Osteoporosis, menopause & testosterone use Flashcards

1
Q

What patient characteristics can increase osteoporosis risk?

A
advanced age
ethnicity (white and asians)
family history
females>males
low body weight
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2
Q

What medical conditions and diseases increase osteoporosis risk?

A
anorexia
diabetes
GERD
hyperthyroidism
hypogonadism in men
menopause
RA, autoimmune diseases
epilepsy, HIV, PD
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3
Q

What lifestyle factors increase osteoporosis risk?

A
smoking
excessive alcohol
low calcium intake
low vitamin d intake
physical inactivity
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4
Q

What medications can increase osteoporosis risk?

A
anticonvulsants
aromatase inhibitors
depo-medroxyprogesterone
GnRH
lithium
PPIs
steroids
thyroid hormones in excess
herpain, loops, SSRIs, TZDs
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5
Q

What is the recommended daily intake of elemental calcium for most adults?

A

1000-1200mg elemental (500mg per dose)

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6
Q

Brand: Oscal

A

generic: calcium carbonate

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7
Q

What is a vitamin d deficiency

A

<30

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8
Q

what is vitamin d dose weekly

A

50,000IU

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9
Q

What is first line treatment or prevention in most patients

A

oral bisphosphonates

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10
Q

What is the PO administration of oral bispphosphonates

A

must stay upright for 30 minutes and drink 6-8oz of plain water

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11
Q

What are the side effects of oral bisphosphonates

A

esophagitis
hypocalcemia
gi effects

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12
Q

How often are oral bisphosphonate given

A

monthly or weekly

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13
Q

IV bisphosphonates are given

A

quarterly or yearly

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14
Q

This is an alternate to bisphosphonates, SC, given every 6 months and the side effect is hypocalcemia

A

denosumab (prolia)

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15
Q

These medications are only recommended for very high risk patients only, SC administration daily

A

teriparatide (Forteo)

abaloparatide (Tymlos)

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16
Q

Which osteoporosis drug can cause hypercalcemia?

A

teriparatide (Forteo)
abaloparatide (Tymlos)

the rest cause hypocalcemia

17
Q

these are an alternate to bisphosphonates if high risk of vertebral fractures; however increased risk for VTE/stroke

A

raloxifene (Evista)

Bazedoxifene/estrogens (Duavee)

18
Q

Which drug can be used if low risk VTE or high risk breast cancer?

A

rolexifene (Evista)

19
Q

Which can be used in women with an intact uterus for prevention of osteoporosis

20
Q

What is used as treatment for vasomotor symptoms in those with an intact uterus

A

Duavee

*inc risk of breast cancer

21
Q

Is estrogen used with progestin for prevention in postmenopausal women with vasomotor symptoms?

A

with or without

Duavee is the one that’s MUST have a uterus (unopposed estrogen = endometrial cancer)

22
Q

What are prevention options for osteoporosis

A

alendronate (Fosamax) PO daily/weekly

Ibandronate (Boniva) PO monthly

Zoledronic acid (Reclast) IV every 2 years

Raloxifene (Evista) - PO daily

Duavee - with a uterus - PO daily

23
Q

What is the most effect treatment for vasomotor symptoms?

24
Q

what should women with a uterus use for menopause?

A

use estrogen in combination with progesterone because unopposed estrogen increases risk of endometrial cancer

25
What are the progestins
norethindrone levonorgesterol drospirenone
26
What is considered to be the safer progestin option?
Prometrium>medroxyprogestin
27
What is the criteria for hormone therapy in menopause?
healthy symptomatic women who are within 10 years of menopause <60 no contraindications
28
Local hormone options
Estring, Estrace, Vagifem conjugated equine estrogens - Premarin
29
Brand: Vivelle-Dot
generic: estrogen
30
Brand: Alora
generic: estrogen
31
Brand: Climara
generic: estrogen
32
How can you tell if an option has progestin?
"Pro"
33
When do you use progestin again?
a women with a uterus!!
34
Natural products for menopause
black cohosh evening primrose oil red clover soy
35
What is the name of the non hormonal treatment for moderate to severe vasomotor symptoms associated with menopause?
Brisdelle (paroxtine)
36
What schedule is testosterone?
III