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Skeletal Systems > Pharmacotherapy of Osteoporosis > Flashcards

Pharmacotherapy of Osteoporosis Flashcards

1
Q

Pharmacotherapy of Osteoporosis

A
  1. Calcium and Vitamin D Therapy
  2. Bisphosphonates
  3. Selective Estrogen Receptor Modulators (SERMs)
  4. Calcitonin
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2
Q

Calcium Salts

A
  1. Prototype Drug
    - Calcium Salts
  2. Therapeutic Class
    - Calcium Supplements
  3. MOA
    - To return serum calcium levels to normal
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3
Q

Primary Use of Calcium Salts

A

Used to prevent and treat mild hypocalcemia for Osteoporosis, Paget’s Disease, Chronic Hypoparathyroidism, Rickets, Pregnancy, Lactation, Rapid Childhood Growth

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4
Q

Adverse Effects of Calcium Salts

A
  1. Hypercalcemia
  2. IV Administration of Calcium may cause Hypotension, Bradycardia, Dysrhythmias, Cardiac Arrest
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5
Q

Role of Nurse (Calcium Salts)

A
  1. Assessment
    - For Signs of Hypocalcemia: Facial Twitching, Muscle Spasms, Paresthsia, Seizure
    - For S&S of Hypercalcemia: Drowsiness, Lethargy, Weakness, Headache, Anorexia, Nausea, Vomiting, Thirst, Increased Urination
  2. Contraindications
    - For patients with a History of Renal Calculi, Digoxin Toxicity, Dysrhythmias, Hypercalcemia
  3. Investigation
    - For History of Fracture
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6
Q

Contraindication of Calcium Salts

A

In patients with Ventricular Fibrillation, Metastatic Bone Cancer, Renal Calculi, and Hypercalcemia

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7
Q

Drug-Drug Interactions with Calcium Salts

A
  1. Concurrent use with Digoxin increases the risk of Dysrhythmias
  2. Magnesium may compete for GI Absorption
  3. Calcium decreases the absorption of Tetracyclines
  4. Calcium may antagonise the effects of Calcium Channel Blockers
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8
Q

Drug-Herbal Food / Food Interaction with Calcium Salts

A
  1. Zinc-Rich foods may decrease the absorption of Calcium
  2. Alcohol, Caffeine, and Carbonated Beverages effect the Absorption of Calcium
  3. Oxalic Acid in Spinach, Rhubarb, Swiss Chard, and Betts can suppress Calcium Absorption
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9
Q

Administration Alerts for Calcium Salts

A
  1. Give Oral (PO) Calcium Supplements with meals or within 1 hour following meals
  2. Administer Intravenous (IV) Supplements slowly to avoid Hypotension, Dysrhythmias, and Cardiac Arrest
  3. Pregnancy Category B
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10
Q

Vitamin D Therapy

A
  1. Prototype Drug
    - Calcitriol
  2. Therapeutic Class
    - Vitamin D
  3. Pharmacological Class
    - Bone Receptor Inhibitor
  4. MOA (As Active Form of Vitamin D)
    - Promotes Intestinal Absorption of Calcium
    - Reduces Bone Resorption
    - Elevates Serum Levels of Calcium
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11
Q

Drug-Drug Interactions with Vitamin D Therapy

A
  1. Thiazide Diuretics may enhance the effects of Vitamin D, causing Hypercalcemia
  2. Too much Vitamin D may cause Dysrhythmias (Abnormal/Irregular Heartbeat) in patients who are receiving Digoxin (Used to improve the strength and efficiency of the Heart)
  3. Magnesium Antacids / Supplement should not be given concurrently due to the increased risk of Hypermagnesemia
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12
Q

Drug-Herbal / Food Interaction with Vitamin D Therapy

A
  • Large amounts of Calcium-rich Foods with Vitamin D as it may cause Hypercalcemia
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13
Q

Administration Alerts with Vitamin D Therapy

A
  1. Protect capsules from Light and Heat
  2. Pregnancy Category C
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14
Q

Bisphosphanates

A
  1. Prototype Drug
    - Alendronate (Fosamax)
  2. Therapeutic Class
    - Drug for Osteoporosis
  3. Pharmacological Class
    - Bisphosphonate, Bone Resorption Inhibitor
  4. MOA
    - Inhibits bone resorption by inhibiting osteoclast activity
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15
Q

Primary Use of Bisphosphonate

A
  • For prevention and treatment of
    1. Osteoporosis in Postmenopausal Women
    2. For Corticosteroid-Induced Osteoporosis
    3. For Osteoporosis in Men
    4. For Paget’s Disease (Disease of bone involving cellular remodelling and deformity of one or more bones)
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16
Q

Adverse Effects of Bisphosphonate

A
  1. Diarrhoea, Nausea, Vomiting, GI Irritation
  2. Metallic- or Altered-Taste Perception
  3. Pathologic fractures with Long-term Use (Bone fractures caused by weakness of bone)
17
Q

Contraindication of Bisphosphonates

A
  1. Patients with osteomalacia (Softening of bones caused by Impaired Bone Metabolism)
  2. *For patients with Renal Impairment, Heart Failure, Hyperphosphatemia, Liver Disease, Fever or Infection, Active Upper GI Problems, and Pregnancy
18
Q

Drug-Drug Interactions with Bisphosphonates

A
  1. Calcium, Iron, Antacids containing Aluminium or Magnesium, and certain Mineral supplements interfere with the absorption of alendronate and have the potential to decrease its effectiveness
  2. Use with Alcohol may increase risk of Osteoporosis and cause Gastric Interaction
19
Q

Herbal/Food Interactions with Bisphosphonates

A
  1. The diet should have adequate amounts of Vitamin D, Calcium, Phosphates
  2. Excessive amounts of Calcium supplements or Dairy products reduce Alendronate (‘Alendronic Acid’ - a Bisphosphonate Medication) Absorption
20
Q

Administration Alerts for Bisphosphonates

A
  1. Take on an empty stomach with plain water, preferably 2 hours before breakfast
  2. Remain in an upright position for at least 30 minutes after a dose and until the first food of the day to reduce oesophageal irritation
21
Q

Selective Estrogen Receptor Modulators (SERMs)

A
  • Decrease bone resorption and increase bone mass and density
  • Either estrogen antagonists or agonists, depending on the drug or tissue involved
  1. Prototype drug
    - Raloxifene (Evista)
  2. Therapeutic Class
    - Drug for Osteoporosis Prevention
  3. Pharmacological Class
    - Selective Estrogen Receptor Modulator
  4. MOA
  5. Decreases bone resorption
  6. Increases bone mass and density by acting through oestrogen receptors
22
Q

Primary Use of SERMs

A

Prevention of Osteoporosis in Postmenopausal Women

23
Q

Adverse Effects of SERMs

A
  1. Hot Flashes
  2. Migraine Headache
  3. Flu-like Symptoms
  4. Endometrial Disorder
  5. Breast Pain
  6. Vaginal Bleeding
  7. May cause fetal harm when administered to pregnant women
24
Q

Administration Alerts with SERMs

A
  • Given with or without food
25
Q

Contraindications of SERMs

A
  • During lactation and pregnancy, and women who may become pregnant
  • Patients with a History of Venous Thromboembolism (When blood clot breaks off from its original site and travels through bloodstream to obstruct blood vessel), and those who are Hypersensitive to Raloxifene should not take this drug
26
Q

Drug-Drug Interaction with SERMs

A
  • Concurrent use with Warfarin may decrease prothrombin time
  • Decreased Raloxifene absorption will result from concurrent use with Ampicillin or Cholestyramine
  • Use of Raloxifene with other highly protein-bound drugs (Ibuprofen, Indomethacine, Diazepam, etc.) may interfere with binding sites
  • Raloxifene should be used with caution in patients receiving concurrent treatment with oestrogen-containing drugs
27
Q

Drug-Herbal / Food Interaction with SERMs

A
  • Black Cohosh has oestrogenic effects and may interfere with the actions of Raloxifene
28
Q

Calcitonin

A
  1. Increases bone density and reduces the risk of vertebral fractures
  2. Indication
    - Osteoporosis in Postmenopausal Women
    - Paget’s Disease
    - Hypercalcemia
  3. As Nasal spray/Subc Injection

Skeletal Systems (3 decks)

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