Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Women's Health 1 > Pharm: Osteoporosis > Flashcards

Pharm: Osteoporosis Flashcards

1
Q

Define Osteoporosis

A
  • Common disease characterized by low bone mass with microarchitectural disruption and skeletal fragility, resulting in an increased risk of fracture, particularily at the spine, hip, wrist, humerus, and pelvis.
  • T-score < -2.5
  • Osteoporotic fractures occur fro a fall from standing height or less without major trauma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define Osteopenia

A
  • Bone density that is not normal but also not as low as osteoporosis.
  • T-score of -1 to -2.5.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define T-score

A
  • Result of DEXA scan.
  • Comparison of a woman’s bone density with that of healthy young women.
  • Negative means thinner bones that average; the more negative, the higher the risk of bone fracture.
  • Normal value is -1 or above
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define DEXA scane

A
  • MC and accurate way to perform bone density scanning.

- Uses low-dose x-rays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define fragility fracture

A

Pathologic fracture that occurs as a result of normal activities. Three sites: vertebral, neck of femur, and wrist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define low trauma fx

A

no definition… I’m thinking this is a fragility fracture…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

4 components of a bone healthy lifestyle

A
  • Smoking cessation
  • Limit alcohol intake
  • Well-balanced diet with adequate calcium and vitamin D
  • Weight bearing exercise and fall prevention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

9 Risk factors for fx

A
  • Advanced age
  • Previous Fx
  • Glucocorticoid therapy
  • Current smoker
  • Low BMI or body weight
  • Hx of osteoporosis/low trauma fx in a first degree relative
  • Excessive alcohol intake
  • Rheumatoid arthritis
  • Secondary osteoporosis dt hypogonadism, premature menopause, malabsorption, chronic liver dz, inflammatory bowel dz.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Osteoporosis prevention Goals

  • gen pop birth to 30
  • gen pop 30+
  • osteopenia
A
  • Gen population birth to 30: achieve highest peak bone mass possible
  • Gen population 30+: maintain BMD and minimize bone loss
  • Osteopenia: prevent progression to osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Osteoporosis prevention treatments

A

Generally a bone healthy lifestyle beginning at birth and continuing throughout life

Treatments:

  • Calcium and Vitamin D
  • Bisphosphonates
  • Raloxifene
  • Hormone therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tx goal for pt with osteoporosis AND

  • high risk for fx
  • with a fracture
A
  • High risk for fx: increase BMD, prevent further bone loss, prevent falls and fx
  • With fx: adequate pain control, max rehab to restore independence and QOL, prevent subsequent fx and death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment options for osteoporosis

A
  • Calcium and Vitamin D
  • Bisphosphonates
  • Raloxifene
  • Denosumab or Teriparatide (PTH)→for high risk fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 steps to take to prevent falls

A
  • Ambulation assistance (cane, walker, etc.)
  • Vision correction
  • Modifications for improved safety in living environment (handles in shower, etc.)
  • Review medication list – remove those that increase fall risk (antidepressants, anti-hypertensives, benzos, diuretics, alcohol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Calcium daily recommendations

A
  • Adults < 50 1000 mg/day elemental calcium
  • Adults ≥ 50 1200 mg/day elemental calcium
  • Adults on long term glucocorticoids 1500 mg/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Vitamin D daily recommendations

A
  • Adults < 50 400-800 IU/day
  • Adults ≥ 50 800-1000 IU/day
  • Adults on long term glucocorticoids 800-1000 IU/day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

% elemental calcium in

  • calcium carbonate
  • calcium citrate
A
  • carbonate: 40%
    Tums and Os-cal
  • citrate: 21%
    Citracal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Example how to calculate dose of calcium in a Tums

A

600 mg calcium carbonate capsule contains 240 mg (40%) elemental calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Note about calcium absorption

A

absorption is dose-related, spread it throughout day into doses ≤ 600 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Place in prevention therapy for bisphosphonate

A

First line for most patients

  • High efficacy
  • Low cost
  • Long-term safety data
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

4 bisphosphonate options list

A
  • Alendroneate
  • Risedronate
  • Ibandronate
  • Zoledronic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which two bisphosphonate options are first line choice

A

Alendronaate and risedronate

  • generic, cheaper
  • reduce both vertebral and hip fractures
  • Avail in Q week dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prevention dose for

  • Alendroneate
  • Risedronate
  • Zoledronic acid
A
  • Alendronate: 35mg PO/week
  • Risedronate: 35mg PO/week
  • Zoledronic Acid: 5mg IV every 2 years
23
Q

How long to use bisphosphonate therapy when using for prevention

A

3-5 years

24
Q

Raloxifene dose

A

60 mg PO daily

25
Q

Raloxifene

  • place in therapy
  • what pt is it not suited for
A
  • May be first line therapy for prevention of osteoporosis in women who are high risk for invasive breast cancer (but bisphosphonate has better efficacy)
  • women who cannot or want to avoid bisphosphonates
  • Not for use in men or pts on long term corticosteroid tx
  • Avoid in premenopausal women dt estrogen-blocking action which can reduce bone density.
26
Q

Hormone therapy

- place in prevention of osteoporosis

A
  • Less efficacy than bisphophonates, similar efficacy to raloxifine
  • Not first line, only use in women who need HT for menopausal sx, do not use solely for osteoporosis prevention
  • Not for men or glucocorticoid induced osteoporosis
27
Q

Forms of hormone therapy used for osteoporosis? how to dose?

A
  • patch or tablet (min benefit with vaginal ring and cream)

- use lowest possible dose

28
Q

Hormone therapy example approved for osteoporosis prevention

A

Menostar

  • ultra-low dose 17β- estradiol
  • weekly patch
29
Q

Bisphosphonate therapy for treatment of osteoporosis dosing for

  • Alendronate
  • Risedronate
  • Zoledronic acid
A
  • Alendronate: 70mg PO/week
  • Risedronate: 35mg PO/week or 150mg PO/month
  • Zoledronic Acid: 5mg IV once a year
30
Q

How long to continue Bisphosphonate when used to treat osteoporosis

A

5+ years as needed

31
Q

How to use denosumab for osteoporosis treatment

A

same as prevention (as far as I can tell?!?!)

32
Q

Denosumab use for treatment of osteoporosis

- indications for use

A
  • not first line for women with uncomplicated osteoporosis
  • Postmenopausal osteoporosis esp who have failed or can’t/won’t take bisphosphonates
  • Renal insufficiency (can’t use bisphosphonates)
  • Prostate cancer, receiving androgen deprivation therapy for prostate cancer (aka good for men)
  • Breast cancer receiving aromatase inhibitor
33
Q

Denosumab

- overview of who should use it

A

osteoporosis in postmenopausal women
- at high risk of fx
OR
- who do not tolerate or get enough benefit from other osteoporosis medications

34
Q

Indications for use of teriparatide for treatment of osteoporosis

A
  • Treatment only (only med that increases bone formation)
  • for those who have failed other therapies
  • Indicated for women, men, and long term glucocorticoid use pts at high-risk for fractures:
  • Hx of fragility fracture
  • Multiple risk factors for fracture
  • Low bone density score (T score < -3.5)
35
Q

2 cases when teriparatide may be considered initial treatment

A
  1. Women with severe osteoporosis (T score < -2.5) AND fragility fracture
  2. Women with severe osteoporosis (T score < -3.5) WITHOUT fragility fracture
36
Q

Administration of teriparatide

A

Prefilled pen (refrigerate), SC 20 mcg daily into thigh or abdomen

37
Q

Time frame for use of teriparatide

A

<2 years due to lack of long term safety studies

38
Q

Bisphosphonate CI

A
  • Cannot remain uprgith for min 30 minutes
  • Esophageal or swallowing disorders
  • Cr clearance <30 mL/min
  • Hypoglycemia
  • Pregnancy
39
Q

Raloxifine CI

A
  • Women with hot flashes
  • Hx venous thromboembolism (increases risk)
  • Hip fx is primary concern
40
Q

Denosumab CI

A

Uncorrected hypocalcemia

41
Q

Teriparatide CI

A
  • Metabolic bone disease
  • Paget’s disease
  • Previous skeletal irradiation
  • Elevated alk phos of unknown etiology
  • Severe renal dysfunction
42
Q

Patient education for administration of bisphosphonate

A
  • Take with a full 6-8 oz glass of plain water

- Stay upright for min 30-60 minutes to minimize esophageal irritation

43
Q

3 Patient factors that indicate the need for therapy

A
  • Vertebral or hip fracture
  • Hip DXA (femoral neck or total hip) or lumbar spine T-score < -2.5
  • Osteopenia and FRAX calculation of 10-year prob of a hip fracture > 3% or the 10-year prob of any major osteoporosis-related fracture is >20%
44
Q

Calcium & VitD

  • for prevention and/or treatment?
  • Reduces risk for what type of fx
A
  • prevention and tx

- n/a

45
Q

Bisphosphonate

  • for prevention and/or treatment?
  • Reduces risk for what type of fx
A
  • prevention and tx
  • Vertebrae and hip: alendronate and risedronate
  • Vertebrae: ibandronate
46
Q

Raloxifene

  • for prevention and/or treatment?
  • Reduces risk for what type of fx
A
  • prevention and tx

- vertebrae

47
Q

Hormone therapy

  • for prevention and/or treatment?
  • Reduces risk for what type of fx
A
  • prevention only
48
Q

Denosumab (Prolia)

  • for prevention and/or treatment?
  • Reduces risk for what type of fx
A
  • Treatment only

- vertebrae and hip

49
Q

Teriparatide (PTH)

  • for prevention and/or treatment?
  • Reduces risk for what type of fx
A
  • treatment only

- vertebrae and non-vertebral

50
Q

ADR

- bisphosphonate

A
  • GI (MC): perforation, ulceration, GI bleeding
    (Use IV ibandronate and zolendronic acid with GI CI or intolerance)
  • MSK pain
  • Osteonecrosis of the jaw
51
Q

ADR Denosumab (Prolia)

A
  • Back pain
  • MSK pain
  • Pain in extremities
  • Hyperlipidemia
  • Cystitis
  • Severe: jaw osteonecrosis and atypical fractures
52
Q

ADR: Teriparatide (PTH)

A
  • Nausea
  • Dizzy
  • Leg cramps
  • Transient orthostatic hypotension
  • Osteosarcoma
53
Q

ADR

- Raloxifene

A

Generally well tolerated – possible hot flashes and leg cramps

Women's Health 1 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions