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Pharm Fall > Osteoporosis and Other Metabolic Bone Disease > Flashcards

Osteoporosis and Other Metabolic Bone Disease Flashcards

1
Q

Osteoporosis treatment of choice

A

Bisphosphonates

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2
Q

Bisphosphonates MOA

A

Mimics pyrophosphate, an endogenous bone resorption inhibitor

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3
Q

Bisphosphonates indicated for postmenopausal, male, and glucocorticoid-induced osteoporosis

A

Alendronate
risedronate
intravenous zoledronic acid

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4
Q

Bisphosphonate ONLY indicated for postmenopausal osteoporosis

A

Intravenous and oral ibandronate

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5
Q

Contraindications for Bisphosphonates

A

Pts with creatinine clearances less than 30 to 35 mL/min
Pts who have serious GI conditions
Pts who are pregnant

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6
Q

Adverse effect of Bisphosphonates

A

Osteonecrosis of the jaw- Black Box Warning

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7
Q

What should the pt do when taking Bisposphonates?

A

The patient should remain upright for at least 30 minutes after alendronate and risedronate and 1 hour after ibandronate administration

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8
Q

Patient’s serum calcium concentrations must be _______ prior to using bisphosphonates

A

Normal

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9
Q

Administration

A

Oral dose should be taken with at least 6 ounces of plain tap water (not coffee, juice, mineral water, or milk) at least 30 minutes before consuming any food, supplements (including calcium and vitamin D), or medications

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10
Q

What is a full human monoclonal antibody used for osteoporosis?

A

Denosumab

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11
Q

Denosumab MOA

A

Inhibits RANKL from binding RANK receptor on the surface of osteoclast precursor cells and mature osteoclasts

aka It inhibits osteoclastogenesis and increases osteoclast apoptosis

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12
Q

Indication for Denosumab

A

women and men at high risk for fracture (used to increase bone mass in men receiving androgen deprivation therapy and in women receiving adjuvant aromatase inhibitor therapy)

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13
Q

Adverse Effects of Denosumab

A

Bone turnover suppression and serious skin infections (Rare)

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14
Q

What is Raloxifene (Mixed Estrogen Agonists/Antagonists) indicated for?

A

prevention and treatment of postmenopausal osteoporosis

invasive breast cancer risk reduction

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15
Q

Raloxifene MOA

A

estrogenic agonist actions in bone but antagonist actions in breast and uterine tissue

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16
Q

Does Raloxifene have positive Lipid effects?

A

Yup.

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17
Q

Does Raloxifene have reduction in cardiovascular effects?

A

Na.

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18
Q

Raloxifene contraindications

A

Pts with active or past history of venous thromboembolic event

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19
Q

When should therapy be stopped?

A

If the pt anticipates extended immobility

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20
Q

Adverse Reaction

A

Hot flashes

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21
Q

What is Calcitonin

A

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

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22
Q

If a pt is allergic to fish (salmon) should Calcitonin be given?

A

No. It comes from salamon

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23
Q

What line treatment is Calcitonin?

A

LAST

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24
Q

Name an Anabolic Therapy

A

Teriparatide

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25
Q

What is Teriparatide?

A

It is a recombinant product representing the first 34 amino acids in human PTH

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26
Q

Teriparatide is indicated in who?

A

postmenopausal women, men, and patients on glucocorticoids who are at high risk for fracture

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27
Q

What position should the pt be in when receiving the first dose?

A

sitting or lying down in case orthostatic hypotension occurs

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28
Q

Teriparatide Adverse Effects

A

Transient hypercalcemia ( measure serum Ca at 1 month and decr Ca intake if high)

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29
Q

Teriparatide black box warning

A

Incr risk of osteosarcoma

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30
Q

Can you use Estrogen and Testosterone as therapy for osteoporosis?

A

Yeah

31
Q

RA is associated with an incr risk of what?

A

Cardiovascular mortality

32
Q

What can be used for symptomatic relief?

A

NSAIDS and/or corticosteriods

33
Q

What does DMARD stand for?

A

Disease-modifying antirheumatic drug

34
Q

How long does it take for DMARDs to show benefit?

A

Weeks to months

35
Q

Examples of Non-Biologic DMARDS

A
  • Methotrexate
  • hydroxychloroquine
  • sulfasalazine
  • leflunomide
  • Minocycline
36
Q

Examples of Biologic DMARDS

A
  • Anti-TNF drugs (etanercept, infliximab, adalimumab, certolizumab, golimumab)
  • abatacept
  • rituximab
37
Q

What do biologic DMARDS do?

A

Deplete Perif B cells

38
Q

What is less commonly used for RA?

A

-IL-1 receptor antagonist anakinra, azathioprine, D-penicillamine

  • gold
  • minocycline
  • cyclosporine
  • cyclophosphamide
39
Q

What properties does Methotraxate have?

A

Anti-inflam

40
Q

When given Methotrexate what also needs to be given?

A

Folic acid suppliment

41
Q

Leflunomide has a risk of?

A

Liver Tox

42
Q

Leflunomide is contraindicated in who?

A

Pts planning to be pregnant or are pregnanat

43
Q

What is the main advantage to Hydroxychlotoquine?

A

the lack of myelosuppressive, hepatic, and renal toxicities

44
Q

What are some short term toxicities of hydroxychloroquine? How can you manages them?

A

nausea, vomiting and diarrhea. Take with a meal

45
Q

Major side effect of hydroxychloroquine

A

Ocular Toxicity

46
Q

Contraindication of Anti-TNF agents

A

CHF

47
Q

Abatacept is approved for …..

A

the treatment of RA in patients with moderate to severe disease who fail to achieve an adequate response from one or more DMARDs

48
Q

How does Abatacept function?

A

by binding to CD80/CD86 receptors (prevents inflammatory process)

49
Q

Who is Rituximab used for?

A

patients who failed methotrexate or TNF inhibitors

50
Q

What does Tocilizumab do?

A

attaches to IL-6 receptors (IL-6 plays a role in RA inflam)

51
Q

What is Anakinra?

A

naturally occurring IL-1 receptor antagonist

52
Q

Can NSAIDs and Acetaminophen be used for Osteoarthritis?

A

Yup

53
Q

If they have kidney problems what should you do?

A

Use Acetaminophen. If you have to us NSAIDs fort some reason use the smallest possible dose.

54
Q

What should you use if they have cardiovascular problem?

A

Naproxen–> Max dose is 1000mg

55
Q

Max dose of Ibuprofen?

A

3200mg

56
Q

Example of a COX2 inhib?

A

Celebrex

57
Q

Where is COX1 expressed?

A

Gastric Mucosa and vascular endothelial cells

58
Q

What should the pt do to minimize adverse drug reactions from NSAIDs?

A

Take with food or milk

59
Q

Do NSAIDs incr BP?

A

Yeah

60
Q

What is a topical Therapy for OA?

A

Capsaicin–> Depletes substance P

61
Q

Alternative Therapies for OA

A
  • glucosamine and chondroitin
  • Coticosteroids
  • Hyaluronic acid
  • Tramadol
  • Low dose opioids
62
Q

How is uric acid cleared form the body?

A

Renally

63
Q

Who is gout consistently higher in?

A

obese individual or those who consume large amounts of alcohol or higher amounts of meat or fish

64
Q

What drugs are capible of inducing hyperuricemia and gout?

A

Diuretics

Salicylates

65
Q

What is a antimitotic drug that is highly effective at relieving acute attacks of gout?

A

Colchicine

66
Q

What happens if you delay the initiation of Colchicine?

A

The probability of success diminishes substantially

67
Q

What does Xanthine Oxidase do?

A

Lowers uric acid Concentration

68
Q

Examples of Xanthine Oxidases

A

Allopurinol (first line but needs renal adjustment) and febuxostat (no renal adjustment needed)

69
Q

What are examples of Uricosuric Drugs?

A

Probenecid and sulfinpyrazone

70
Q

How should uricosuric drugs be administered?

A

Start with a low dose to avoid stone formation

71
Q

What is a major disadvantage of Uricosurics?

A

Salicylates may interrupt its mechanism resulting in treatment failure

72
Q

Contraindication of uricosurics

A

Creat clearance <50 mL/min and hx of renal calculi

73
Q

Major adverse effects of uricosurics

A

gi irritation, rash, hypersensitivity, precipitation of acute gouty arthritis, stone formation

74
Q

When taking uricosurics they should be kept…

A

well hydrated

Pharm Fall (12 decks)

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