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MSK 2-Pharmacology > Pharm of Osteoporosis (Fitz) > Flashcards

Pharm of Osteoporosis (Fitz) Flashcards

1
Q

T score of -1 to -2.5 indicates__

T score of -2.5 to -4 or higher indicates__

A

osteopenia

osteoporosis

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2
Q

this Ca supplement NEEDS ACID to dissolve and for absorption, taken “at” or “after” meals, less stomach acid with aging

A

Ca carbonate

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3
Q

this Ca supplement does not require stomach acid for absorption, may be taken between meals, but costs more

A

Ca citrate

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4
Q

when does the Vit D requirement exceed >800 IU/day?

A
  • GI malabsorption disorders
  • If on corticosteroids, certain anticonvulsants, loops, heparin
  • elderly who have less exposure/response to sunlight, less hydroxylation in liver and kidney
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5
Q

adverse effect of Glucocorticoids?

A

Impairs vit D absorption and imapirs metabolic activation in liver and kidney

Lowers serum Ca

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6
Q

adverse effect of carbamazepine and phenytoin?

A

induction of CYP450, hepatic inactivation of Vit D

Lowers serum Ca

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7
Q

adverse effect of Furosemide?

A

Ca wasting

lowers serum Ca

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8
Q

list drug classes mentioned in lecture that are responsible for secondary cause of osteoporosis:

A

glucorticoids-prednisone, methyprednisolone, budesonide

anticonvulsants-carbamazepine, phenytoin

loop diuretics-furosemide

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9
Q

what effect do the following hormones have on Ca resorption:
Calcitonin: ___
PTH: ___

A

calcitonin: decrease Ca resorption

PTH: increase Ca resorption

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10
Q

effect of 1,25(OH)-D3 (calcitriol) in Ca absorption?

A

increase absorption of Ca in intestine

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11
Q

list SERMs for osteoporosis

A

Raloxifene and Tamoxifen

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12
Q

List bisphosphonates for osteoporosis

A

the “-dronates”

alendronate, ibandronate, pamidronate, risedronate, zolendronate

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13
Q

list biologicals for osteoporosis

A

teraparatide and calcitonin

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14
Q

list Abs for osteoporosis

A

denosumab

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15
Q

which drug classes inhibit OSTEOCLASTS and are anti-resorptive tx?

A

SERMs
Bisphosphonates
Biologicals-Calcitonin
Abs

Anabolic tx that activates OSTEOBLASTS=Teraparatide (biological)

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16
Q

Benefits of Estrogen HRT in ALL tissues? Risks?

A

benefits: Increased bone health, decreased menopause symptoms
risks: increase breast cancer, increased uterine cancer, increase heart attack, increase stroke, increased osteoporosis

17
Q

SERMs (raloxifene) and Bisphosphonates are FDA approved for __

A

prevention AND tx

tx only=calcitonin, terparatide, denosumab

18
Q

MOA of estrogens and SERMs in osteoclasts? MOA in breast epithelium

A

agonists at estrogen receptors in osteoclasts

antagonists at estrogen receptors in breast epithelium

19
Q

what is the SERM of choice d/t its safety and efficacy..it is usually chosen for osteoporosis prevention when there is an independent need for breast CA prophylaxis

A

Raloxifene

20
Q

__ has a worse endometrial adverse effect profile than Raloxifene and will have increased uterine bleeding and cancer with this drug

A

Tamoxifen

-Raloxifene is NOT associated with bag bleeding or an increased risk of endometrial hyperplasia or cancer

21
Q

what is a major risk associated with HRT & estrogens, Raloxifene, and Tamoxifen?

A

all increase the risk of venous thromboembolic events

MI, stroke

22
Q

MOA of Bisphosphonates?

A

inhibit FPP synthase

inhibit bone resorption through effects on osteoclasts

23
Q

contraindication for using bisphosphonates?

adverse events associated with oral bisphosphonates?

A

pre-existing hypocalcemia is a contraindication

esophagitis and esophageal ulcer are well-recognized adverse events associated with oral bisphosphonates

24
Q

how to administer bisphosphonate?

A
  • take with a full glass of water in morning
  • do NOT eat or drink anything for at least 30 mins after taking (Ibandronate: 60 mins)
  • do NOT lie down for at least 30 mins (Ibandronate: 60 min)
25
Q

how to improve bisphosphonate compliance?

A

IV Zoledronate 5 mg, 1x per yr –> 100% bioavailability d/t IV, high potency

improved convenience, compliance, and efficacy

26
Q

rare complication seen in pts taking bisphosphonates?

A

Osteonecrosis of the jaw
most commonly in pts w:
-receiving IV bisphosphonates, ~90%
-Dx with MM, breast CA, and prostate CA, ~85%
-having tooth extractions, dental trauma, ~60%

27
Q

issues with chronic bisphosphonate use?

A

Bps remain in bone for decades-there is no known way to remove Bps from bones

-consider periodic reevaluation of continued BP tx, particularly pts who have been tx for > 5 yrs

28
Q

Denosumab is a monoclonal Ab against __, inhibits __ formation, administered __ at 6 month intervals. It increased BMD and reduces risk of fx

A

RANKL

Osteoclast

SubQ

29
Q

this hormone tx inhibits osteoclast action (anti resorptive), has a modest effect < bisphosphonates, given 200 IU nasally/day, DECREASE PAIN WITH ACUTE VERTEBRAL COMPRESSION FX

A

Calcitonin

30
Q

this drug is is administered intermittently, and stimulates osteoblastic activity (anabolic). Has very short t1/2, no deposition in bone

A

Teriparatide

31
Q

Teriparatide is reserved for these pts:

A

Reserved for high risk pts: his cost, risk of osteosarcoma

32
Q

approved indications for Teriparatide?

A
  • postmenopausal women with osteoporosis at HIGH RISK for fx
  • increase bone mass in men with primary or hypogonadal osteoporosis at HIGH RISK for fx
  • tx of men and women with osteoporosis with sustained, systemic glucocorticoid tx at HIGH RISK for fx
33
Q

these osteoporosis drugs are effective in men:

A

bisphosphonates

34
Q

__ is a CaSR activator that lowers PTH levels by increasing sensitivity of CaSR to extracellular Ca

A

Cinacalcet

35
Q

what drug to tx overactive PT gland in dialysis pts with CKD?

A

Cinacalcet

also used to tx high blood Ca levels in pts with PT cancer

MSK 2-Pharmacology (7 decks)

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