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MSK 2 > Osteoporosis Pharm: fitz > Flashcards

Osteoporosis Pharm: fitz Flashcards

1
Q

what T score means osteoporosis

A

less than -2.5

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2
Q

The efficacy for prevention and treatment of osteoporosis depends on adequate intake of what

A

vit D and calcium

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3
Q

Contrast Calcium carbonate with calcium citrate

A
  • Ca carb: needs acid to dissolve, Take at or after meals, and you have less stomach acid with aging
  • Ca citrate: no need for stomach acid. may be taken whenever, higher cost
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4
Q

What level of serum vitamin D2 is sufficient for Ca absoption

A

30 ng/ml

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5
Q

normal vitamin D requirement is 400-8– IU/day but it exceeds 800 in who?

A
  • GI malabsorption disorders
  • recieving corticosteroids, anticonvulsants, loop diuretics, heparin
  • elderly who have limited sunlight exp.
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6
Q

drugs that lower serum Ca

A
  • prednisone
  • methylprednisolone
  • Budesonide (inhaled for asthma)
  • Carbamazepine
  • Phenytoin
  • Furosemide
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7
Q

initiation of systemic glucocorticoid therapy is considered an indication for what?

A

bone densitometry. bone loss usually occurs within 6 months

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8
Q

Gender for osteoporosis

A

W

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9
Q

race for Osteoporosis

A

White, asian > Black, hispanic

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10
Q

SERMS used for Osteoporosis

A
  • Raloxifene

- Tamoxifen

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11
Q

Bisphosphonates used for Osteoporosis

A

end in Dronate

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12
Q

Biologicals used for osteoporosis

A
  • Teraparatide

- Calcitonin

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13
Q

Antibody used for osteoporosis

A

-Denosumab

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14
Q

Most of the drugs are anti resporptive in that they inhibit osteoclasts, what is the only one that is anabolic and activates osteoblasts to deposit hydroxyapatiti

A

Teraparatide

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15
Q

HRT will increase bone health and decrease menopause symptoms but what do they have a risk for

A
  • Breast Cx
  • Uterine Cx
  • Heart attaack
  • stroke
  • Thrombosis
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16
Q

what agents are used for treatment AND prevention

A
  • Raloxifen

- Bisphosphonates

17
Q

Raloxifen and other SERMS bind ER of osteoclasts and do what

A

-block gene transcription

18
Q

Both Raloxifene and Tamoxifen have protection against Breast cancer but why is Tamoxifen not chosen over Raloxifen

A

-increased uterine bleeding and cancer

19
Q

all HRT and Raloxifene and Tamoxifen have what risk

A

venous thromboembolic events

20
Q

Explain what bisphosphonates do

A
  • bind to hydroxyapatite crystals in bone and inhibit bone resorption throught effects on osteoclasts . . induces apoptosis
  • live in bone and release when bone is resorped
21
Q

osteoclast activation and survival required G protein what?

A

preylation

22
Q

what enzyme does bisphosphonate inhibit

A

Farnesyl pyrophosphate synthase

23
Q

Contraindications and adverse effects of bisphosphonates

A
  • contraindication: pre existing hypocalcemia

- Esophagitis and esophageal ulcer

24
Q

advice on administration of bisphosphonates

A
  • take with full glass of water
  • do not eat or drink anything for at least 30 minutes after
  • Do NOT lie down for at least 30 minutes
25
Q

what is the risk when non compliance of advice on administration of bisph.

A

esophagitis

26
Q

which bisph. is IV and is give just 1x/year

A

Zoledronate

27
Q

Osteonecrosis of the Jaw is a rare but serious complication of bisph. therapy but most commonly in what patients

A
  • IV administration
  • Diagnosed with MM, breast or prostate Cx
  • having tooth extractions, dental trauma
28
Q

long term evaluation of Bisph use

A

stays in bone for long time so consider reevaluation after 5 years

29
Q

Denosumab is a monoclonal antibody for what

A

RANKL

-inhibits osteoclast formation

30
Q

Calcitonin is administered how?

decreases what?

A
  • nasally

- decreases pain with acute vertebral compression fracture

31
Q

Teriparatide is a fragment ofwhat

A

PTH

32
Q

Teriparatide therapy is reserved for what patients

A

high risk due to high cost and risk of osteosarcoma

33
Q

what are disadvantages of Teriparatide

A
  • injection daily

- high cost

MSK 2 (16 decks)

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