Reading...
Play button
Play button
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;
77 Cards in this Set
- Front
- Back
|
Definition of osteoporosis?
|
Systematic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture.
|
|
|
Risk factors of developing osteoporosis?
|
Female,
Age, Menopause, Caucasian/ Asians, Fam hx, Smoking, Sedentary, Hx fracture, High caffeine, ETOH, Low wt or BMI, Meds |
|
|
Meds that can cause increased risk of osteoporosis?
|
Glucocorticoids,
Excess thyroid hormone, Phenobarb, Phenothiazines (Chlorpromazine, perphanazine, Prochlorperazine), Phenytoin, Heparin, Methotrexate, Cyclosporin |
|
|
What is primary osteoporosis?
|
Deterioration of bone mass unassoc w/ chronic illness
|
|
|
What is secondary osteoporosis?
|
Results from chronic conditions that contribute to accelerated bone loss
|
|
|
5 types of secondary causes of osteoporosis?
|
Endocrine/ Metabolic,
Nutritional, Collagen/ Genetic, Renal failure, Multiple Myeloma |
|
|
8 types of endocrine/ metabolic causes of osteoporosis?
|
Acromegaly,
Anorexia nervosa, Athletic amenorrhea, Hemochromatosis, Hyperadrenocorticism, Hyperparathyroidism, Hyperprolactinemia, Thyrotoxicosis |
|
|
6 nutritional causes of osteoporosis?
|
ETOH,
Calc deficiency, Chronic liver dz, Gastric operations, Malabsorption syndromes, Vit D deficiency |
|
|
Evaluation of osteoporosis?
|
Single-energy xray absorptiometry,
DUAL ENERGY XRAY ABSORPTIOMETRY (GOLD STANDARD!!), Quant CT scan, US *Serum calc NOT diagnostic!!! |
|
|
What is dual energy xray absorptiometry?
|
Bone Mineral Densiometry test.
|
|
|
In bone mineral densitometry, what are T scores?
|
Standard deviation from normal adult of same sex.
|
|
|
In bone mineral densitometry, what are Z scores?
|
Standard deviation from age and sex - matched control subjects
|
|
|
In Bone mineral densitometry, what is normal score?
|
T score > -1
|
|
|
In bone mineral densitometry, what score is indicative of osteopenia?
|
T score between -1 and -2.5
|
|
|
In bone mineral densitometry, what score is indicative of osteoporosis?
|
T score < -2.5
|
|
|
What are 5 indications to screen for osteoporosis according to AACE (American association of clinical endocrinologists)?
|
Perimenopausal - willing to start drug ther,
Radiographic evidence of bone loss, Hx of use of glucocorticoids, Asx hyperparathyroidism if osteoporosis would warrant parathyroidectomy, Monitoring response to tx. |
|
|
8 recommendations for prevention of osteoporosis according to NOF (National osteoporosis foundation)?
|
-Counsel on risk factors,
-Eval postmenopausal w/ fx, -BMD for postmenopausal <65 w/ >1 risk factor in addition to menopause. -BMD women >65 -Dietary intake of calc (1200-1500 mg/day), -Wt bearing and muscle strengthening to prevent falls. -Stop smoking, moderate ETOH, -Consider postmenopausal w/ vertebral or hip fx as candidates for tx. |
|
|
Recommended dose of calcium for older women and older men in prevention and treatment for osteoporosis?
|
Older women: 1500 mg/day
Older men: 1200 mg/day |
|
|
How much elemental calcium is in calcium carbonate?
|
40%
|
|
|
How much elemental calcium is in calcium citrate?
|
21%
|
|
|
How much elemental calcium is in calcium lactate?
|
13%
|
|
|
How much elemental calcium is in calcium gluconate?
|
9%
|
|
|
How much calcium approximately can the stomach absorb at one time?
|
500-600 mg
|
|
|
What does Vitamin D do in regards to calcium and how?
|
Maintains blood levels of calcium.
Does this by increasing absorption of calcium from food and reducing loss in urine. |
|
|
What are 3 natural things that contain Vitamin D (besides sunlight)?
|
Cod liver oil,
Egg yolks, Butter |
|
|
What is the recommended dietary allowance of vitamin D?
|
400 IU for adults.
800-1000 IU for max effect on preserving bone density and preventing fractures in older pts. Also pts w/ malabsoprtion, long term anticonvulsants, glucocorticosteroids: 800 IU |
|
|
2 types of Vitamin D?
|
Cholecalciferol (D3)
Ergocalciferol (D2) |
|
|
What is the first line drug for osteoporosis?
|
Bisphosphonates
|
|
|
What is osteonecrosis of jaw?
|
AKA avascular necrosis of bone or osteochondritis dissecans.
Death of bone --> collapse of bone's structural architecture. Causes bone pain, loss of function, and bone destruction. Result of number of conditions --> impairment of blood supply to bone. |
|
|
Risk factors of osteonecrosis of jaw?
|
Estrogen or glucocorticoid use,
>65 years old, Prolonged use of bisphosphonates (but use of much higher doses of bisphos like those used for malignancy than what is used as prev/tx of osteoporosis) |
|
|
Although Estrogen still can be a treatment for osteoporosis, why is it no longer the first-line therapy?
|
While it decreases hip fractures and colorectal cancers, there is increase seen in:
- Breast cancer - Stroke - DVT - CAD |
|
|
What is the second line therapy as treatment of osteoporosis?
|
Calcitonin
|
|
|
Definition of pharmacokinetics?
|
What the body does to the drug
-absorption, -Distribution -elimination -metabolism |
|
|
What is pharmacodynamics?
|
What the drug does to the body
|
|
|
How is absorption changed in the elderly?
|
Increased gastric pH
Delayed gastric emptying Slowed transit Decreased GI blood flow |
|
|
How does decreased gastric acidity impact pharmacokinetics?
|
Affects dissolution of drugs soluble in acid media --> decreased absorption of meds requiring acid (calcium carbonate, antifungals).
|
|
|
How does decreased GI blood flow impact pharmacokinetics?
|
Can slow removal of drug from GI tract.
Prob not very clinically significant d/t large surface area of small intestine, which is major site of absorption. |
|
|
How does delayed gastric emptying impact pharmacokinetics?
|
Slow inital obsorption of meds. May affect ht of peak level and time to reach peak level.
Important for timing doses of sedatives/ hypnotics. |
|
|
How does reduced lipid content of skin impact pharmacokinetics?
|
Reduces percutaneous absorption of hydrophilic drugs.
Decreased absorption of clonidine by patch. |
|
|
What kind of changes cause a change in distribution in the elderly?
|
Decreased total body water
Increased body fat Decreased lean body mass Decreased serum albumin and alpha-1 acid glycoprotein |
|
|
How does decreased body water in elderly impact pharmacokinetics?
|
Decreases volume of distribution for water soluble drugs --> decreased toxic levels for dig, aminoglycosides.
Risk for dehydration w/ diuretic use. |
|
|
How does increased body fat in elderly impact pharmacokinetics?
|
Increases vol of distribution and elim half life of fat soluble drugs, espec in females.
Increases elim 1/2 life of benzos, TCAs, barbituates. Allow for increased time to achieve steady state levels prior to dose increases. |
|
|
How does decreased serum albumin in elderly impact pharmacokinetics?
|
Increases unbound or free drug w/ highly bound drugs.
May affect response to phenytoin, naproxen, diazepam. Increased risk of interactions w/ concurrently administered protein bound drugs. |
|
|
How does decreased total body weight in elderly impact pharmacokinetics?
|
Decreased mass for drug distribution.
Decrease dose of drugs w/ low therapeutic index. |
|
|
Metabolism changes in elderly?
|
Bc more meds are taken usually, increased risk of CYP interactions.
Decreased liver size, Decreased liver blood flow, Decreased concentration of some cytochrome P450 enzymes: CYP3A4 |
|
|
Elimination changes in elderly?
|
Decreased GFR,
Decreased renal blood flow, Decreased tubular secretion All these lead to decreased clearance and increased 1/2 life of renally eliminated meds. |
|
|
Formula of creatinine clearance?
|
(140-age)xwt in kg/ 72xScr (x0.85 for women).
|
|
|
Drugs needing dosage adjustments and/or cautious use in pts w/ renal insufficiency?
|
Abx,
Antivirals, CV drugs, GI drugs, NSAIDs, Allopurinol, Insulin, Lithium, Quinine |
|
|
General term for how individual patients respond to drugs is?
|
Pharmacodynamics
|
|
|
Are pharmacodynamics or pharmacokinetics more responsible for adverse drug reactions in the elderly?
|
Pharmacodynamic changes
|
|
|
What are some pharmacodynamic changes in the elderly?
|
Ability to respond to changes in environment or physiological challenges are impaired.
Changes in receptor site density, characteristics of the receptor site or changes in how signals are communicated. |
|
|
How might sedative/ hypnotic drugs, diuretics, or antipsychotics lead to falls in the elderly?
|
Impaired ability to maintain postural control,
Volume depletion, Reduced baroreceptor activity. |
|
|
How might anticholinergics, TCAs, antihistamines lead to reduced intestinal motility, constipation, impaction, or obstruction?
|
Anti-SLUD
|
|
|
What does the mneumonic SLUDGE stand for?
|
Used for effects of massage discharge of the parasympathetic nervous system, usually d/t drug OD.
S: Salivation L: Lacrimation U: Urination D: Defication G: GI upset, including diarrhea E: Emesis |
|
|
How might anitcholinergics, TCAs, Antihistamines, or Benzos lead to disorientation, delirium, psychosis?
|
Anti-slud,
Increased benzo receptor sensitivity. |
|
|
How might diuretics cause urinary incontinence in elderly?
|
Bladder filling exceeds capacity.
Urinary outflow obstruction |
|
|
How might corticosteroids or saline laxatives/ enemas cause edema and worsening CHF in elderly?
|
Sodium retention
|
|
|
How might antipsychotics or Metocloproamide cause tardive dyskinesias and extrapyramidal symptoms?
|
Depletion of CNS dopamin
|
|
|
How might thiazides, beta adrenergic blockers, or corticosteroids cause hyperglycemia?
|
Decreased glucose tolerance
|
|
|
How might Benzos or Warfarin cause increased response to pharmacotherapy in elderly?
|
More CNS effects.
Increased anticoag effect at same dose. |
|
|
What are some CV changes in the elderly that may affect drug effects?
|
Decreased myocardial sensitivity to Beta adrenergic stimulation.
Decreased cardiac output. Increased total peripheral resistance. |
|
|
What are some respiratory system changes in the elderly that may effect drug effects?
|
Decreased respiratory muscle strength.
Decreased vital capacity. Decreased total alveolar surface. |
|
|
What are some integument system changes in the elderly that may affect drug effects?
|
Increased skin dryness,
Epithelial and dermal thinning, Decreased number of hair follicles. |
|
|
7 drug classes that tend to be overused in elderly?
|
Antianginal,
Psychotropics, CV, Anticonvulsant, Laxatives/ multivits, NSAIDs, H2 Blockers/ sucralfate |
|
|
What is Beers Criteria?
|
Criteria established through expert consensus and lit review regarding use of meds in elderly. Established in '91.
Used to determine what meds should be AVOIDED in >65 because they're ineffective or safer alternatives are available. And what meds should NOT BE USED in elderly w/ specific med conditions. High and low severity categories. |
|
|
Definition: Teratogenicity?
|
Capability to produce congenital abnormalities.
Major: incompat w/ life or req major surgery. Minor. No drug produces abnormalities in ALL exposed infants. |
|
|
What additional structure can metabolize drugs in pregnancy?
|
Placenta
|
|
|
What factors influence drug transfer through placenta?
|
Molec wt: 400-600 daltons cross easily. Most drugs < 600 daltons, so assume most can reach fetus. >1000 daltons (heparin) cross w/ difficulty or not at all.
Lipid sol: lipophilic> hydrophilic. Ionization: nonionized > ionized. Protein binding (free> low> high): only unbound drugs cross membrane. |
|
|
What is Category A teratogenicity?
|
Fail to demonstrate risk
|
|
|
What is Category B teratogenicity?
|
Animal studies don't show risk, but no controlled studies in humans or animal studies show adverse event.
|
|
|
What is Category C teratogenicity?
|
Animal studies showed adverse effects on fetus and there are no controlled studies in women or studies in women and animals are not available.
Give only if benefit > risk. |
|
|
What is Category D teratogenicity?
|
Positive evidence of human fetal risk but benefits from use in preg woman may be acceptable (ex. life threatening situation or serious dz where other agents are ineffective)
|
|
|
What is Category X teratogenicity?
|
Animal or human studies show fetal abnormalities or there is evidence of fetal risk based on human experience or both.
Risk outweighs any benefits. |
|
|
Medication factors that influence excretion into breast milk?
|
Ionization,
Solubility, Protein binding, Molecular wt |
|
|
Maternal pharmacokinetics that influence excretion of drug into breast milk?
|
Drug dose, freq, route,
Clearance rate, Protein binding |
|
|
Infant factors that influence excretion of drug into breast milk?
|
Suckling behavior,
Amt consumed per feeding, Feeding intervals, Time of feeding in relation to drug dosing. |
|
|
Breast milk factors that influence excretion of drug into breast milk?
|
Blood flow and pH,
Ion and other transport mechanisms, Drug metabolism and reabsorption, Composition |
