Pharm2 8 Osteoporosis pt2 Flashcards
If someone needs to be pulled off a bisphosphonate, and needs another osteoporosis med, which is the next best (in general)?
Denosumab (also has evidence for reducing vertebral, nonvertebral, and hip fractures)
Adverse effects of bisphosphonate, depending on route of admin
All
Oral (3)
IV (5)
All: N/V
Oral: Irritation or burning of the esophagus, Difficulty swallowing, Painful swallowing
IV: Arthralgia, Myalgia, Bone pain, Fever, Flulike symptoms (prevent by giving acetaminophen 1 hr beforehand)
Calcitonin Nasal Spray
Indications
Significantly reduces ___.
What’s the deal with it?
treatment of osteoporosis in women at least 5 years postmenopausal
Significantly reduces risk of new vertebral fractures
Not considered first-line monotherapy for osteoporosis
Efficacy not demonstrated for nonvertebral or hip fractures
Most common adverse effects of Calcitonin (2)
Rhinitis, nasal symptoms
Raloxifene
Indications
What does/doesn’t it reduce risk for?
Indications: prevention and treatment of osteoporosis in postmenopausal women
Significantly reduces risk of vertebral fracture
Not shown to reduce risk of nonvertebral or hip fractures
What’s an absolute CI for Raloxifene?
3 other adverse fx
Deep vein thrombosis
Other side fx: hot flashes, leg cramps, fluid retention
Teriparatide [rDNA origin] injection
Indications (3)
What’s it do?
Treatment of osteoporosis in postmenopausal women and men at high risk for fracture
Treatment of women and men with glucocorticoid-induced osteoporosis at high risk for fracture
Increasing bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture
Significantly reduces risk of vertebral and nonvertebral fractures
This is an IV-effusion, won’t see primary providers doing this.
What’s the unique drug that builds up bone instead of preventing demineralization?
Denosumab
Denosumab: Newest Approved Agent.
How is it administered?
Twice Yearly Sub Q. builds up bone.
Fully human monoclonal antibody against RANKL
Indications: treatment of osteoporosis in postmenopausal women at high risk for fractures
Increases BMD
MoA of Denosumab
Denosumab is a fully human monoclonal antibody to the receptor activator of nuclear factor-κB ligand (RANKL) that blocks its binding to RANK, inhibiting the development and activity of osteoclasts, decreasing bone resorption, and increasing bone density
Given its unique actions, denosumab may be useful in the treatment of osteoporosis
This is something you’d switch to prevent the chalkstick fractures with bisphosphonates
Denosumab Adverse fx (7)
Most common: back pain, pain in the extremities, musculoskeletal pain, high cholesterol levels, urinary bladder infections
Serious adverse reactions: infections of the skin, cellulitis
Quality of Evidence for Antifracture Efficacy In Postmenopausal Osteoporosis
Name the 4 drugs that have A’s in each category (spine, nonvertebral, hip)
Alendronate
Estrogen
Risedronate
Zoledronic acid
Referral to an osteoporosis specialist is appropriate when a patient:
Is intolerant of approved therapies
Fails to respond to treatment
Apparent loss of BMD on serial studies
Fractures despite treatment
Assessing “Treatment Failure” with osteoporosis meds. If the BMD continuous to decline beyond any significant change: (2)
Rule out undiagnosed secondary problems
Evaluate compliance and absorption issues
Maybe they’re sneaking a liter of scotch w/o sharing some with me ☺
20%-30% of patients taking oral osteoporosis medications suspend their medications within 6-12 months of initiation due to: (3)
Side effects
Lack of knowledge
Reluctance to take regular medications
