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Pharmacology (Dale Turley) > Tx of Osteoporosis > Flashcards

Tx of Osteoporosis Flashcards

1
Q

Osteoporosis and Osteopenia: Significant Public Health Problem ?

A

Structural deterioration of bone mass

Increase propensity of bone fractures

Post menopausal women

Women 5 times more likely to develop Osteoporosis

Women10% to 15% more likely die from hip fracture in one year

Men 25% likely

Half a million vertebral fractures yearly

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2
Q

Osteoporosis and Osteopenia confirmed by ?

A

Confirmed by hip or spiral bone mineral density (BMD) or DEXA scan

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3
Q

Osteoporosis and Osteopenia: Once treatment is initiated

A

Assess successful treatment

Based on either lack of fractures

Increased bone mineral density scores.

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4
Q

Osteoporosis and Osteopenia: Medication Goals ?

A

Achieve optimal peak bone mass

Minimize further bone loss

Decrease falls and fractures

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5
Q

____ required for vascular contraction and dilation, nerve transmission, intracellular signaling, hormonal secretion

A

Ca++

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6
Q

_______ required for uptake of calcium and phosphorus from GUT and absorption into bone

A

Vitamin D

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7
Q

Calcium and Vitamin D: Human requirements ?

A

Ergocalciferol (vitamin D2 from plants)

Cholecalciferol (vitamin D3 synthesized in skin from sunlight and converted in liver to active form)

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8
Q

Calcium needs ?

A

1,000 mg/day males

1,200 mg/day females

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9
Q

Vitamin D needs ?

A

600IU for females

800 IU/day males

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10
Q

The lighter a person’s skin the more__________ they make

A

vitamin D

caution on side of skin cancer risk

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11
Q

Some people may have genetic predisposition against __________ absorption

A

vitamin D

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12
Q

People in _____________ may not get enough vitamin D

A

northern climates

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13
Q

Consider a well-rounded _____________ with adequate calcium

A

health diet

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14
Q

Calcium intake in males ?

A

1,000 mg/day males

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15
Q

Calcium intake in females ?

A

1,200 mg/day females

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16
Q

Bisphosphonates reduction of __________________ in postmenopausal women (40–70% effective)

A

vertebral fractures

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17
Q

Bisphosphonates challenges ?

A

correct administration

avoid serious GI upset

poor bioavailability

18
Q

Bisphosphonates: Bone undergoes constant _________

A

turnover

homeostasis by osteoblasts creating bone and osteoclasts destroying bone

19
Q

Bisphosphonates MOA ?

A

Inhibit both normal and abnormal bone resorption and slow down bone remodeling in postmenopausal women

20
Q

Bisphosphonates indications ?

A

osteoporosis,

Paget’s disease of the bone

Bone conditions involving fragile, breakable bones

21
Q

Bisphosphonates two types ?

A

non- nitrogenous

nitrogenous

22
Q

Non-nitrogenous ?

A

Non-N-containing bisphosphonates

23
Q

Nitrogenous ?

A

N-containing bisphosphonates:

24
Q

Nitrogenous bisphosphonates examples ?

A

Alendronate (Fosamax)

Ibandronate (Boniva)

Risedronate (Actonel)

25
Q

Alendronate (Fosamax)

dosing ?

A

PO form 5mg, 10mg, 35mg, 40 mg tab, 70/75 mL oral soln

Osteoporosis
70 mg PO qwk

26
Q

Ibandronate (Boniva) dosage ?

A

Dose: 150 mg PO qmo

27
Q

Ibandronate (Boniva) considerations ?

A

give w/ water 60min before first food/drink/med

avoid lying down x60min

calcium and vitamin D supplementation recommended if inadequate dietary intake

periodically reassess need for treatment

consider D/C after 3-5y in low-risk pts

28
Q

Ibandronate (Boniva)

adverse effects ?

A

osteonecrosis, jaw
musculoskeletal pain, severe

hypersensitivity rxn
Stevens-Johnson syndrome

Anaphylaxis
hypocalcemia

Uveitis
scleritis

acute renal failure (IV use)

29
Q

Bisphosphonates patient / family education ?

A

Warn patient of joint, muscle, bone jaw pain

Advise to take with full glass of water

Use food if need to offset upper GI distress

IV forms for 3 months or once a year administration

30
Q

Bisphosphonates Conscientious Prescribing ?

A

Use cautiously in patients with renal impairment

Watch for jaw bone necrosis

Watch for abnormal diagnostic imaging

Monitor serum calcium and phosphorus

31
Q

SERMs AKA?

A

Selective estrogen receptor modulators

32
Q

SERMs examples ?

A

Raloxifene (Evista)

33
Q

Raloxifene (Evista) MOA ?

A

Mimic estrogen antagonists and provide estrogen resorption effects without need for estrogen

34
Q

Raloxifene (Evista) pharmacokinetics ?

A

60% absorbed from GI

Metabolized liver

Excreted in feces

Half-life is 27–32 hours.

35
Q

Raloxifene (Evista) black box warning ?

A

Risk of death from stroke in postmenopausal women w/ documented CHD or risk factors for major coronary events

consider risk/benefit in women w/ stroke risk

36
Q

Raloxifene (Evista) adverse effects: CV ?

A

thromboembolism

37
Q

Raloxifene (Evista) adverse effects: MS ?

A

leg cramps

38
Q

Raloxifene (Evista) adverse effects: MISC ?

A

hot flashes

39
Q

Raloxifene (Evista) adverse effects: NEURO ?

A

dizziness

40
Q

Raloxifene (Evista) patient / family education ?

A

Advise weight-bearing exercise is helpful

Advise of adequate vitamin D and calcium intake

Avoid prolonged sitting as leg cramps could be risk of venous thrombosis

Take medicine for the full course of therapy

Do not double dose if patient misses a dose

Drug will not reduce incidence of hot flashes

41
Q

Hormone therapy: Synthetic form of calcitonin found in ______ ?

A

salmon

42
Q

Calcitonin - hormone therapy

?

A

Promotes new bone formation by unknown method

Administered as a nasal spray

Watch for rhinitis, allergic reaction, and bone pain

Not considered a first-line treatment

Periodic nasal exams are needed

Pharmacology (Dale Turley) (31 decks)

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