Pharm - Osteoporosis Flashcards

1
Q

what drugs increase risk of osteoporosis

A
  • anticoags
  • anticonvulsants
  • glucocorticoids
  • methotrexate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

indications for oral calcium salts

A
  • mild hypocalcemia

- dietary supplements in adolescents, elderly, and post-menopausal women

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

adverse effects oral calcium salts

A

hypercalcemia, GI disturbances (constipation), lethargy, renal dysfunction

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

indications for parenteral calcium salts

A

rapidly increase calcium levels in patients with severe hypocalcemia

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

compare ergocalciferol and cholecalciferol

A

ergocalciferol: vitamin D2, occurs in plants and is used as a prescription drug and to fortify foods
cholecalciferol: vitamin D3, produced when our skin is exposed to sunlight, also available as a prescription drug

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

MOA and effects calcitonin-salmon

A

similar in structure and function to human calcitonin (decreases plasma calcium) but has a longer half life and greater potency

decreases plasma calcium, keeps calcium in the bones

inhibits activity of osteoclasts –> decreases bone resorption

also inhibits renal tubular absorption of calcium and increases calcium excretion

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

indications calcitonin-salmon

A

tx of establish osteoporosis but NOT prevention

also Paget dz of bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

administration calcitonin-salmon

A

intranasal spray and as parenteral for SC or IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

adverse effects calcitonin-salmon

A
  • nasal dryness (from the nasal spray)

- inflammatory reaction (from injection site)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MOA and effects of biphosphonates - alendronate

A

structural analogs of pyrophosphate, a normal constituent of bone

inhibits bone resorption by decreasing # and activity of osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

indications biphosphonates - alendronate

A
  • postmenopausal osteoporosis
  • osteoporosis in men
  • glucocorticoid induced osteoporosis
  • paget dz of bone
  • hypercalcemia of malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

administration of biphosphonates - alendronate

A

PO

other biphosphonates can be given PO or IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

side effects biphosphonates - alendronate

A

esophagitis***

osteonecrosis of jaw

atypical femur fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

list the other biphosphonates (other than alendronate) and how they are administered

A
  • risedronate (PO)
  • ibandronate (PO, IV)
  • tiludronate (PO)
  • zolendronic acid (IV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

adverse effects zolendronic acid

A

osteonecrosis of jaw and dose-dependent kidney damage

sometimes a fib

avoids GI problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA and effects raloxifene

A

selective estrogen receptor modulator (SERM)

blocks estrogen effects in breast and uterus and is an agonist of estrogen effects in bone

17
Q

indications raloxifene

A

prevent and treat postmenopausal osteoporosis

reduces risk of estrogen dependent breast cancer

18
Q

administration and half life of raloxifene

A

administration: oral

half life: 28 hours

19
Q

adverse effects raloxifene

A
  • increases risk of DVT, PE, stroke
  • pregnancy category X
  • hot flashes
20
Q

MOA and effects teriparatide (PTH 1-34)

A

recombinant PTH that retains activity of full length PTH

given as a daily pulsed therapy, allowing osteoblast responses to predominate over osteoclast –> increases bone formation

21
Q

indications teriparatide (PTH 1-34)

A

osteoporosis in postmenopausal women

osteoporosis in men

glucocorticoid-induced osteoporosis

22
Q

administration of teriparatide (PTH 1-34)

A

20 mcg given once daily by using pre-filled injectors with 28 doses

pulsed therapy

23
Q

adverse effects teriparatide (PTH 1-34)

A

nausea, headache, back pain, leg cramps

24
Q

MOA and effects denosumab

A

monoclonal antibody that is a RANKL inhibitor

decreases formation and function of osteoclasts –> decreased bone resorption

25
indications denosumab
treatment of osteoporosis in menopausal women at high risk of fractures prevention of skeletal related events in pts w/ bone mets form solid tumors
26
denosumab should be taken with what
calcium and vitamin D to prevent hypocalcemia
27
administration denosumab
injected every 6 months SQ
28
adverse effects denosumab
women w/ osteoporosis: back pain, pain in extremities, hypercholesteremia, UTI bone mets pts: fatigue, hypophosphatemia, nausea delays fracture healing osteonecrosis of jaw skin reactions
29
compare high and low ratios of RANKL/OPG
high: osteoclasts functioning and bone resorption occurs low: apoptosis of osteoclasts --> decreased breakdown of bone
30
what are some specific aspects of osteoporosis treatment in men
testosterone replacement
31
what are some drugs for hypercalcemia
- furosemid - glucocorticoids - biphosphenates - EDTA - gallium nitrate
32
MOA and effects cinacalcet
a "calcimemtic" drug (mimics calcium) binds to CaSR in parathyroid gland and increases their sensitivity to calcium and decreases PTH secretion
33
indications cinacalcet
primary and secondary hyperparathyroidism
34
administration and half life of cinacalcet
administration: oral half life: 30-40 hrs
35
adverse effects cinacalet
N/V/D
36
what is the management for osteoARTHRITIS
- weight management/exercises, braces - NSAIDs - duloxetine - opioid analgesics
37
what is the treatment for osteomyelitis
antibiotic treatment - clindamycin - rifampin - trimethoprim-sulfamethoxazole (bactrim) - fluoroquinolone