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1-NAPLEX (Review Daily) > Pregnancy & Osteoporosis > Flashcards

Pregnancy & Osteoporosis Flashcards

1
Q

Acne Teratogenic Drugs

A

-Isotretinoin
-Topical Retinoids

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2
Q

Antibiotic Teratogenic Drugs

A

-Quinolones
-Tetracyclines

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3
Q

Anticoagulant Teratogenic Drugs

A

-Warfarin

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4
Q

CV Teratogenic Drugs

A

-Statins
-ACE/ARB
-Aliskiren
-Entresto (Sacubitril/Valsartan)

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5
Q

Hormone Teratogenic Drugs

A

-Progesterone
-Estradiol
-Raloxifene
-Testosterone
-Contraceptives

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6
Q

Migraine Teratogenic Drugs

A

-Dihydroergotamine
-Ergotamine

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7
Q

Other important Teratogens

A

-Hydroxyurea
-Lithium
-Methotrexate
-Misoprostol
-NSAID
-Paroxetine
-Thalidomide
-Topiramate
-Weight loss drugs
-Valproic Acid

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8
Q

Risk Factors of Osteoporosis

A

-Age
-Ethnicity
-Family History
-Sex (females > males)
-Low body weight
-Smoking
-Excessive alcohol intake
-Low calcium intake
-Low vitamin D intake
-Physical inactivity

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9
Q

Medications which may cause Osteoporosis

A

-Anticonvulsants (Carbamazepine, Phenytoin, Phenobarbital)
-Depo-medroxyprogesterone
-GnRH agonists
-Lithium
-PPI
-Steroids
-Thyroid hormones (in excess)
-Loop diuretics
-SSRI
-TZDs

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10
Q

Osteoclasts vs Osteoblasts

A

1) Osteoclasts - bone resorption: they breakdown tissue in the bone.

2) Osteoblasts - bone formation

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11
Q

When should a BMD be measured?

A

BMD: Bone Mineral Density

Men: >= 70
Women: >= 65

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12
Q

What is FRAX?

A

The FRAX tool is a computer-based algorithm developed by WHO, that estimates the risk of osteoporotic fracture in the next 10 years.

Clinical Risk Factors include:
-Age, Sex, Weight, Height
-Previous Fracture
-Parental Hip Fracture
-Femoral Neck BMD
-Smoking Status
-Steroid Use
-Alcohol Intake
-Rheumatoid Arthritis

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13
Q

T-Score Interpretation

A

Normal: >= -1
Osteopenia (low bone mass): -1 to -2.4
Osteoporosis: <= -2.5

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14
Q

Calcium Requirement

A

Adults: 1000-1200 mg Elemental Calcium per day

Calcium Carbonate: 40% elemental calcium
Calcium Citrate: 21% elemental calcium

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15
Q

Vitamin D Requirement

A

-Required for Calcium Absorption

Deficiency: < 30 mg/mL
-Treat with Cholecalciferol (D3) or Ergocalciferol (D2)
-Cholecalciferol (D3): 125-175 mcg (5000-7000 IU) daily
-Ergocalciferol (D2): 1250 mcg (50,000 IU) weekly

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16
Q

When to initiate treatment for Osteoporosis?

A

1) T-score <= -2.5 at the femoral neck, total hip or lumbar spine or 1/3 radius

OR

2) Presence of a fragility fracture, regardless of BMD

17
Q

When to initiate treatment of Osteopenia (if high risk)?

A

1) Low bone density (T-score between -1 and -2.5)

AND

2) FRAX score of >=20% of a major osteoporosis-related fracture or >= 3% hip fracture probability

18
Q

Medications for Prevention of Osteoporosis

A

1) Bisphosphonates
2) Estrogen-based therapies
3) Raloxifene
4) Bazedoxifene+Estrogens (Duavee)

19
Q

Medications for the TREATMENT of Osteoporosis

A

1) Bisphosphonates
2) Denosumab
3) Parathyroid hormone analogs (Teriparatide, Abaloparatide)
4) Calcitonin

20
Q

Bisphosphonates

A

MOA: Increases bone density by inhibiting osteoclast activity and bone resorption.

-They reduce vertebral and hip fracture risk. (Ibandronate only reduces vertebral fractures)
-First-line therapy for BOTH prevention and treatment
-Drug holiday for low-risk patients after 3-5 years of treatment

DRUGS:
1) Alendronate (FOSAMAX) - PO
2) Risendronate - PO
3) Ibandronate - PO & IV-q3mths
4) Zoledronic Acid (Reclast) - IV

Contraindications:
1) Hypocalcemia
2) Inability to stand upright for atleast 30 minutes

Warnings:
1) Osteonecrosis of the jaw
2) Do not eat or drink 30 mins before or after medication. Except for water

21
Q

Raloxifene

A

MOA: SERM which decreases bone resorption

-Used for BOTH prevention and treatment (postmenopausal women)
-Second line to Bisphosphonates if there is a high risk of vertebral fractures
-Use if there is a low VTE risk or high breast cancer risk
-Contraindication: History of DVT/PE, Pregnancy

BOXED WARNING:
- Increased risk for DVT/PE
- Increased risk of death in women with CHD

22
Q

Conjugated Estrogens+Bazedoxifene (Duavee)

A

MOA: Horse (Equine)/SERM combination indicated for osteoporosis prevention in postmoenpausal women with a UTERUS.

BOXED WARNING:
-Endometrial Cancer
-Increased risk of DVT and Stroke
-Dementia

CONTRAINDICATION:
-Breast Cancer (or history of)
-Pregnancy
-Undiagnosed uterine bleeding
-VTE (or history of)
-MI or Stroke

23
Q

Calcitonin

A

MOA: Inhibits bone resorption by osteoclasts

-Not as effective as bisphosphonates and estrogen products

24
Q

Parathyroid Hormone 1-34

A

MOA: Analogs of human parathyroid hormone, which stimulates osteoblast activity and increases bone formation.

-Used to treat osteoporosis when there is a very high risk of fracture
-Cumulative lifetime treatment duration: 2 years or less
-Daily SQ injections
-Recommended for very high risk patients only

DRUGS:
1) Teriparatide
2) Abaloparatide

25
Q

Denosumab (Prolia)

A

MOA: -mab which binds to RANKL and blocks its interaction with RANK (a receptor on osteoclasts) to prevent osteoclast formation. This leads to decreased bone resorption and increased bone mass.

-SQ every 6 months
-Alternative to bisphosphonates
-Used to treat osteoporosis when there is a high risk of fracture.
-Contraindication: Pregnancy, hypocalcemia
-If dc, bone loss can be rapid. Consider alternative agents to maintain BMD

26
Q

Romosozumab

A

MOA: Inhibits sclerostin, a protein that blocks bone formation

-Treatment limit: 1 year
-Indicated for postmenopausal women with a history of an osteoporotic fracture or multiple risk factors

27
Q

Which osteoporosis drug can males use?

A

-No med is used for the prevention of osteoporosis in MALES <—Treatment only!

1) Alendronate, Risendronate, Zoledronic Acid
2) Parathyroid hormone 1-35
3) Denosumab and Romososumab

-All are indicated for females

1-NAPLEX (Review Daily) (32 decks)

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