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7262 MS Block 2 > Osteoporosis Pharmacotherapy Atanda > Flashcards

Osteoporosis Pharmacotherapy Atanda Flashcards

1
Q

Limit caffeine to how many servings/day?

A

two

excessive caffeine consumption can cause calcium excretion

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2
Q

Limit alcohol to how many drinks/day for women?

A

1 to 2

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3
Q

Limit alcohol to how many drinks/day for men?

A

2 to 3

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4
Q

Most older pts consume about __mg of dietary calcium daily.

A

600

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5
Q

Which therapies show evidence of reduction in both hip and vertebral fracture risk?

A
  • calcium and vitamin D
  • bisphosphonates
  • denosumab

these are the drugs of choice

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6
Q

Goal vitamin D level is __ to __ ng/mL

A

30, 50

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7
Q

Which form of calcium should not be given with meals?

A

calcium citrate

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8
Q

Some examples of drugs that have interactions with calcium:

A

tetracyclines
fluoroquinolones
levothyroxine

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9
Q

What is main AE of calcium supplementation?

A

constipation

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10
Q

Which form of calcium has the highest elemental %?

A

calcium carbonate

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11
Q

Should bisphosphonates be administered with calcium and vitamin D?

A

no

do not administer with any other meds/supps

administer in morning on empty stomach

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12
Q

For zolendronate consider drug holiday after __ years in high risk or until fracture risk no longer high

A

3

can continue for 6 years in high risk pts

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13
Q

Which bisphosphonate has highest bone absorption?

A

zolendronic acid

zolendronic acid > alendronate > ibandronate > risedronate

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14
Q

Which two bisphosphonates are not recommended if CrCl < 35?

A

alendronate

zolendronic acid

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15
Q

Which two bisphosphonates are not recommended if CrCl < 30?

A

ibandronate

risedronate

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16
Q

Can premedicate with acetaminophen to decrease infusion rxns of which bisphosphonate?

A

zolendronic acid

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17
Q

Bisphosphonate drug holiday:

What are criteria for high risk?

A

T-score <= -2.5
fracture
6-10yr duration of use

need 1-2 year drug holiday

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18
Q

Bisphosphonate drug holiday should last for __ or fewer years with intermittent BMD assessment

A

5

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19
Q

Bisphosphonate drug holiday:

What are criteria for low risk?

A

T-score above -2.5
no fracture
5 years duration of use

monitor BMD with drug holiday

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20
Q

What is dose of denosumab (antiresorptive)?

A

60mg subQ once every 6 months

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21
Q

2 CIs for denosumab?

A

hypocalcemia

pregnancy

22
Q

2 main aEs of denosumab?

A

peripheral edema

HTN

23
Q

Which osteoporosis agent can be used in pts with renal impairment?

A

denosumab

24
Q

2 recombinant PTH drugs?

A

teriparatide

abaloparatide

25
Q

Duration of teriparatide (anabolic) is limited to __ years

A

2

26
Q

There is a concern for __ with teriparatide ad abaloparatide

A

hypercalcemia

27
Q

What is dose of teriparatide?

A

20mcg subQ once daily

28
Q

Teriparatide is indicated for __ osteoporosis

a. postmenopausal
b. male
c. glucocorticoid induced

select all that apply

A

all of them

29
Q

Which recombinant PTH is only used for postmenopausal women at high risk for fractures?

A

abaloparatide

30
Q

Duration of abaloparatide use is limited to __ years

A

two

31
Q

Abaloparatide dose?

A

80mcg subQ once daily

32
Q

Mixed estrogen agonist/antagonists (SERMs) are indicated for who?

A

postmenopausal women with osteoporosis

33
Q

All mixed estrogen agonist/antagonists (SERMs) are contraindicated with what two conditions?

A

VTE

pregnancy

34
Q

Which mixed estrogen agonist/antagonist (SERM) is contraindicated with Hx of uterine bleeding, arterial thromboembolic disease, carcinoma of breast, hepatic impairment, and thrombophilic disorders?

A

bazedoxifene

35
Q

Which SERM is only indicated for postmenopausal women with a uterus?

A

bazedoxifene

36
Q

Is romosozumab an anabolic of antiresorptive?

A

anabolic

37
Q

Romosozumab is indicated for use in what pt population?

A

postmenopausal females at high risk for fracture

approved in 2019

38
Q

Romosozumab dose?

A

210mcg subQ once monthly

two consecutive injections of 105mcg each

39
Q

Duration of romosozumab is __ months

A

12

anabolic effects wane after 12 months

40
Q

Calcitonin is not preferred therapy

a. true
b. false

A

a. true

41
Q

Calcitonin is indicated for postmenopausal pts at least __ years past menopause

A

5

42
Q

What is dose of IM and subQ calcitonin?

A

100 units daily

43
Q

What is dose of intranasal calcitonin?

A

200 units (1 spray) in one nostril once daily

44
Q

What drug has an interaction with calcitonin and increases its urinary clearance?

A

lithium

lithium concentration decreases

45
Q

Should calcitonin be refrigerated?

A

yes

46
Q

Which osteoporosis agent has suggested link to malignancies?

A

calcitonin

47
Q

Which drug is indicated for osteoporosis prevention?

A

estrogen

48
Q

Estrogen dose?

A

0.3mg daily or cyclical (adjusted based on response)

49
Q

Osteoporosis is postmenopausal women and men > 50 with __ or __ fracture

A

hip, vertebral

50
Q

Osteoporosis is postmenopausal women and men > 50 with T-score <= __ at femoral neck, hip, or lumbar spine

A

-.25

51
Q

Osteopenia high risk is T-score between __ and __ AND 10yr probability of hip fracture >= __% OR 10 yr probability of major osteoporosis related fracture >= __ %

A

-1, -2.5, 3, 20

52
Q

consider calcium and vitamin D supplementation if steroid therapy >= __ months.

A

3

7262 MS Block 2 (10 decks)

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