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Pharm Exam 4, URI, LRI, URI, PNE, abx, STD, Seizure, HA, Osteo > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Define osteoporosis (OP)

A

progressive, systemic disease characterized by low bone density, impaired bone architecture, compromised bone strength. Increased fracture risk. 80 percent are women

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2
Q

What are the 3 categories of OP

A

postmenopausal
Age-Related
Secondary

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3
Q

Postmenipausal OP

A

decreased estrogen causes accelerated bone loss. Estrogen deficiency increases bone reabsorption more than formation

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4
Q

Age Related OP

A

occurs in M and F > 70 yoa
M and F lose bone mass as they age
Occurs due to hormone, Ca, Vit D deficiency

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5
Q

Secondary OP

A

any age; related to drug therapy and other diseases

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6
Q

Patho of OP

A

Bone loss occurs when bone reabsorption exceeds bone formation
Skeletal growth peaks around 30 yoa

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7
Q

Risk Factors of OP

A 
low bone mineral density
low trauma FX as an adult
smoking
low body weight or BMI
age
> 3 ETOH drinks day
chronic steroid use
family history of 1st degree relative 
Female
white
low Ca intake
Secondary OP (RA)
low physical activity 
Frail low sun exposure
recent falls
cognitive impairment
estrogen deficient before 45 yoa
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8
Q

Medical conditions associated with OP

A 
ETOH abuse 
CKD
Cushings
CF
DM
Eating disorders
Hyperparathyroidism
Hyperthyroidism
hypogonadal states
organ transplant
Skeletal CA- myeloma
GI issues- gastrectomy, malabsorption 
Hemophilia
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9
Q

Drugs associated with OP

A 
Phenytoin
Phenobarbital
Methotrexate- cytotoxic 
thyroid supplements ( over replacement )
TPN
Lithium

Corticosteriods 5mg>/ prednisone day for 3mos or >
Gonadatroin releasing analog
Heparin
Immunosuppressants - tacrolimus

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10
Q

Glucocorticoids in OP:

A

Exogenough admin results in n increase in bone resorption , inhibits bone formation, decreases estrogen and testosterone production

risk > with > dose and long term therapy
Most bone loss occurs in the first 6-12 most of initial therapy and continues to decline

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11
Q

Therapy for OP from glucocorticoids

A

Start pt on biphosphenate:
- when initiation of steroid therapy- 5mg > d x3mos >
Calcitonin is an alternative to biphosphenates

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12
Q

OP clinical presentation

A

asymptomatic unless fracture occurs
Most common fx: vertebrae, proximal femur, distal radius
height loss > 1.5cm
postural changes bone pain

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13
Q

Screening of OP

A 
F and M >50yoa 
women with early menopause
older adults with fractures
medication use associated with bone loss
high risk persons
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14
Q

Diagnosis of OP

A

GS: dexa scan

  • Measure of central (hip and spine) bone mineral density
  • t-score: comparison of the pt BMD to that of a healthy younger individual, its the number of standard deviations from the mean
  • NORMAL: t-score > 1
  • OSTEOPENIA: t-score of -1 to -2.4
  • OSTEOPOROSIS: t-score of -2.5 or
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15
Q

Non-Rx therapy for OP

A

smoking cessation, ETOH use reduction, exercise, limiting caffeine and soda intake
Adequate CA and Vit D intake

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16
Q

Treatment with Ca

A 
Increases BMD, fraction prevention is minimal
Do not take with high fiber foods
Can cause constipation
go by % of elemental Ca
Take in small doses of 600mg day or <
Adult men 1000-1200mg day
PM women 1200-1500mg day
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17
Q

Calcium Pearls

A

Calcium carbonate should be taken with food
Pt on PPI/H2 or elderly can have absorption issues rt to decreased stomach acidity - calcium citrate is better absorbed and it can be taken with or wo food

18
Q

Calcium Pearls

A

Calcium carbonate should be taken with food
Pt on PPI/H2 or elderly can have absorption issues rt to decreased stomach acidity - calcium citrate is better absorbed and it can be taken with or wo food
Calcium intake > 2.5g/d should be avoided, can cause toxicity- hypercalcemia, hypercalciuria

19
Q

VIT D

A

Maximizes intestinal Ca absorption
Increases BMD and reduces fractures
800-1000 U day for adults
Goal is a 25 (OH) Vit D serum concentration of 30ng.dL or higher

20
Q

VIT D

A 
Maximizes intestinal Ca absorption
Increases BMD and reduces fractures
800-1000 U day for adults
MAX dose is 2000 U
Goal is a 25 (OH) Vit D serum concentration of 30ng.dL or higher 
D2- ergocalciferol
D-3 Cholecalciferol
OTC or Rx
21
Q

Rx therapy is recommended when

A

all M and F over age 50 if they meet any of the following criteria:
hx of hip or vertebral fx
T score

22
Q

Biphosphonates

A

1st line therapy proven to prevent hip and vertebral fx
Provides greater BMD and fx reduction
Most common Rx of all for OP

23
Q

Biphosphonates MOA

A

mimics pyrophosphate
binds to bone matrix- inhibits osteoclast activity, becomes incorporated into the bone
remain in bone extended periods of time- Half like of 10 years

24
Q

pyrophosphate

A

endogenous bone reabsorption inhibitor resulting in decreases osteoclast maturation

25
Q

AE of Biphosphonates

A

GI: mild NV to severe esophagitis. Dispepsia, ABD pain, reflux, esophagus ulceration

26
Q

CI of Biphosphonates

A

Pt with Hx of esophageal abnormalities, gastritis, PUD
caution with pt on NSAIDS
Not recommended for pt with CKD, (GFR <30-35)
Hypocalcemia

27
Q

Biphosphate administration

A

poorly absorbed
decreased absorption when taken with food, Fe, Ca
Take in AM with water, swallow whole
sit upright for 30m post admin

28
Q

IV Biphosphonates

A

can cause osteonecrosis of jaw, atypical femoral fx with Cancer, chemo, radiation and steriod use

Lab Monitoring:
SrCr
Alk Phos
phosphate
Mag
Ca

obtain prior to admin of each dose

29
Q

Biphosphonate Alendronate dosing

A 
Fosomax, Binosto
PO
prevention 5mg daily or 35mg weekly
PM 10mg daily or 70mg weekly 
Steroid induced 5mg/d for M, 10mg/d for PM not on estrogen therapy 
Men 10mg/d or 70mg/week
$4 for a 70mg tab
30
Q

Biphosphonate Ibandronate

A

Boniva
150mg PO monthly
3mg IV every 3 mos
$92 for a 150mg pill

31
Q

Biphosphonate Risedronate

A

Actonel, Ateliva
5mg/d or 35mg/w or 150mg/month
Men 35mg/week
$95 for a weekly tab

32
Q

Biphosphonate Zoledronic Acid

A

Reclast, Zometa
treatment and steroid induced 5mg once yearly IV >15min
PM 5mg IV every 2 years

33
Q

SERM

A

Indicated for preventing and treating OP
AKA mixed estrogen agonist toward the bones/antagonist toward breast and uterus
decreased breast Ca risk
Increases BMD- not as well as Biphosphonates and once stopped, benefits are lost

34
Q

SERM treatment

A 
Raloxifene/Evista
60mg a day
supplement with Ca and Vit D
AE: hot flashes, GI, leg cramps, Arthralgia, DVT
CI: nursing, preg,potential pregnancy
Do not use with hx of VTE
35
Q

HRT

A

Estrogen alone or in combo with progesterone- very effected however high risks with long term use
Only use for ST therapy
risk of VTE and breast Ca with use

36
Q

Calcitonin

A

nasal spray 200 U/d- alternate nostrils daily
IM or SC- 100U/d
PO- can’t- inactivated by gastric acid
AE rhinitis, rhino ulcerations, GI, rash

37
Q

Anabolic Agents Teriparatide

A

Forteo
Recombinant parathyroid hormone
moderate to severe OP
stimulates osteoblastic activity to form new bone when given daily
t-score < -3.5, hx of fractures, or multiple RF failed Biphosphonate therapy
proven reduction of fracture risk in F, approved for M and steroid use but no proven improvement

38
Q

Teriparatide Dosing

A

20u daily SC in thigh/abd up to 2 years, must stay refrigerated
AE: hypotension, transient hyperCa, N, HA,
CI: pt at risk for osteosarcoma- black box
$900 per pen

39
Q

Combo therapy

A

> BMD
no reduced Fx
Concern with forming brittle bones dt high turnover
not recommended

40
Q

Pre-M women

A

use Biphosphonates with caution dt pregnancy risk

no good date on Rx therapy and fx reduction

41
Q

MEN

A

only alodrenonte has clinical evidence reducing fx in men

Teriparatide should be an alternative therapy

Pharm Exam 4, URI, LRI, URI, PNE, abx, STD, Seizure, HA, Osteo (23 decks)

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