Osteoporosis, Menopause, and Testosterone Use Flashcards
Counseling on the use of Forteo should include the following points EXCEPT:
a. There may be a small risk of bone cancer with the use of this med.
b. You will need to take this med for 3-5 years.
c. Keep the pens refrigerated while in use.
d. You may feel dizzy or lightheaded after the 1st few doses.
e. Inject the med once daily into your abdomen.
b
-Teriparatide (Forteo) comes in a prefilled SC injection pen that lasts 28 days. Each injection provides the 20 mcg dose, and it should injected into the abdomen or thigh.
-The pends need to be refrigerated.
-Forteo has a boxed warning for bone cancer (osteosarcoma) that is dose and duration dependent. It shouldn’t be used for > 2 years.
-For the first few doses, pts should sit or lie down d/t the risk of dizziness/orthostasis.
MK is a 65 y/o male with NYHA Class I HF, prostate enlargement, mild cognitive decline, and erectile dysfunction. His meds include valsartan, metoprolol ER, HCTZ, tamsulosin, finasteride, and donepezil. MK’s testosterone level is WNL. He wishes to use sildenafil, but it’s not covered by his Medicare plan, and he finds the cost per tablet prohibitive. He asks his Dr for another option, and the Dr suggests testosterone. Which of the following statements is NOT true:
a. Testosterone can cause acne, male pattern baldness, and gynecomastia
b. Testosterone products have the potential for abuse
c. The FDA recommends testosterone for sexual dysfunction even if levels are normal
d. Testosterone will worsen the prostate symptoms
e. A popular form of testosterone is called Androderm
c
The FDA only recommends testosterone therapy if the pt has low testosterone with a related condition, such as muscle wasting.
A pt gave the pharmacist a prescription for Prometrium. Which of the following is an appropriate generic substitution for Prometrium?
a. Conjugated equine estrogens
b. Ethinyl estradiol, conjugated
c. Medroxyprogesterone acetate
d. Micronized progesterone
e. Conjugated equine estrogens and medroxyprogesterone
d
HPI: SC, a 69 y/o post-menopausal Caucasian female, is being seen in clinic after routine screening for various health conditions. She doesn’t smoke or drink and has limited knowledge of her family hx.
Allergies: Lisinopril (cough)
PMH: Rheumatoid arthritis, HTN, dyslipidemia
Current Meds:
Etanercept 50 mg SC weekly
Methotrexate 15 mg SC weekly
Prednisone 20 mg PO daily
Atorvastatin 20 mg PO daily
Losartan 100 mg PO daily
Ramelteon 8 mg PO 30 min before bedtime
Calcium carbonate 1250 mg PO BID MVI daily
Vitals:
Height 5’4”, Weight 106 lbs
BP 149/92, HR 83
RR 20, Temp 98.6 F
Pain: 4/10
Abnormal Labs:
GLU = 90 (100-125)
BUN = 22 (7-20)
Ca = 7.6 (8.5-10.5)
Albumin = 2.3 (3.5-5_
Vit. D = 22
Tests:
ECG: LVEF 46%
DXA: T-score lower spine (-2.8), T-score left hip (-3.4)
Colonoscopy: Polyps noted
Mammography: Calcifications noted throughout
Based on the info provided, which of the following is correct?
a. SC may have breast cancer
b. SC has osteopenia
c. SC has osteoporosis
d. SC has hypocalcemia
e. SC has diabetes
c
SC has osteoporosis, which is defined by a T-score of -2.5 or less Her calcium level corrects to a normal range when the albumin is considered.
HPI: SC, a 69 y/o post-menopausal Caucasian female, is being seen in clinic after routine screening for various health conditions. She doesn’t smoke or drink and has limited knowledge of her family hx.
Allergies: Lisinopril (cough)
PMH: Rheumatoid arthritis, HTN, dyslipidemia
Current Meds:
Etanercept 50 mg SC weekly
Methotrexate 15 mg SC weekly
Prednisone 20 mg PO daily
Atorvastatin 20 mg PO daily
Losartan 100 mg PO daily
Ramelteon 8 mg PO 30 min before bedtime
Calcium carbonate 1250 mg PO BID MVI daily
Vitals:
Height 5’4”, Weight 106 lbs
BP 149/92, HR 83
RR 20, Temp 98.6 F
Pain: 4/10
Abnormal Labs:
GLU = 90 (100-125)
BUN = 22 (7-20)
Ca = 7.6 (8.5-10.5)
Albumin = 2.3 (3.5-5_
Vit. D = 22
Tests:
ECG: LVEF 46%
DXA: T-score lower spine (-2.8), T-score left hip (-3.4)
Colonoscopy: Polyps noted
Mammography: Calcifications noted throughout
Based on SC’s lab results, which of the following is correct?
a. SC has a serum vitamin D level that’s appropriate for her age and doesn’t require vitamin D supplements
b. SC has a serum vitamin D level that’s appropriate for her age, but she should take vitamin D 800 IU daily to prevent deficiency
c. SC has a serum vitamin D level that indicates deficiency; she will need to take vitamin D 50,000 IU weekly
d. SC has a serum vitamin D level that indicates deficiency; she will need to take vitamin D 1,000 IU weekly
e. SC has a serum vitamin D level that indicates deficiency; she should increase her exposure to sunlight to increase her vitamin D levels
c
SC has a serum vitamin D level below 30 ng/mL, which means she is deficient. Vitamin D2 or D3 50,000 IU weekly or 5,000-7,000 IU daily for 8-12 weeks is recommended. Then lower doses can be used for maintenance therapy.
HPI: SC, a 69 y/o post-menopausal Caucasian female, is being seen in clinic after routine screening for various health conditions. She doesn’t smoke or drink and has limited knowledge of her family hx.
Allergies: Lisinopril (cough)
PMH: Rheumatoid arthritis, HTN, dyslipidemia
Current Meds:
Etanercept 50 mg SC weekly
Methotrexate 15 mg SC weekly
Prednisone 20 mg PO daily
Atorvastatin 20 mg PO daily
Losartan 100 mg PO daily
Ramelteon 8 mg PO 30 min before bedtime
Calcium carbonate 1250 mg PO BID MVI daily
Vitals:
Height 5’4”, Weight 106 lbs
BP 149/92, HR 83
RR 20, Temp 98.6 F
Pain: 4/10
Abnormal Labs:
GLU = 90 (100-125)
BUN = 22 (7-20)
Ca = 7.6 (8.5-10.5)
Albumin = 2.3 (3.5-5_
Vit. D = 22
Tests:
ECG: LVEF 46%
DXA: T-score lower spine (-2.8), T-score left hip (-3.4)
Colonoscopy: Polyps noted
Mammography: Calcifications noted throughout
Which risk factors for osteoporosis are present in this patient?
a. Postmenopausal
b. Low body weight
c. Advanced age
d. Prednisone use
e. Rheumatoid arthritis
a, b, c, d, e
HPI: SC, a 69 y/o post-menopausal Caucasian female, is being seen in clinic after routine screening for various health conditions. She doesn’t smoke or drink and has limited knowledge of her family hx.
Allergies: Lisinopril (cough)
PMH: Rheumatoid arthritis, HTN, dyslipidemia
Current Meds:
Etanercept 50 mg SC weekly
Methotrexate 15 mg SC weekly
Prednisone 20 mg PO daily
Atorvastatin 20 mg PO daily
Losartan 100 mg PO daily
Ramelteon 8 mg PO 30 min before bedtime
Calcium carbonate 1250 mg PO BID MVI daily
Vitals:
Height 5’4”, Weight 106 lbs
BP 149/92, HR 83
RR 20, Temp 98.6 F
Pain: 4/10
Abnormal Labs:
GLU = 90 (100-125)
BUN = 22 (7-20)
Ca = 7.6 (8.5-10.5)
Albumin = 2.3 (3.5-5_
Vit. D = 22
Tests:
ECG: LVEF 46%
DXA: T-score lower spine (-2.8), T-score left hip (-3.4)
Colonoscopy: Polyps noted
Mammography: Calcifications noted throughout
Which med puts SC at increased risk for falls (and consequently) injury and fractures?
a. Methotrexate
b. Ramelteon
c. Prednisone
d. Etanercept
e. Atorvastatin
b
HPI: SC, a 69 y/o post-menopausal Caucasian female, is being seen in clinic after routine screening for various health conditions. She doesn’t smoke or drink and has limited knowledge of her family hx.
Allergies: Lisinopril (cough)
PMH: Rheumatoid arthritis, HTN, dyslipidemia
Current Meds:
Etanercept 50 mg SC weekly
Methotrexate 15 mg SC weekly
Prednisone 20 mg PO daily
Atorvastatin 20 mg PO daily
Losartan 100 mg PO daily
Ramelteon 8 mg PO 30 min before bedtime
Calcium carbonate 1250 mg PO BID MVI daily
Vitals:
Height 5’4”, Weight 106 lbs
BP 149/92, HR 83
RR 20, Temp 98.6 F
Pain: 4/10
Abnormal Labs:
GLU = 90 (100-125)
BUN = 22 (7-20)
Ca = 7.6 (8.5-10.5)
Albumin = 2.3 (3.5-5_
Vit. D = 22
Tests:
ECG: LVEF 46%
DXA: T-score lower spine (-2.8), T-score left hip (-3.4)
Colonoscopy: Polyps noted
Mammography: Calcifications noted throughout
Select the best tx option for SC?
a. Duavee
b. Miacalcin
c. Prolia
d. Forteo
e. Atelvia
e
Bisphosphonates are first-line for patients. SC is not hypocalcemic when you correct her calcium for her albumin of 2.3 g/dL.
-Duavee is for prevention only.
-Prolia and Forteo are for high-risk patients
-Miacalcin is last line only if other options are not suitable
HPI: SC, a 69 y/o post-menopausal Caucasian female, is being seen in clinic after routine screening for various health conditions. She doesn’t smoke or drink and has limited knowledge of her family hx.
Allergies: Lisinopril (cough)
PMH: Rheumatoid arthritis, HTN, dyslipidemia
Current Meds:
Etanercept 50 mg SC weekly
Methotrexate 15 mg SC weekly
Prednisone 20 mg PO daily
Atorvastatin 20 mg PO daily
Losartan 100 mg PO daily
Ramelteon 8 mg PO 30 min before bedtime
Calcium carbonate 1250 mg PO BID MVI daily
Vitals:
Height 5’4”, Weight 106 lbs
BP 149/92, HR 83
RR 20, Temp 98.6 F
Pain: 4/10
Abnormal Labs:
GLU = 90 (100-125)
BUN = 22 (7-20)
Ca = 7.6 (8.5-10.5)
Albumin = 2.3 (3.5-5_
Vit. D = 22
Tests:
ECG: LVEF 46%
DXA: T-score lower spine (-2.8), T-score left hip (-3.4)
Colonoscopy: Polyps noted
Mammography: Calcifications noted throughout
Which of the following statements regarding SC’s calcium supplementation is correct?
a. SC is receiving 1000 mg of elemental calcium daily
b. SC is receiving 550 mg of elemental calcium daily
c. SC should take her calcium supplement on an empty stomach to increase absorption
d. SC should switch to a more expensive formulation that has a higher percentage of elemental calcium
e. SC should switch from calcium carbonate to Calcitrate
a
Calcium carbonate contains 40% elemental calcium. It should be taken with food since absorption is acid dependent. There’s no advantage to switching a different formulation in this pt, but based on her age, she should increase her intake to 1,200 mg of elemental calcium daily.
A pt uses Boniva. This med is usually administered in the following formulation:
a. Daily tablet
b. Weekly tablet
c. Monthly tablet
d. Yearly infusion
e. Patch
c
Ibandronate (Boniva) comes in an injection that’s administered every 3 months and a tablet that’s taken monthly.
The use of testosterone can cause which of the following effects?
a. Decreased risk of blood clots
b. Decreased cholesterol
c. Decreased appetite
d. Hepatotoxicity
e. Increased sperm count
d
Testosterone use can increase creatinine, appetite, cholesterol, and cause sensitive nipples and acne. It can cause hepatotoxicity and thrombosis. It’s contraindicated in breast or prostate cancer.
JV is a 60 y/o post-menopausal female who’s overweight and sedentary. Last year, while taking a 5 hour cross-country flight, she developed a DVT. This was her 2nd DVT in 2 years. She has refused warfarin but agreed to use an aspirin daily. Aspirin is her only med. Recently, JV’s sister was diagnosed with breast cancer. During the workup, JV’s sister was found to have low bone density. D/t her sister’s new diagnosis, JV is inquiring if she can use raloxifene, which she heard might protect her against breast cancer and will help her build strong bones. Choose the correct statement:
a. Raloxifene is only indicated for the tx of osteoporosis, not prevention.
b. A better choice for JV to prevent osteoporosis and breast cancer is Duavee (conjugated estrogens/bazedoxefine).
c. She’s contraindicated for raloxifene d/t her hx of DVT.
d. She’s contraindicated for raloxifene d/t her breast cancer risk.
e She’s contraindicated for raloxifene d/t her age.
c
Raloxifene (Evista) and conjugated equine estrogen/bazedoxefine (Duavee) have an increased risk for thromboembolism. Women with an active or past history of VTE can’t use this med. Raloxifene decreases breast cancer risk, while Duavee increases the risk.
CW is a 66 y/o female who frequents the pharmacy. She has many medical conditions, including HTN, epilepsy, and stress incontinence. She had an MI this past spring. During the hospital stay, she was diagnosed with HF. Her current prescriptions include Coreg, Lasix, Klor-Con, Catapres TTS, Nexium, and phenytoin. Which of the following meds increase the risk for low bone density?
a. Catapres TTS
b. Nexium
c. Phenytoin
d. Klor-Con
e. Coreg
b, c
Anticonvulsants and PPIs are key drugs that increase the risk of osteoporosis.
Which of the following natural products can be used to help vasomotor symptoms?
a. Black cohosh
b. Evening primrose oil
c. Red clover
d. Saw palmetto
e. Soy
a, b, c, e
The Fracture Risk Assessment Tool (FRAX) is used to assess the need for prescription drug therapy in pts with low bone density. Which of the following statements apply to this tool?
a. The tool should only be used in pts with a hx of fragility fracture.
b. The tool isn’t well validated and not recommended by the National Osteoporosis Foundation.
c. The tool is intended for any pt > 40 years of age.
d. It’s not necessary to use this type of tool in most pts since it’s well established that drugs, such as alendronate are safe and useful.
e. The tool predicts the risk of osteoporosis-related fracture in the next 10 years.
e
