Pharm Iii Exam 2

Front 1

measures BMD
used in dx of osteoporosis

Back 1

DEXA scan

Front 2

minimize bone loss
delay progression of osteoporosis
prevent fracture-related M/M
tx for life (may not be necessary anymore)

Back 2

goals of Drug tx in osteoporosis

Front 3

what is now more important than calcium intake?

Back 3

vit D

Front 4

how should calcium supplements be given?

Back 4

divided doses - one large dose will NOT be absorbed)

NATURALLY is the best way to get all vitamins/minerals
except Folic Acid - supplements are preferred

Front 5

calcium requirements for adolescents

Back 5

1200-1500/day

Front 6

calcium requirements for premenopausal women (25-50)

Back 6

1000/day

Front 7

calcium requirements for postmenopausal women
not receiving HRT/ERT

receiving HRT/ERT

Back 7

1200

1000

Front 8

calcium requirements for men
<70
>70

Back 8

1000/day

1200/day

Front 9

commonly used calcium salts

Back 9

calcium carbonate - TUMS, Caltrate, Oscal (40% elemental calcium)

calcium citrate - Citracal (21%)

Front 10

calcium carbonate

Back 10

TUMS
Caltrate
Oscal
Require acid for absorption
not taken in elderly or pts on PPI

Front 11

does not require acid for absortion

Back 11

calcium citrate (citracal)

need higher dose because less elemental calcium

Front 12

does calcium increase risk of MI?

Back 12

some evidence that it might, especially in people who do not take Vit D along with it

multivitamin may increase MI/death

Front 13

vit D deficiencies are more common than previously realized because

Back 13

decreased ability to absorb it as we age
increased use of sunscreens
more time indoors

Front 14

best measure of Vit D

Back 14

25-hydroxyvitamin D

Front 15

to prevent Vit D deficiency
<70 y/o
>70 y/o
general recommendation

also weight bearing exercise and walking

Back 15

600 IU/day
800IU/day

800-2000

Front 16

to TREAT vit D deficiency

Back 16

50,000 IU once WEEKLY x 6-8 weeks
re-check levels in 8 weeks

Front 17

2 categories of drug therapy in osteoporosis

Back 17

1. antiresorptives (biphosphonates, calcitonin, estrogen, estrogen agonists/antagonists=SERMs)

2. anabolic drugs (teriparatide/forteo)

Front 18

antiresorptives MOA
biphosphonates
calcitonin
estrogen
estrogen agonsits/antagonists = SERMs

Back 18

slow progression of bone loss
pts stop losing bone as quickly as they did before treatment and still make bone at a normal pace

Front 19

anabolic drugs MOA
teriparatide/forteo

Back 19

INCREASES the rate of bone formation
only class of drugs able to do this

Front 20

HRT place in therapy

Back 20

used to be 1st line for prevention of osteoporosis in post-menopausal
now LAST choice due to CV risks

Front 21

Selective Estrogen Receptor Modulators (SERMs)
aka
estrogen agonists/antagonists

Back 21

prevention AND treatment of osteoporosis in POSTmenopausal women
increases bone density
reduces risk of SPINE fx

Front 22

these drugs only reduce risk of SPINE fx

Back 22

SERMs (Raloxifene/Evista)
estrogen agonist in bone and lipid
antagonist in breast and uterus

*used more in prevention of breast cancer

Front 23

can you use Raloxifene/Evista with Biphosphonates?

Back 23

yes

Front 24

Evista/Raloxifene side effects
SERM

Back 24

hot flashes
leg cramps
DVT (black box warning)

^menopause sx

Front 25

contraindications to SERMs/any drug messing with estrogen?

Back 25

active thromboembolic dz
pregnancy

Front 26

these drugs reduce the risk of breast cancer by 65% over 8 years

Back 26

SERMs
Raloxifene/Evista

Front 27

major therapeutic class for osteoporosis
and how long should they be given

Back 27

biphosophonates x 5 years

Front 28

prevention AND treatment of osteoporosis in pre and post-menopausal women, men, and steroid-induced osteoporosis

Back 28

Biphosphonates (usually with Vit D)
Alendronate (Fosamax)
Ibandronate (Boniva)
Risedronate (Actonel)
Risedronate (Atelvia)

Front 29

these drugs decrease both spine AND hip fx
usually include vit D

dosing

Back 29

Bisphonphonates (Fosamax)

tx dose is 2x prevention dose (although tx dose is usually given)

Front 30

how often are biphosphonates given

Back 30

weekly for 5 years

Front 31

risedronate (Atelvia)

Back 31

release in the small intestine
can be taken AFTER breakfast instead of 30 minutes before

tx only - no prevention

Front 32

Parenteral biphosphonates

Back 32

ibandronate (Boniva)
Zoledronic Acid (Reclast)

Front 33

side effects of biphosphonates

Back 33

GI upset with PO drugs (so use Reclast)
musculoskeletal pain
osteonecrosis of the jaw (ONJ)

Front 34

ONJ (osteonecrosis of the jaw)
death of bone cells

Back 34

95% are cancer patients receiving biphosphonates
inhibiting bone turnover needed for healing
chlorhexidine gluconate rinse (Peridex) preferred before any dental surgery - to prevent ONJ

Front 35

when is Peridex (chlorhexidine gluconate rinse) used?

Back 35

prevent ONJ in pts getting dental surgery

Front 36

contraindications for biphosphonates

Back 36

hypocalcemia

Front 37

considerations for biphosphonates (alendronate/Fosamax)

Back 37

must be taken FIRST thing in the morning with at least 8ox WATER
must sit/stand for 30 MINS (boniva=60)
do NOT eat/drink anything or take meds for 30 mins
should not be given in NPO state

Front 38

can patients stop biphosphonates?

Back 38

yes - d/c drug if they haveb een on them for 5 years with good response and stable DEXA and low fracture risk

get DEXA q 2 years

Front 39

calcitonin use in therapy

Back 39

least effective in osteoporosis
but used in women 5 years beyond menopause to tx
used in patients with BONE PAIN

Front 40

contraindications to calcitonin

Back 40

hypersensitivity to salmon protein

should be given to osteoporosis pts experiencing BONE PAIN

Front 41

miscellaneous osteoporosis drugs
Denosumab (Prolia)

Back 41

used if pts failed/intolerant to other osteoporosis tx (like biphosphonates)
inhibits RANKLigand
given q 6 months (2x/year)

Front 42

ADRs of Denosumab (Prolia)
subq osteoporosis drug q 6 mos inhibits RANKL

Back 42

used after Reclast
skin reactions (eczema, dermatitis)
musculoskeletal pain
ONJ

Front 43

eczema and dermatitis are ADRs of what drug

Back 43

Denosumab (Prolia)

Front 44

anabolic (bone formation) drugs used in osteo

Back 44

teriparatide (Forteo)
parathyroid hormone

Front 45

this drug is PTH and used for MAX od 2 years in osteo

Back 45

Teriparatide (Forteo)
rebuilds bone and increased bone mineral density

Front 46

nictonie is in

Back 46

cigarettes, chewing tobacco

excites neurons = DA requirements of an addictive drug

Front 47

nicotine withdrawal

Back 47

irritability
sleeplessness
anxiety
diff concentrating
h/a
change in appetite
relapse

Front 48

nicotine products
nicotine gum (nicorette)
transdermal nicotine patch (nicoderm CQ)
nicotone nasal spray (nicoTROL NS)
nictoine inhaler (Nicotrol inhaler)

Back 48

reduce nicotine withdrawal sx
should NOT smoke while on these products

Front 49

nicorette (nic gum)

Back 49

sugar-free gum
FIXED schedule NOT prn
contraindicated: mouth/jaw problems or dentures/braces

Front 50

Vareniciline (Chantix)

Back 50

can smoke for first week
contains NO nicotine
targets nicotine receptors in brain, blocks nicotine from reaching them-->less dopamine is released compared to nicotine
if pt relapses, varenciline decreases reward-like effects of nicotine

Front 51

varenciline

Back 51

chantix
contains NO nicotine

Front 52

ADRs of varenciline (chantix)

Back 52

nausea
psych changes

Front 53

when should chantix be stopped?

Back 53

agitation
depressed mood
changes in behavior
suicidal

Front 54

antidepressants (SSNI) that may have efficacy in smoking cessation

Back 54

Bupropion (Ziban)
brand name = Welbutrin

Front 55

Bupropion/Ziban
Welbutrin

Back 55

antidepressant that may help with smoking cessation

Front 56

gout attach is always preceded by

Back 56

hyperuricemia

Front 57

therapeutic goal in gout

Back 57

lower UA below saturation point
< 6mg/dL
prevent deposition of urate crystals

Front 58

proteins-->purines-->hypoxanthine-->xanthine-->UA

Back 58

allopurinol plugs in to inhibit xanthine oxidase
colchicine blocks leukotrienes

Front 59

NSAIDs (all except aspirin) used as
indomethacin

Back 59

1st line tx of ACUTE gout attacks

Front 60

Typical NSAID used in acute gout attacks

Back 60

Indomethacin
(or ibuprofen)

Front 61

why is aspirin NOT used in acute gout attacks?

Back 61

causes hyperuricemia because competes with UA for excretion

Front 62

Colchicine should NOT be used

Back 62

in acute gout attacks
it has NO effect on metabolism or excretion of uric acid
it DOES prevent recurrent gout episodes

Front 63

does colchicine affect metabolism/excretion of UA

Back 63

NO! so not used in acute gout

also diarrhea is a bad ADR

Front 64

when should you avoid colchicine?

Back 64

ELDERLY (use allopurinol)
acute attacks (used NSAIDs, not aspirin)

Front 65

NSAIDs and Colchine are not used in

Back 65

Kidney impairment

Front 66

ADRs of colchicine

Back 66

DIARRHEA - good for monitoring toxicity (may be 1st sign)
IV is so toxic because you will not get diarrhea so no "initial" sx of toxicity
MYOPATHY
IV colchicine can lead to bone marrow suppression

Front 67

IV colchicine ADR

Back 67

bone marrow suppression
not used because no diarrhea = no wy to monitor toxicity

Front 68

uricosurics
probencid (Benemid)
Sulfinpyrazone

Back 68

used in UNDERexcreters
should NOT be started until 2-3 weeks after an acute attack
inhibits re-absorption of UA in renal tubules)

Front 69

these drugs should not be started until 2-3 weeks after an acute gout attack

Back 69

uricosurics (Probencid) used in under-excreters
inhibit reabsorption of UA = more UA in the urine

Front 70

beacause uricosurics increase UA in the urine (inhibit reabsorption of UA) they often cause

Back 70

kidney stones
maintain high urine volume (2L/day)

Front 71

drug interactions with probencis (uricosuric)

Back 71

ASA = retention of UA
Penicillin

Front 72

kidney stones are seen with what drugs

Back 72

uricosurics (Probencid)

do not give with ASA or PCN

Front 73

allopurinol (Zyloprim)

Back 73

standard drug used in between acute gouty episodes to decrease total UA
used in over-producers

Front 74

xanthine oxidase inhibitor

Back 74

allopurinol (zyloprim)

can be given once/day because allopurinol + alloxanthine give 24 hour control

Front 75

how should allopurinol be doseed

Back 75

titrated up
give Colchicine or NSAID until uric acid <6 to prevent gout attack

Front 76

allopurinol and febuxostat should be given after

Back 76

NSAID or colchicine reduce UA <6

titrate up

Front 77

ADR of allopurinol

Back 77

Allergic rxn

Front 78

drug interactions of allopurinol

Back 78

azathioprine or mercaptopurine (chemo drugs) - must decrease dose by 75%

allopurinol inhibits metabolism of probencid and warfarin

Front 79

if pt is on chemo drugs, must reduce allopurinol by

allopurinol decreases mtabolism of

Back 79

75%

warfarin and probencid

Front 80

Febuxostat (Uloric)
new xanthine oxidase inhibitor

Back 80

chronic gout in overproducers OR underexcretors

used if they cannot tolerate allopurinol
give NSAID or colchicine until UA <6

Front 81

corticosteroids in gout

Back 81

sometimes if attack is severe

Front 82

rasburicase (Elitek) used for gout

Back 82

in CA patients whose therapy results in tumor lysis and increase plasma uric acid

Front 83

this drug is used to reduce UA in cacner pts

Back 83

Rasburicase (Elitek)

Front 84

when should you consider prophylactic gout therapy?

Back 84

> 2 attacks in one year
severe primary attack
complicated by kidney stones
serum UA >10
urinary excretion of urate >1000 in 24 hours