Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
56 Cards in this Set
- Front
- Back
|
-ONATE....think ___________ |
osteoporosis drugs aka Risedronate |
|
|
what is OP? |
skeletal fragility due to progressive loss of bone mass |
|
|
who is at risk for OP? |
elderly postmenopausal women women >50 Men >60 |
|
|
frequent bone fx is a major cause of ___________ |
disability |
|
|
osteoblasts ______ bone cells and __________ "crunch" bone cells |
build osteoclas |
|
|
what is the gold standard to measure bone mineral density? |
DXA (dual-energy xray absorptiometry)
xray form |
|
|
what areas are most frequently scanned in DXA? why? |
bilateral hips lumbar spine wrist
most ppl have fx in these areas |
|
|
what is the diagnosis of OP? |
>2.5 standard deviation of BMD= OP |
|
|
what helps clinicians determine risk/benefit of starting treatment for OP? |
FRAX risk calculator |
|
|
what are RF for OP? |
smoking postmenopausal steroids alcohol |
|
|
what are some drugs that contribute to bone loss or ↑ fx risk? |
aluminum antacids (TUMS, mylanta) anticonvuslants- phenytoin aromatase inhibitors furosemide glucocorticoids heparin medroxyprogesterone acetate (Provera) PPIs (-prazole) SSRIs Thiazolidinediones Thyroid (excessive replacement) |
|
|
what are nonpharmacologic tx strategies for OP? |
-adequate intake for both supplementary and dietary vit D and calcium -weight bearing exercise -smoking and ETOH cessation -avoid drugs assoc. w/ ↓ BMD |
|
|
you must have _____ to absorb ______ what's the dosage for vit D and calcium? |
vit D to absorb calcium Vit D 600-800 IU QD Calcium 1200 mg QD
|
|
|
what are other unique markers about vit D? |
-↓ vit D @ risk for autoimmune diseases - vit D ↑ mood -vit D fat soluble so can become toxic
everybody is low on vit D. DOOR TO BONE |
|
|
what are unique markers for calcium? |
if eating diary, only need 600 mg more of calcium. overdose of Ca→ ↑ risk of MI |
|
|
what job profession is at risk of OP? |
astronauts- lose bone density b/c no gravity. nothing is pulling on the muscles on the bones |
|
|
what are the 5 classes of OP drugs? |
Biphosphonates SERMS Calcitonin Teriperatide Denosumab |
|
|
Bisphosphonates is an analog of __________ |
pyrophosphate |
|
|
what is the MOA of biphosphonates? |
↓ osteoCLAST activity via SOAP like molecules by Proctor & Gamble |
|
|
efficacy of biphosphonates? short term or long term? |
siginificant gain in bone mass= less fx long-term |
|
|
what are the indications for bisphosphonates? |
PREVENTION AND TREATMENT OF OP -low bone density or osteopenia -Paget's disease, Bone mets, hypercalcemia of malignancy |
|
|
T or F: Bisphosphonates uptake in other organs. |
False. only specific to bones and can reduce fx by 30-50% |
|
|
what are SE of Bisphosphonates? |
-diarrhea -GI pain -esophagitis -esophageal ulcers -MSK pain -think SOAP in throat (REFlux esophagitis)
|
|
|
what are RED FLAGS of bisphosphonates? |
-ONJ -atypical femur |
|
|
what's the half life of bisphosphonates? |
10-15 YEARS |
|
|
what's the 1st and prototype drug? |
alendronate (Fosamax) in 1992 |
|
|
what are some bisphosphonates? |
alendronate- daily or weekly PO ibandronate - daily or monthly PO or every 3 months IV risedronate - daily or weekly PO zoledronic acid- yearly IV |
|
|
what are dosing instructions for oral bisphosphonates? |
-MUST TAKE WITH 6-8 OZ OF PLAIN WATER ONLY -@ least 30 min (60 min for ibandronate) before other food, drink, or meds -remain UPRIGHT and don't lie down or recline for @ least 30 min (60 min for ibandronate) -concomitant food= POOR ABSORPTION |
|
|
dosing instructions for Risedronate |
-take w/ @ least 4 oz of plain water -take delayed-release tablet immediately after breakfast |
|
|
Zoledronic acid (Reclast) is given in ____ min IV infusion once ______ |
15 min yearly |
|
|
IV formulations avoid ________ |
SOAP in throat |
|
|
Ibandronate (Boniva) is given _____ every ____ mon |
IV 3 months |
|
|
what are treatment considerations |
-drug holidays -atypical femur fxs -ONJ -calcium and vit D intake -smoking -exercise- weight bearing |
|
|
tell me about the ONJ. what's required? |
theory is that bone can't be remodeled (healed). can be caused by infection, dental manipulation like tooth extraction or women receiving IV biphosphonates @ high doses LONG terM for malignancy, hypocalcemia
REQUIRED: ALL PTS MUST HAVE DENTAL EXAM BEFORE STARTING TX W/ BIPHOS |
|
|
biphos MUST KNOW......
|
-can cause severe renal impairment (eliminated by kidney)
-drink 6-8 oz H20 -wait 30-60 min before eating -remain upright -don't take with food- poor absorption |
|
|
Raloxifene (Evista) is what type of class of drug? |
SERM |
|
|
what's the queen of bone strength for both men and women? |
ESTROGEN |
|
|
so ↓ estrogen is at risk for _______ but too much of it is at risk for _______ |
osteopenia uterine CA, BRCA, CVA, VTE, CAD |
|
|
What are indications for Raloxifene? |
prevention and treatment of OP reduce risk of invasive BRCA |
|
|
Raloxifene ______ BMD and does or doesn't have ↑ entrometrial CA risk |
↑ BMD no endometrial risk |
|
|
T or F: Raloxifene ↓ LDL cholesterol |
True |
|
|
what's 1st line alternative in bisphos intolerant? |
Raloxifene |
|
|
SE of Raloxifene? |
venous thromoboembolism= estrogen HOT FLASHES leg cramps |
|
|
what are 2 drugs of calcitonin? |
fortical miacalcin
|
|
|
how is it administered? |
intranasally |
|
|
indication for calcitonin? |
OP in women who are PMP x min. 5 years |
|
|
what's the MOA of calcitonin? |
reduces bone resorption but less effective than bisphosphonate |
|
|
what's the unique characteristic about calcitonin? |
RELIEF OF PAIN of OP fx esp. vertebral fx |
|
|
what drug has the SE of ↑ infections, cellulitis, and sescondary malignancies? |
Denosumab (Prolia) |
|
|
what are other SE of Denosumab |
hypocalcemia, ONJ, atypical fx |
|
|
what's the MOA of Denosumab? |
monoclonal ab- targets RANK ligand to BLOCK OSTEOCLAST activity |
|
|
what are indications of Denosumab? |
OP in PMP women at HIGH RISK for fx |
|
|
how often is it administered? |
subcutaenous injection every 6 mos |
|
|
what's the only agent that STIMULATES BONE FORMATION? |
Teriperatide (Forteo) |
|
|
indication? how is it administered? what's it's special SE? |
once DAILY SQ injections for 24 MOS indication: OP at high risk fx pts SE: OSTEOSARCOMA IN RATS |
|
|
what's the last drug to use as a backup but used commonly in athletes? |
Teriperatide (Forteo) |
