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Advanced Pharma > Osteoporosis (OP) > Flashcards

Osteoporosis (OP) Flashcards

1
Q

osteoporosis

A

a skeletal disease:

low bone density
decreased bone strength
deterioration of bone microarchitecture

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2
Q

key players involved

A

vit D
PTH
calcitonin
calcium
FGF23 gene

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3
Q

men and women impacted differently

A

-accelerated bone loss as a result of loss of estrogen
-age or secondary cause (hypogonadism) is usually the most contributing factor

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4
Q

bone healthy lifestyle includes

A

-exercise
-no smoking
-limiting EToH (<3 drinks/d)
-limiting caffeine
-fall prevention measures
-calcium & vit D to supplement dietary sources

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5
Q

calcium carbonate

A

-40% elemental calcium
-available in tablet, chewable, liquid
-dose: 500-600mg taken w/ food
acid-dependent disintegration & dissolution

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6
Q

calcium citrate

A

-21% elemental calcium
-available in tablet, chewable
-dose: 200-625mg w/ or w/o food
acid independent absorption

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7
Q

RDA of calcium: 19-49 yr (men up to 70)

A

1000 mg

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8
Q

RDA of calcium: =/> 50 (men over 70)

A

1200 mg

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9
Q

vitamin D

A

cholecalciferol

OTC 200-1000 IU daily

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10
Q

rx: vit D

A

ergocalciferol

50,000 IU weekly or monthly based on 25 (OH) D concentrations

goal: serum 25-OH vit D >30 ng/mL

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11
Q

vit D goals: national osteoporosis foundation

A

800-1000 IU for all age groups

however, institute of medicine
up to 70 yo = 600 IU
over 70 = 800 IU

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12
Q

MVI abbr

A

multi-vitamin injection

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13
Q

NOF recommends that all men & women over 50 years be considered for pharmacologic tx if they meet any of the following:

A
  • hx of hip or vertebral fx
  • T-score: -2.5 or less at femoral neck or spine
    -osteopenia and at least a 3% 10-year probability of hip fx or at least a 20% 10-yr probability of major osteoporosis-related fx as determined by FRAX
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14
Q

what should be added to all drug therapy regimes for osteoporosis

A

calcium and vit D

-increases bone density and decreases the risk of hip & vertebral fx

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15
Q

FRAX tool

A

only valid in naive pt risk assessment
-not valid if pt is/was on treatment of any kind

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16
Q

bisphonates

A

antiresorptive agents

provide the most significant fx risk reduction and BMD increases

duration: 3-5 years
long-term: unknown

1/2 of absorbed drug accumulates in bone, remainder is eliminated renally

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17
Q

bisphonates: contraindicated

A

-cannot remain upright or have esophageal abnormalities
-risk of osteonecrosis of the jaw
-renal insuff or failure (CrCl <30-35mL/min)

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18
Q

increased risk of a-fib with?

A

zolendronic acid

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19
Q

counseling for oral agents (bisphosphonates)

A

must be taken on an empty stomach first thing in the am w/ 8 ounces of plain water (no other liquid)

wait at least 60min before eating, drinking or taking any other meds

must remain upright for at least an hour after taking the medication

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20
Q

pt should be advised importance of

A

calcium
vit D
wt bearing exercise

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21
Q

ibandronate

A

indicated only in women for prevention and tx of OP
-no indication in men or for GIOP

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22
Q

GIOP abbr

A

glucocorticoid-induced osteoporosis

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23
Q

estrogens / HRT

A

estrogen deficiency is associated w/ a gap between bone resorption and bone formation

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24
Q

estrogen / hormone therapy approved by the FDA for

A

-prevention of osteoporosis
-relief of vasomotor sxs
-vulvovaginal atrophy assoc w/ menopause

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25
Q

for intact uterus rx

A

estrogen w/ progestin

26
Q

when ET/HT use is considered solely for prevention of osteoporosis the FDA recommends that

A

non-estrogen txs should first be carefully considered

27
Q

transdermal estrogen for

A

(lower doses)

-older
-metabolic syndromes such as fatty liver or hypertriglyceridemia w/ risk of pancreatitis
-smokers

28
Q

SERMs abbr

A

selective estrogen receptor modulators

tx:
-osteoporosis after menopause
-dec risk of breast ca
-menopause sxs

29
Q

raloxifine

A

FDA approved for the prevention and tx of osteoporosis in postmenopausal women and reduction of risk of invasive breast cancer in postmenopausal women w/ OP

30
Q

MOA of raloxifene

A

acts as an estrogen agonist in bone
-it decreases bone resorption and bone turnover, increases BMD, decreases fx incidence

31
Q

raloxifene: contraindications

A
  • inc risk of VTE or previous hx of VTE

-pregnancy cat X
-BLACK BOX WARNING: inc TG (triglycerides test) and fatal stroke

32
Q

conjugates estrogens/Bazedoxifine

A

FDA approved for women who suffer from moderate-severe hot flashes (vasomotor sxs) associated w/ menopause and to prevent osteoporosis after menopause

33
Q

Bazedoxifine component

A

reduces the risk of endometrial hyperplasia that can occur w/ the estrogen

no progestins needed to be taken

34
Q

estrogen precautions

A

-shortest duration consistent w/ tx goals and risks for the individual woman
-when using this drug only for the prevention of OP, such use s/b limited to are at significant risk of OP and only after carefully considering alternatives that do not contain estrogen

35
Q

conjugates estrogens/Bazedoxifine: s/e

A

N, D, dyspepsia

36
Q

calcitonin

A

tx of OP in women who are 5 years past menopause

-less robust decrease in reduction of fx (3rd line therapy)

-due to the possible association between malignancy and calcitonin-salmon use, the need for con’t therapy s/b reevaluated on a periodic basis

37
Q

calcitonin: s/e

A

rhinitis, mucosal ulceration (rare), backache, HA , N, flushing

38
Q

denosumab

A

1st line therapy

consider for those who cannot tolerate bisphonates

tx of post-menopausal OP

39
Q

denosumab: rx for men when

A

-for those at high risk of fracture
-defined as history of OP fx or multiple risk factors for fx

40
Q

denosumab: rx for women when

A

tx w/ breast cancer on aromatase inhibitor therapies and in men receiving gonadotropin-reducing hormone tx for prostate cancer

tx of OP in postmenopausal women & men who have failed or are intolerant of other available OP therapies

NOT OP prevention

41
Q

denosumab: s/e

A

hypocalcemia

(must be corrected before starting on this therapy

dose: 60mg every 6months as a subq injection
**dose adjustment not needed in renal pts

if creatitine clearance is less than 30: monitor for hypocelcemia

42
Q

denosumab: s/e

A

hypocalcemia

(must be corrected before starting on this therapy

dose: 60mg every 6 months as a subq injection
**dose adjustment not needed in renal pts

if creatinine clearance is less than 30: monitor for hypocalcemia

43
Q

teriparatide

A

-stimulates osteoblast # & fn
-increases GI calcium absorption
-increase renal tubular reabsorption of calcium

44
Q

teriparatide: indications

A

-postmenopausal women at high risk for fx
-men w/ primary or hypogonadal OP as high risk for fx
-men & women at high risk of fx on sustained systemic glucocorticoid therapy
-unresponsive or intolerant to other therapies

45
Q

teriparatide: pharmacokinetics

A

single-dose were not significantly affected in adult pts w/ mild-moderate renal impairment, suggesting no need for dose adjustment

46
Q

teriparatide: CIs

A

-pts at increased baseline risk for osteosarcoma (Paget’s disease of nome or unexplained elevation of alkaline phosphate, open epiphyses, or prior external beam or implant radiation therapy involving the skeleton)

47
Q

teriparatide: tx duration

A

max of 2 years

48
Q

abaloparatide

A

PTH analog which acts as an agonist at the PTH receptor; results in activation of the cAMP signaling pathway in target cells
-increase in BMD and bone mineral content (BMC) = inc bone strength at vertebral and/or nonvertebral sites

49
Q

abaloparatide: indications

A

-tx of postmenopausal women w/ OP at high risk for fx defined as a history of OP fx, multiple risk factors for fx, or patients who have failed or are intolerant to other available OP therapy

50
Q

abaloparatide: s/e

A

similar to teriparatide

possibly with a low risk of hypercalcemia

51
Q

romosozumab

A

humanized monoclonal antibody that inhibits the action of sclerostin, a regulatory factor in bone metabolism leading to increased bone formation, and to a lesser extent, decreases bone resorption

-not considered initial therapy

52
Q

romosozumab: possible candidates

A

-pts w/ multiple fragility fractures
-@ high risk for fx who cannot tolerate any other OP therapies
-fail other OP therapies (fx w/ loss of BDM in spite of compliance w/ therapy)

53
Q

romosozumab: contraindications

A

pts w/ MI or stroke within the preceding year

54
Q

romosozumab: duration

A

12 monthly doses
must be admin by healthcare professional

pts s/b adequately supplemented w/ calcium and vit D during tx

55
Q

calcitriol

A

synthetic vit D analogue, which promotes calcium absorption

approved for managing hypocalcemia and metabolic bone disease in renal dialysis pts

use in hypoparathyroidism: both surgical & idiopathic, and pseudohypoparathroidism

no reliable data demonstrate a reduction of risk for OP fx

56
Q

other bisphosphonates

A

etidronate, pamidronate, tiludronate

vary in chemical formation

NOT approved for prevention or tx of OP

57
Q

sodium fluoride

A

stimulates new bone formation

conflicting results on reduced fx risk is conflicting and conroversial

58
Q

GIOP

A

most common secondary cause of osteoporosis

3rd most common cause overall

59
Q

American College of Rheumatology (ACR) recommends

A

oral bisphosphonate therapy for all patients age 40 and over at moderate-high of fx receiving glucocorticoids (prednisone 2.5 mg or more daily or equivalent) for 3 months+

60
Q

men and postmenopausal women

A

bisphosphates as 1st-line therapy

alendronate or risedronate preferred

61
Q

alternative to those intolerant of bisphosphonates or the dosing requirements

A

zoledronic acid

Advanced Pharma (27 decks)

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