Osteoporosis, menopause, and testosterone use Flashcards
Which meds cause osteoporosis risk?
What to know about T scores?
What to know about calcium and vitamin D supplementation?
Anticonvulsants, Aromatase inhibitors, depo-medroxyprogesterone, GnRH agonists, Lithium, PPI, Steroids(long term use is the major drug contributing factor), Thyroid hormones, Others(heparin, loop diuretics, SSRi’s, TZD’s).
A score that is at or above -1 correlates with stronger bone health, women age >65 and men >70 should get it, younger patients at higher fracture risk, Osteopenia is -1 to -2.4, Osteoporosis is
What is drug summary treatment for osteoporosis?
What are the oral bisphosphonates and their side effects?
What are the injectable bisphosphonates?
Bisphosphonates, Estrogen agonist/antagonists, Teriparatide(Forteo), Abaloparatide(tymlos), Denosumab(prolia), estrogen not recommended, calcitonin.
Alendronate is Fosamax , treatment is 10 daily or 70 weekly. CI’d in inability to stand or sit upright for at least 30 minutes, hypocalcemia, Watch for ONJ, femur fractures, esophagitis, esophageal ulcers, erosions, follow administration instructions, hypocalcemia to be repaired before use, renal impairment. Dyspepsia, N/V, dysphagia, heartburn, separate at least 2 hours form chemistry drugs, Atelvia is a delayed release that requires an acidic gut for absorption, H2RA’s and PPI’s should be avoided completely.
Treatment for ibandronate is every 3 months, Zoledronic Acid(Reclast) is 5 mg every 2 years prevention, treatment is 5 mg once yearly. Hypocalcemia, renal impairment, preferred if esophagitis is present, risk for esophageal cancer.
What to know about Raloxifene (Evista)?
What to know about Estrogens/Bazedoxifene (Duavee)?
What to know about Calcitonin?
SERM, Conjugated estrogens/bazedoxifene(Duavee). Increase risk of VTE, increased risk of death due to stroke, CI’d in VTE and pregnancy, hot flashes, peripheral edema, arthralgia, leg cramps.
Have to have a uterus, Endometrial cancer, unopposed estrogen use, increased risk of VTE and stroke. Increased risk of breast cancer and ovarian cancer. Breast cancer or uterine bleeding, active VTE, pregnancy is CI’d.
Miacalcin, Nasal spray, injection, one nostril daily(alternate). Inhibits osteoclastic bone resorption. Hypocalcemia, increased risk of malignancy, hypersensitivity reaction, salmon-derived product. Prime pump.
What to know about Teriparatide (Forteo)?
What is the RANKL inhibitor?
What are the topical products that treat menopause?
Injection, Osteosarcoma(bone cancer) risk, hypercalcemia, arthralgias, leg cramps, pain, nausea,orthostasis/dizziness, keep refrigerated and protect from light. Analogs of human parathyroid hormone, treatment duration is 2 years or less and only used in high risk of fracture. Discard pen after 28 days.
Denosumab(Prolia). Injection, Hypocalcemia, pregnancy, Prevents osteoclast formation, ONJ, femur fractures, hypocalcemia, hypertension, fatigue, edema, dyspnea, headache, N/V/D, Low phosphate.
Estrace, Estring, Vagifem, Premarin.
What are the systemic hormone therapies?
Should women with a uterus take estrogen alone?
What are the warnings about the estrogens?
Estradiol (Alora, Climara, Vivelle-Dot), 17-beta-estradiol (Estrace). Conjugated equine estrogens (Premarin tablet and injection), Conjugated equine estrogens with medroxyprogesterone(MPA) (Prempro, Premphase). Medroxyprogesterone (Provera), Micronized progesterone (Prometrium).
NO! Never apply patch to the breasts. Apply to lower waist below abdomen.
Endometrial cancer, dementia, increased risk of VTE and stroke, breast cancer, Vivelle-dot, Alora are applied twice weekly, Climara is once weekly.
What other drugs treat menopause?
What to know about testosterone use?
What medications can cause hypogonadism?
Black cohosh, red clover, soy, flaxseed, dong quai, st johns wort, evening primrose oil. Paroxetine (Brisdelle), bloxs effectiveness of Tamoxifen, increase risk of bleeding in patients using warfarin, can also use desvenlafaxine. Ospemifene is not indicated for mild symptoms.
Cardiovascular risks, low testosterone levels, increased clotting risk and hematocrit, prostate growth is restricted with severe BPH, baldness, acne, and gynecomastia.
Methadone, chemotherapy, cimetidine, spironolactone.
What are the topical gels and solutions of testosterone?
What are the injections of testosterone?
What are the testosterone side effects?
Androgel, Androgel Pump. Androderm is the patch apply each night. Do not use same patch sight for 7 days. Gel is flammable.
Testosterone Cypionate, Depo testosterone.
Secondary exposure to children can occur so watch out, increased appetite, acne, edema, hepatotoxicity, reduced sperm count. Skin irritation, buccal irritation(striant), Natesto(nasal irritation), Gels apply at same time every morning, Androderm can treat irritation with hydrocortisone and remove patch before an MRI.
