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LAST PHARM TEST > Osteoporosis Tx > Flashcards

Osteoporosis Tx Flashcards

1
Q

Vitamin D 3 supplements called

A

cholecalciferol

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2
Q

Vitamin D2 supplements called

A

ergocalciferol

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3
Q

is D3 or D2 more potent

A

D3 at higher concentrations

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4
Q

when is vit D toxic?

A

over 500 nmol/L of 25 OH vit D

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5
Q

Signs of vit d toxic

A

anorexia, weight loss, arrhythmias, polyuria, hypercalcemia

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6
Q

when over 125 nmol/L of 25 OH vit D what risks are there?

A

increased risk of mortality, cancer, CVE, falls/ fractures

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7
Q

what do corticosteroids do if taken with vit d?

A

impair vit D metabolism

reduces calcium absorption

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8
Q

orlistat, cholestyramine with vit d?

A

decreases absorption of fat soluble vitamins (vit D)

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9
Q

phenobarbital and phenytoin with vit D?

A

increase liver metabolism of vit D

reduces calcium absorption

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10
Q

what is MORES 2016

A

male osteoporosis risk estimation score

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11
Q

when should men get DXA screening?

A

men with MORE score over 6

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12
Q

what is FRAX?

A

online fx risk calculator
only works for tx naïve pts
10 yr probability of hip and major osteoporotic fx

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13
Q

when does FRAX recommend tx ?

A

when osteopenic pts have a risk for hip fx over 3%, or a major osteoporosis fracture risk over 20%

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14
Q

T/F calcium / vit D should be an adjuvant therapy for all individuals over 65

A

TRUE!!

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15
Q

is carbonate or citrate absorbed better?

A

citrate! can take whenever in regards to food

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16
Q

Calcium carbonate must be __

A

taken with food

and its cheaper :)

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17
Q

why need to take vit D BID?

A

body can only absorb so much vitamin D at one time.. take BID to get full absorption

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18
Q

4 bisphosponates

A

Alendrontae
Risedronate
Ibandronate
Zolendronic acid

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19
Q

T/F bisphosphonates treat and prevent osteoporosis?

A

TRUE

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20
Q

bisphosphonate MOA

A

interrupt osteolytic cycle

increase bone mass, reduce incidence of fx by stopping osteoclast activity

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21
Q

complication bsiphos?

A

osteonecrosis of jaw (seen mostly with IV use)

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22
Q

warning bisphosphates

A

Avoid pill induced esophagitis
Take on empty stomach and sit up for 30-60 min
avoid in childbearing age

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23
Q

why avoid bisphosphate in childbearning age women?

A

bind to bone for 10 years questionable what can occur to a fetus down the road

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24
Q

4 things to monitor in bp use

A

DXA, BAP, urine NTX and CTX, watch for uveitis and scleritis in first time users

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25
Q

black box warning for all bisphosphonates

A

thigh or groin pain

requires XRAY order to look for atypical trochanteric fx

26
Q

alendronate main ADR

A

more GI side effects than other bp

also..hypocalcemia

27
Q

alendronate brand

A

Fosamax.. if on too long can actually cause osteoporosis / fx

28
Q

ibandronate reduces ___ by 50% over 3 years

A

spine fractures

pt wait 60 min before eating or drinking

29
Q

zoledronate is a yearly ___

A

5 mg IV for more than 15 min

REDUCED spine fx by 70% over 3 years and hip by 41% over 3 yr

30
Q

zoledronic acid indication

A

hypercalcemia of malignancy, MM and bone metasis

31
Q

___ bp is the one with highest incidence of ONJ

A

zolendronic acid

32
Q

monitor __ with zolendronic acid

A

renal fx

esp pts over 65 y

33
Q

pamidronate is similar to ___ but less potent

A

zoledronic acid

34
Q

BP concerns

A 
GI side effects 
infusion rxn 
ONJ 
arrhythmias 
bone quality 
uveitis/ scleritis
35
Q

men and women rates OP fx

A

women one in two
men one in 4
over 50 yo
will get fx

36
Q

SERM MOA

A

selective modulators?

37
Q

MOA Teriparatide

A

helps stmulate osteoblast activity
for postmenopausal women with OP and high fx risk
male primary or hypogonadal OP with high fx risk

38
Q

chemical name teriaparatide

A

N1-34 PTH

39
Q

teriaparatide good for pts who..

A

have blunted bp effects

40
Q

teriaparatide black box

A

osteosarcoma
- don’t give to anyone who had prior RT or skeletal malignancies ..this drug builds bone.. if had previous problems not a good idea

41
Q

CI teriaparatide

A

pagest dz, preg and nursing, peds, young adults, prior radiation, bone mets, skeletal malignancies, hypercalcemia

42
Q

max length of teriparatide tx

A

2 yrs only

43
Q

compliance issues with teriparatide?

A

a lot like insulin, have to carry and keep cold

44
Q

teriparatide adr

A

hypercalcemia, HA< myalgia, arthralgia

45
Q

abaloparatide is a ___ analong

A

parathyroid hormone analog

46
Q

abaloparatide ADR

A 
hypercalciuria 
dizzy 
n 
HA 
palpitations 
fatigue 
upper abd pain 
vertigo
47
Q

___ is monoclonal ab that blocks RANK ligand

A

Denosumab

48
Q

what does RANK ligand do?

A

stimulates osteoclasts

49
Q

RANKL is a member of what cytokine family?

A

TNF

50
Q

indications denosumab

A

treatment of postmenopausal with OP and high fx risk

51
Q

how is denosumab delivered?

A

sub Q injections every 6 mo

52
Q

what should pt take with denosumab?

A

calcium and vit d

53
Q

denosumab indications

A

more for pt with unresectable giant cell tumor of bone

or at risk for rx: pts on ADT or AI therapy for prostate or breast cancer

54
Q

denosmab can prevent___

A

Skeletal related events in pts with bone metases from solid tumors

55
Q

ADR denosumab

A

cellulitis, eczema, flatulence, fatigue, asthenia, hypophosphatemia, N/ dyspnea, arthralgia, HA

56
Q

warnings densoumab

A

hypocalcemia, ONJ, rash, infection, atypical fx

- similar to bp meds

57
Q

denosumab is pregger class___

A

D: associated with fetal loss and deformity in animal studies

58
Q

calcitonin

A

inhibits bone resorption

59
Q

indications calcitonin

A

for women who cannot take estrogen and are 5 yrs or more post menopause

60
Q

calcitonin effective?

A

not really.. mild increase in vertebral BMD .. but fx risk help? no..

61
Q

OP first line tx options (4)

A

alendronate, risedronate, zoledronic acid, or denosumab

62
Q

T/F advise against combo OP tx?

A

TRUE!

LAST PHARM TEST (4 decks)

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