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DNP Pharm > Week 10 > Flashcards

Week 10 Flashcards

1
Q

National Osteoporosis Foundation recommendations for calcium and vitamin D intake

A

Men age 50-70: 1000 mg/day calcium
Women >50 and men >70: 1,200 mg/day calcium
Men and women >50: 800-1000 IU

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2
Q

Dietary sources of calcium

A

Milk, yogurt, cheese,spinach, kale, soy beans, fish, calcium fortified foods (orange juice, oatmeal, breakfast cereal)

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3
Q

Dietary sources of Vitamin D

A

Fatty fish, fortified foods, cheese, egg yolks

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4
Q

Treatment options for osteoporosis

A
  • Adequate calcium and vitamin D, primarily from dietary intake
  • Regular weight-bearing/muscle strengthening activities
  • Fall prevention
  • Lifestyle modification
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5
Q

When to treat Osteoporosis

A
  • Hip or vertebral fractures
  • Osteoporosis (as defined by T-scores)
  • Osteopenia + FRAX 10-year risk score ≥3 % for hip fracture ≥20% for any major osteoporotic fracture
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6
Q

T-score classifications

A

≥-1 = normal BMD
-1 to -2.5 = osteopenia
≤-2.5 = osteoporosis

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7
Q

Calcium supplements

A 
***Calcium carbonate
Least expensive
Take with food- requires stomach acid to be absorbed
GI upset
***Calcium citrate
Doesn’t require stomach acid to get absorbed
Better absorption in older patients
Can take on empty stomach
More expensive
\+++Adverse effects for both:
Constipation, gas upset stomach
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8
Q

Osteoporosis Pharmacologic Treatment (Drug classes)

A 
Bisphosphonates
RANK-L inhibitor
Parathyroid hormone analogs
Estrogens/testosterone
Raloxifene
Calcitonin
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9
Q

Bisphosphonates: Drug names

A

Alendronate (Fosamax®)
Risendronate (Actonel®)
Ibandronate
Zoledronic acid (Reclast®)

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10
Q

Bisphosphonates: Mechanism of action

A

Inhibits bone resorption via action on osteoclasts

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11
Q

Bisphosphonates: Place in treatment

A

First-line therapy

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12
Q

Bisphosphonates: Administration keys

A

-Administer in the morning prior to food, beverage, or other medications
30 minutes prior for alendronate and risendronate
60 minutes prior for ibandronate
-Give with glass of water
-Remain standing/sitting straight up for 30-60 minutes
-Important to have adequate calcium/vitamin D intake

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13
Q

Bisphosphonates: Adverse effects

A
  • Decreased serum calcium
  • Abdominal pain
  • Acid regurgitation
  • Dysphagia
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14
Q

Bisphosphonates: Contraindications

A
  • Abnormalities of the esophagus
  • Hypocalcemia
  • Inability to stand or sit upright for at least 30 minutes
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15
Q

Bisphosphonates: Precautions

A
  • Atypical femur fractures
  • Bone/join/muscle pain
  • Gastrointestinal mucosa irritation
  • Hypocalcemia
  • Osteonecrosis of the jaw
  • Drug interactions (absorption issues with vitamins and food)
  • Renal dose adjustment: not recommended if CrCl < 30 mL/min (risendronate, ibandronate) or < 35 mL/min (alendronate, zoledronic acid)
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16
Q

Bisphosphonate Drug Holiday

A
  • Consider after 3-5 years of continuous, compliant, effective bisphosphonate therapy
  • Duration of 2-3 years

-Benefits:
Minimal BMD reduction
Persisting reduction of bone turnover markers
No unequivocal increase in fracture risk

17
Q

RANK-L Inhibitor: Drug names

A

Denosumab (Prolia®)

18
Q

RANK-L Inhibitor: Mechanism of action

A

monoclonal antibody which binds to RANKL and prevents osteoclast formation, leading to decreased bone resorption

19
Q

RANK-L Inhibitor: Place in treatment

A

2nd line (Not for prevention of osteoporosis)

20
Q

RANK-L Inhibitor: Administration keys

A

Very important to have adequate calcium intake

21
Q

RANK-L Inhibitor: Adverse effects

A

Common side effects:

  • Hypertension (11%)
  • Dermatitis/Rash (3-11%)
  • Hypercholesterolemia (7.2%)
  • Arthralgia (7-14%)

Serious side effects:

  • Malignant neoplasm (3-5%)
  • Pancreatitis (< 1%)
22
Q

RANK-L Inhibitor: Contraindications

A

Hypocalcemia, Pregnancy

23
Q

RANK-L Inhibitor: Precautions

A
  • Atypical femur fractures
  • Osteonecrosis of the jaw
  • Hypocalcemia
  • Increased risk of infections
24
Q

Parathyroid Hormone Analogs (PTH Analogs): Drug names

A

Teriparatide

Abaloparatide

25
Q

PTH Analogs: Mechanism of Action

A

imitates PTH to stimulate osteoblast function, increase calcium absorption, and increase renal tubular absorption of calcium

26
Q

PTH Analogs: Place in treatment

A

Patients who fail bisphosphonates
T-score ≤-3.5
Contraindications to other agents

27
Q

PTH Analogs :Administration keys

A

Requires antiresorption therapy after discontinuation to prevent bone density decline and fractures

28
Q

PTH Analogs: Adverse effects

A 
Nausea
Orthostatic hypotension
Hyperuricemia
Antibody development
Hypercalcemia
Osteosarcoma* (BBW for this!)
Injection site reaction
29
Q

PTH Analogs: Precautions

A

Max of 2 yrs (because risk of osteosarcoma increases with length of use)

30
Q

Selective Estrogen Receptor Modulator (SERM): Drug names

A

Raloxifene

31
Q

Selective Estrogen Receptor Modulator (SERM): MOA

A

Estrogen agonist in bone to prevent bone loss

32
Q

Selective Estrogen Receptor Modulator (SERM): Place in therapy

A

2nd line for postmenopausal women only

33
Q

Selective Estrogen Receptor Modulator (SERM): Adverse effects

A

Hot flushes
Leg cramps
Peripheral edema

34
Q

Selective Estrogen Receptor Modulator (SERM): Contraindications:

A

History or recurrent thromboembolic disorders

Pregnancy

35
Q

Selective Estrogen Receptor Modulator (SERM): Precautions

A
  • BBW for thromboembolic events and stroke

- Caution in hepatic impairment, renal impairment, and hypertriglyceridemia

36
Q

Other Osteoporosis Agents: Calcitonin

A

-MOA: PTH antagonist to inhibit osteoclastic bone resorption
-Place in therapy: last line only in women who are at least 5 years postmenopause
-Adverse effects:
Rhinitis
Epistaxis
-Precautions:
Allergic reactions (salmon-derived)
Hypocalcemia

37
Q

Other Osteoporosis Agents: Estrogen Therapy: Conjugated estrogens/bazedoxifene (Duavee®)

A
  • MOA: Estrogen inhibits RANK-L
  • Place in therapy: postmenopausal women who have contraindications to other agents
  • Potential for serious adverse events (e.g. stroke, VTE, coronary heart disease)
  • Lack of long term fracture and safety data

DNP Pharm (1 decks)

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