q

Rare adverse effects of biphosphonates

A

perforation, ulceration, GI bleeding (PUG)

Musculoskeletal pain

atypical fx

ONJ

39
Q

COntraindications of biphosphonates

A

CrCl 30-35mL/min

serious GI conditions:

esophagus abnormalities delaying emptying-stricture or achalasia

esophageal varices

barrett’s esophagus

Pregnancy

40
Q

Black box warning of biphosphonates regarding ONJ

A

ONJ occurs more commonly in patients with cancer, chemotherapy, radiation, and or glucocorticoid therapy receiving higher-dose intravenous bisphosphonate therapy.

41
Q

Another ADE of biphosphonates

A

Subtrochanteric femoral (atypical) fracture

42
Q

Who can take a “drug holiday”?

A

women w/o evidence of a low-trauma fx

pts who have responded well to biphosphonate therapy

Those w/BMD increasing into the osteopenic range (T-score > -2)

43
Q

What is a “drug holiday”?

A

Patients are taken off their bisphosphonate therapy and followed serially with bone turnover markers and central DXA BMD

44
Q

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

Treatment for women who are at least 5 years past menopause

Third-line treatment

May provide pain relief with acute verterbral fracture

What is this describing?

A

Calcitonin

45
Q

Refrigerate nasal spray until opened for daily use, then room temperature.

Prime with first use

Which drug?

A

Calcitonin

46
Q

For postmenopausal women with an uterus; no progestogen needed

Which drug?

A

Bazedoxifene

47
Q

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

Which drugs?

A

2nd gen mixed estrogen agonist/antagonist (EAA)

selective estrogen receptor modulators (SERMs)

Raloxifene, Bazedoxifene

48
Q

Why is estrogen therapy used short-term to manage menopausal sx?

A

risks of estrogen therapy > bone benefits

49
Q

Replacement of ___________ (male) or _________ (female) have demonstrated increases in BMD, but no data on fracture prevention exist

A

Replacement of testosterone (male) or methyltestosterone (female) have demonstrated increases in BMD, but no data on fracture prevention exist

50
Q

Recombinant product representing the first 34 amino acids in human PTH

Increases bone formation, the bone remodeling rate, and osteoblast number and activity.

Both bone mass and architecture are improved

Indicated for postmenopausal women, men, and patients on glucocorticoids at high risk (Bone density T score < -3.5)

Which drug?

A

Teriparatide (Anabolic Therapy)

51
Q

Commercially available as a prefilled “pen” delivery device

first dose should take place with the patient either sitting or lying down in case orthostatic hypotension occurs

Which drug?

A

Anabolic Therapies: Teriparatide

52
Q

approved for treatment of high-risk postmenopausal osteoporosis

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

Which drug?

A

Abaloparatide (Tymlos)

53
Q

What did the ACTIVE trial demonstrate about Abaloparatide (Tymlos)

A

reduced new vertebral and nonvertebral fractures and increased bone mineral density after 18 months

54
Q

When___________ is discontinued, antiresorptive treatment should be considered as ______________to protect against bone loss.

A

When abaloparatide is discontinued, antiresorptive treatment should be considered as sequential therapy to protect against bone loss

55
Q

MOA:

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

Inhibits osteoclatogenesis and increases osteoclast apoptosis

Which drug?

A

RANKL inhibitor: Denosumab

56
Q

Indications: Postmenopausal women and possibly chemotherapy induced osteoporosis

A

RANKL inhibitor: Denosumab

57
Q

ADEs:

back, extremity, and musculoskeletal pain

increased cholesterol, cystitis, decreased serum calcium, skin problems

Which drug?

A

RANKL Inhibitor: Denosumab

58
Q

What are the 4 1st line tx for osteoporosis?

A

Alendronate

Risedronate

Zoledronic acid

Denosumab

“AZRD”

59
Q

Alt tx for osteoporosis

A

Ibandronate, raloxifene, and teriparatide

60
Q

Agent of last resort

A

Calcitonin

61
Q

When should you consider a Vertebroplasty and Kyphoplasty

A

Patients with debilitating pain between 6 and 52 weeks after a vertebral fracture might undergo vertebroplasty or kyphoplasty

62
Q

bone cement is injected into the fractured vertebral space

A

Vertebroplasty and Kyphoplasty

63
Q

ADEs:

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

A

Vertebroplasty and Kyphoplasty

64
Q

Define osteomalacia

A

“soft bones”

condition seen in adults in which the bone is significantly undermineralized

65
Q

_________ is the childhood equivalent of osteomalacia.

A

Rickets

66
Q

Cause of osteomalacia

A

MCC: severe, prolonged vitamin D deficiency

disorders that cause hypophosphatemia, medications like long-term antoconvulsant therapy

67
Q

Clinical px of osteomalacia

A

pathologic fractures and/or deep bone pain, proximal muscle weakness, or no obvious symptoms but low BMD

68
Q

Osteomalacia causes extremely low __________ concentration.

A

Osteomalacia causes extremely low 25(OH) vitamin D concentration (<10 ng/mL [<25 nmol/L]) concentration.

69
Q

Tx for osteomalacia

A

Ergocalciferol once to twice weekly fofr at least 8 weeks

Once 25(OH) vitamin D concentrations are > 30 ng/mL (75 nmol/L), chronic maintenance vitamin D therapy can be instituted

Maintenance therapy:

oral ergocalciferol 1 or 2 times a mo

OR

nonprescription cholecalciferol once daily

MJ- Pharm II Exam 1 (2 decks)

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