Osteoporosis Pharm: fitz Flashcards
what T score means osteoporosis
less than -2.5
The efficacy for prevention and treatment of osteoporosis depends on adequate intake of what
vit D and calcium
Contrast Calcium carbonate with calcium citrate
- 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
What level of serum vitamin D2 is sufficient for Ca absoption
30 ng/ml
normal vitamin D requirement is 400-8– IU/day but it exceeds 800 in who?
- GI malabsorption disorders
- recieving corticosteroids, anticonvulsants, loop diuretics, heparin
- elderly who have limited sunlight exp.
drugs that lower serum Ca
- prednisone
- methylprednisolone
- Budesonide (inhaled for asthma)
- Carbamazepine
- Phenytoin
- Furosemide
initiation of systemic glucocorticoid therapy is considered an indication for what?
bone densitometry. bone loss usually occurs within 6 months
Gender for osteoporosis
W
race for Osteoporosis
White, asian > Black, hispanic
SERMS used for Osteoporosis
- Raloxifene
- Tamoxifen
Bisphosphonates used for Osteoporosis
end in Dronate
Biologicals used for osteoporosis
- Teraparatide
- Calcitonin
Antibody used for osteoporosis
-Denosumab
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
Teraparatide
HRT will increase bone health and decrease menopause symptoms but what do they have a risk for
- Breast Cx
- Uterine Cx
- Heart attaack
- stroke
- Thrombosis
what agents are used for treatment AND prevention
- Raloxifen
- Bisphosphonates
Raloxifen and other SERMS bind ER of osteoclasts and do what
-block gene transcription
Both Raloxifene and Tamoxifen have protection against Breast cancer but why is Tamoxifen not chosen over Raloxifen
-increased uterine bleeding and cancer
all HRT and Raloxifene and Tamoxifen have what risk
venous thromboembolic events
Explain what bisphosphonates do
- 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
osteoclast activation and survival required G protein what?
preylation
what enzyme does bisphosphonate inhibit
Farnesyl pyrophosphate synthase
Contraindications and adverse effects of bisphosphonates
- contraindication: pre existing hypocalcemia
- Esophagitis and esophageal ulcer
advice on administration of bisphosphonates
- 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
what is the risk when non compliance of advice on administration of bisph.
esophagitis
which bisph. is IV and is give just 1x/year
Zoledronate
Osteonecrosis of the Jaw is a rare but serious complication of bisph. therapy but most commonly in what patients
- IV administration
- Diagnosed with MM, breast or prostate Cx
- having tooth extractions, dental trauma
long term evaluation of Bisph use
stays in bone for long time so consider reevaluation after 5 years
Denosumab is a monoclonal antibody for what
RANKL
-inhibits osteoclast formation
Calcitonin is administered how?
decreases what?
- nasally
- decreases pain with acute vertebral compression fracture
Teriparatide is a fragment ofwhat
PTH
Teriparatide therapy is reserved for what patients
high risk due to high cost and risk of osteosarcoma
what are disadvantages of Teriparatide
- injection daily
- high cost
