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Orthopaedics > Pathology - Fractures > Flashcards

Pathology - Fractures Flashcards

1
Q

Mechanism of Action of Bisphosphonates?

A

Increases osteoclast cell death

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2
Q

Examples of Bisphosphonates?

A

Risedronate or alendronate (oral); Zoledronic acid (IV)

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3
Q

ADME of bisphosphonates?

A

Oral bisphosphonates on empty stomach with at least 240ml of water; wait before taking food (30min)

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4
Q

Adverse effects of bisphosphonates?

A

Significant: Atypical femoral fractures (prolonged use), severe bone, joint or muscle pain; Upper GI mucosa irritation; ocular effects (iritis, uveitis), hypocalcemia; osteonecrosis of jaw & external auditory canal
Oral: Nausea, Abdominal Pain, Heart-burn like symptoms
IV: Flu-like symptoms

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5
Q

Contraindications of bisphosphonates?

A

Hypocalcemia; abnormalities of esophagus; renal impairment; pregnancy & lactation

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6
Q

Precautions in bisphosphonates?

A

Active Upper GI, Risk Factors for Osteonecrosis of Jaw & External Auditory Canal

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7
Q

Mech of Action Denosumab?

A

Human Monoclonal Antibody vs RANKL = Less development of osteoclasts

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8
Q

Administration of Denosumab?

A
  1. SubCU injection every 6 m
  2. Co-administer 1000mg calcium + 400 IU vitamin D daily
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9
Q

Adverse Effects of Denosumab?

A
  1. Muscle, Back, Bone or Joint Pain
  2. GI effects - nausea, vomitting, diarrhoae
  3. Fatigue
  4. Increased cholesterol
  5. Osteonecrosis of Jaw (rare)
  6. Atypical Femur Fractures (rare)
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10
Q

Contraindications for Denosumab?

A

Hypocalcemia, Pregnancy

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11
Q

Precautions for denosumab?

A

Do not discontinue as may cause risk of spinal column fractures

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12
Q

Oestrogen therapy mechanism of action?

A

Maintain bone density

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13
Q

Uses of oestrogen therapy?

A

i) bone health in younger women
ii) women whose other menopausal symptoms also require treatment

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14
Q

Mechanism of Action of Raloxifene?

A

Selective oestrogen receptor modulator: mixed oestrogen receptor agonism and antagonism, mimicking effects of oestrogen on bone density in post menopausal women

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15
Q

Adverse Effects of Raloxifene?

A

Increase risk of blood clots, cause hot flashes

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16
Q

Advantage of Raloxifene?

A

Reduces risk of some types of breast cancer

17
Q

Calcitonin mechanism of action?

A

Secreted by parafollicular cells of thyroid gland, reduces blood calcium, inhibiting osteoclastic bone resorption (opposed action of PTH)

18
Q

Administration of calcitonin?

A

injection (IV, SC, IM) or nasal spray

19
Q

Adverse Effects of calcitonin?

A

Red streaks on skin
Injection site reaction
Feeling warmth
Redness of face, neck, arms and upper chest

20
Q

Contraindications of Calcitonin?

A

Hypersensitivity, hypocalcemia

21
Q

Mechanism of Action of Romosozumab?

A

Humanized mouse monoclonal antibody against sclerostin; removes sclerostin inhibition of the canonical Wnt signaling pathway that regulates bone growth = increasing bone formation and decreases bone resorption

22
Q

Uses of Romosozumab?

A

For women at high risk of fracture or who have failed or are intolerant to other osteoporosis therapies

23
Q

Administration of Romosozumab?

A

Subcu injection once monthly for 12m

24
Q

Adverse Effects of Romosozumab?

A

Significant: MI, Increase risk of CV death, stroke; transient hypocalcemia, hypersensitivity reactions (angioderma, erythema multiforme, urticaria, dermatitis, rash)
Rare: Osteonecrosis of Jaw, Atypical femur fractures

25
Q

Contraindications of Romosozumab?

A

Hypersensitivity, uncorrected hypocalcemia, history of MI or stroke

26
Q

Mechanism of Action of PTH therapy (parathyroid hormone similars - e.g. teriparatide)

A

PTH action, stimulates new bone formation and increases bone strength

27
Q

Administration of Teriparatide?

A

Once daily SC injection

28
Q

Precautions of Teriparatide?

A

Maximum treatment duration 24m in life time (increases risk of osteosarcomas)

29
Q

Adverse Effects of Teriparatide?

A
  1. Serious calciphylaxis
  2. Worsening of previously stable cutaneous calcification
  3. Transient Orthostatic Hypotension
  4. Hypercalcemia
30
Q

Contraindications of Teriparatide?

A
  1. Hypersensitivity
  2. Pre-existing hypercalcemia
  3. skeletal malignancies or bone metastases
  4. other metabolic bone diseases (Paget’s, Hyperparathyroidism), 5. unexplained elevations of alkaline phosphatase
  5. previous implant or external beam radiation to the skeleton
  6. hereditary disorders predisposing to osteosarcoma
  7. severe renal impairment
  8. pregnancy

Orthopaedics (6 decks)

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