Pharm - Osteoporosis

Question 1

what drugs increase risk of osteoporosis

Answer 1

• anticoags
• anticonvulsants
• glucocorticoids
• methotrexate

Question 2

indications for oral calcium salts

Answer 2

• mild hypocalcemia

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

Question 3

adverse effects oral calcium salts

Answer 3

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

Question 4

indications for parenteral calcium salts

Answer 4

rapidly increase calcium levels in patients with severe hypocalcemia

Question 5

compare ergocalciferol and cholecalciferol

Answer 5

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

Question 6

MOA and effects calcitonin-salmon

Answer 6

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

Question 7

indications calcitonin-salmon

Answer 7

tx of establish osteoporosis but NOT prevention

also Paget dz of bone

Question 8

administration calcitonin-salmon

Answer 8

intranasal spray and as parenteral for SC or IM

Question 9

adverse effects calcitonin-salmon

Answer 9

• nasal dryness (from the nasal spray)

- inflammatory reaction (from injection site)

Question 10

MOA and effects of biphosphonates - alendronate

Answer 10

structural analogs of pyrophosphate, a normal constituent of bone

inhibits bone resorption by decreasing # and activity of osteoclasts

Question 11

indications biphosphonates - alendronate

Answer 11

• postmenopausal osteoporosis
• osteoporosis in men
• glucocorticoid induced osteoporosis
• paget dz of bone
• hypercalcemia of malignancy

Question 12

administration of biphosphonates - alendronate

Answer 12

PO

other biphosphonates can be given PO or IV

Question 13

side effects biphosphonates - alendronate

Answer 13

esophagitis***

osteonecrosis of jaw

atypical femur fractures

Question 14

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

Answer 14

• risedronate (PO)
• ibandronate (PO, IV)
• tiludronate (PO)
• zolendronic acid (IV)

Question 15

adverse effects zolendronic acid

Answer 15

osteonecrosis of jaw and dose-dependent kidney damage

sometimes a fib

avoids GI problems

Question 16

MOA and effects raloxifene

Answer 16

selective estrogen receptor modulator (SERM)

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

Question 17

indications raloxifene

Answer 17

prevent and treat postmenopausal osteoporosis

reduces risk of estrogen dependent breast cancer

Question 18

administration and half life of raloxifene

Answer 18

administration: oral

half life: 28 hours

Question 19

adverse effects raloxifene

Answer 19

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

Question 20

MOA and effects teriparatide (PTH 1-34)

Answer 20

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

Question 21

indications teriparatide (PTH 1-34)

Answer 21

osteoporosis in postmenopausal women

osteoporosis in men

glucocorticoid-induced osteoporosis

Question 22

administration of teriparatide (PTH 1-34)

Answer 22

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

pulsed therapy

Question 23

adverse effects teriparatide (PTH 1-34)

Answer 23

nausea, headache, back pain, leg cramps

Question 24

MOA and effects denosumab

Answer 24

monoclonal antibody that is a RANKL inhibitor

decreases formation and function of osteoclasts –> decreased bone resorption

Question 25

indications denosumab

Answer 25

treatment of osteoporosis in menopausal women at high risk of fractures prevention of skeletal related events in pts w/ bone mets form solid tumors

Question 26

denosumab should be taken with what

Answer 26

calcium and vitamin D to prevent hypocalcemia

Question 27

administration denosumab

Answer 27

injected every 6 months SQ

Question 28

adverse effects denosumab

Answer 28

women w/ osteoporosis: back pain, pain in extremities, hypercholesteremia, UTI bone mets pts: fatigue, hypophosphatemia, nausea delays fracture healing osteonecrosis of jaw skin reactions

Question 29

compare high and low ratios of RANKL/OPG

Answer 29

high: osteoclasts functioning and bone resorption occurs low: apoptosis of osteoclasts --> decreased breakdown of bone

Question 30

what are some specific aspects of osteoporosis treatment in men

Answer 30

testosterone replacement

Question 31

what are some drugs for hypercalcemia

Answer 31

- furosemid - glucocorticoids - biphosphenates - EDTA - gallium nitrate

Question 32

MOA and effects cinacalcet

Answer 32

a "calcimemtic" drug (mimics calcium) binds to CaSR in parathyroid gland and increases their sensitivity to calcium and decreases PTH secretion

Question 33

indications cinacalcet

Answer 33

primary and secondary hyperparathyroidism

Question 34

administration and half life of cinacalcet

Answer 34

administration: oral half life: 30-40 hrs

Question 35

adverse effects cinacalet

Answer 35

N/V/D

Question 36

what is the management for osteoARTHRITIS

Answer 36

- weight management/exercises, braces - NSAIDs - duloxetine - opioid analgesics

Question 37

what is the treatment for osteomyelitis

Answer 37

antibiotic treatment - clindamycin - rifampin - trimethoprim-sulfamethoxazole (bactrim) - fluoroquinolone