Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Keystone Exam 1 > Osteoporosis/Calcium and Bone disorder Drugs > Flashcards

Osteoporosis/Calcium and Bone disorder Drugs Flashcards

1
Q

What are the non-pharmacologic treatments for osteoporosis?

A

Calcium and Vitamin D (Target: 25OH vitamin D > 30)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Antiresorptives include all of the following classes of drugs except:
A. Biologic
B. Hormones
C. SERM (Selective Estrogen Receptor Modulator)
D. Bisphosphonates
E. Anabolic

A

E. Anabolic (teriparatide)

All the others work against catabolism by osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Raloxifene is a _____

A

SERM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Alendronate is a _____

A

Bisphosphonate, Oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risedronate is a _____

A

Bisphosphonate, Oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Ibandronate is a _____

A

Bisphosphonate, Oral or IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Zoledronic acid is a _____

A

Bisphosphonate, IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Denosumab is a _____ agent used in osteoporosis treatment

A

Biologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What two hormones can be used as antiresorptive/anticatabolic osteoporosis meds?

A

Calcitonin and Estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

True or False: Raloxifene is a more potent antiresorptive than denosumab and bisphosphonates

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Raloxifene is an _____ in bone and an ______ in breast tissue

A

agonist, antagonist

*In bone, inhibits osteoclasts - improve BMD, decrease fracture risk
In breast, reduces risk of breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Side effects of Raloxifene include which two of the following:
A. DVT
B. Headaches
C. Hot flushes
D. Palpitations
E. Thickening of endometrium
A

A. DVT and C. Hot flushes

*Raloxifene is neutral on cardiovascualar/endometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bisphosphonates work in treating osteoporosis by

A

Impair osteoclast function
Decrease osteoclast differentiation and increase apoptosis
Overall effect - Increase BMD and decrease fracture risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
Side effects of bisphosphonates include all of the following except:
A. Flu-like symptoms w/ IV use
B. Hyponatremia
C. Hypocalcemia
D. Bone and muscle pain
E. Esophagitis w/ oral use
A

B. Nope

*E. avoid oral use in patients with upper GI disease, Barret’s esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Bisphosphonates are contraindicated in patients with creatinine clearance ___

A

Less than 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the two potential long-term side effects of bisphosphonates?

A

Atypical subtrochanteric fractures

Osteonecrosis of the jaw

17
Q

Basis of atypical subtrochanteric fractures and bisphosphonate use

A

Use of bisphosphonates decreases rate of bone turnover that is necessary for repair of daily wear and tear -> accumulation of microcracks in the bone -> transverse/short oblique fractures with little/no trauma

18
Q

It takes a median of 7 years for subtrochanteric fractures to occur in bisphosphonate use. What can be done to prevent this?

A

Give the patient “drug holidays” every 4-5 years

19
Q

What is osteonecrosis of the jaw?

A

Area of exposed necrotic bone +/- infection

  • more common with IV bisphosphonates, usually after invasive dental procedures
  • avoid invasive dental procedures, be hygienic!
20
Q

Potential mechanism of osteonecrosis

A

Decreased jaw bone turn over -> accumulation of microcracks
Antiangiogenic effects of bisphosphonates -> necrosis
Invasive dental work -> microbes track into bone

21
Q

Denosumab mechanism of action

A

Binds to RANKL (released by osteoblast) to prevent it from binding RANK receptor on osteoclasts ->prevent osteoclast differentiation/maturation

22
Q

Denosumab is administered by

A

Subcutaneous injection every 6 months

23
Q

Side effects of denosumab

A

Hypocalcemia
Possible increase in infections/neoplastic effects
Concern for subtrochanteric fractures and ONJ

24
Q

True or False: Denosumab does not have any renal restrictions and can be used in patients with creatinine clearance

A

True

25
Q

True or False: Calcitonin is not a potent antiresorptive, but can provide some relief of acute pain in vertebral fractures

A

True

26
Q

Estrogen is not recommended as treatment of osteoporosis, why?

A

Side effects! Breast cancer and cardiovascular disease

27
Q

Teriparatide is human recombinant PTH1-34, who does it differ from antiresorptives?

A

It’s the only current anabolic drug. Induce differentiation/maturation of osteoblasts, increase function, reduce apoptosis.

28
Q

Teriparatide is administered daily by

A

Subcutaneous injection

*money money money, expensive, so only for severe cases or if other treatments fail or patient contraindicated

29
Q

Side effects of Teriparatide

A

Increase uric acid - gout attacks
Hypercalcemia - small, rare
Osteosarcoma concern - 2 year lifetime Tx limit

30
Q

Teriparatide is contraindicated in

A

Patients with high risk of osteosarcoma: kids, Paget, prior radiation
Patients with cancer in last 5 years
Patients with elevated PTH

31
Q

Cessation of teriparatide results in loss of gains in BMD, what can be done to minimize this?

A

Follow-up with antiresorptives

32
Q

Signs and Symptoms of hypercalcemia

A

CNS: fatigue, lethargy, depression
Neuromuscular: weakness
Cardiovascular: HTN, bradycardia, Short QT
Renal: polyuria, fluid depletion, kidney stoens
GI: nausea, vomiting, constipation, anorexia

33
Q

Cinacalcet is a

A

calcimimetic

  • mimics calcium, binds CaSR on parathyroid cells, decrease PTH secretion -> decrease serum calcium
  • used in cases of very high calcium in primary hyperparathyroidism
34
Q

Main side effect of cinacalcet

A

nausea

35
Q

Symptoms and Signs of hypocalcemia

A

Neuromuscular: parasthesias (fingers/around mouth), tetany, seizures, confusion/fatigue/depression
Cardiac: Prolonged QT

PE: carpopedal spasm and Chvostek’s sign

36
Q

If PTH is low, serum phosphrus will be ____

A

High. PTH is needed to promote renal P excretion

37
Q

If PTH is low, urine calcium is ____

A

High. PTH needed to promote renal calcium reabsorption

38
Q

List 4 causes of PTH elevation with low serum calcium

A 
Poor calcium intake
Vitamin D deficiency
PTH resistance (pseudohypoparathyroidism)
Vitamin D resistance

Keystone Exam 1 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions