Pharmtx - Final - Osteoporosis/vitamin D

Front 1

THe most important Risk Factors for Osteoporosis?

Back 1

Low bone mineral density and a personal hx of adult fracture

Front 2

A standardized approach for diagnosing OP...

Back 2

Central dual-energy x-ray absorptiometry (DXA) measurements

Front 3

Who should receive treatment for osteoporosis?

Back 3

All postmenopausal women with a personal history of osteoporotic fracture and/or low bone mineral density with risk factors for osteoporosis.

Front 4

First line therapy for postmenopausal osteoporosis? What else is added to all drug therapy regimens?

Back 4

Bisphosphonates. Vit D and Ca++

Front 5

First-line treatment for primary OP in men...

Back 5

Alendronate. Proven benefit in reducing fractures and relatively safe.

Front 6

For glucocorticoid-induced OP, bisPHOSphonate therapy is recommended in all patients who are starting treatment with Glucocorticoids for at least __ months. Bisphosphonate tx is also recommended if the bone mineral density is low or there is a history of fracture

Back 6

3

Front 7

RFs for Osteoporosis
-Ethnicities?
-Sex?
-etc.

Back 7

White or Asian Ethnicity
FHistory
Female sex
Advanced age
Small body frame(less than 58kg or 128 lbs)
Smoker
Sedentary
Xcess EtOH
Malnutrition
Hormonal deficiencies(hypogonadal)
Drugs

Front 8

List medical conditions associated with OP:
-para/thyroid
etc.

Back 8

Alcoholism, Chronic renal disease, Cushing's sydrome, CFibrosis, DM, GI disorders, Hemophilia, Hyperparathyroidism, hyperthyroidism

Front 9

List drugs associated with OP

Back 9

Anticonvulsants
Aromatase inhibitors
Cytotoxic drugs
Prednisone
GnRH, Heparin, Immunosuppressants
Li+
Thyroid supplements

Front 10

WHO T-Scores(Bone density) for:
-Normal
Ostepenia
-Osteoporosis

Back 10

-Normal-less than or equal to 1
-Osteopenic- 1 to 2.5
-Osteoporosis - greater than 2.5

Front 11

Elemental Ca++ requirements for:
Young adults
Men
Men > 65
Women 25-50
Postmenopausals(on HRT, not on HRT)
Women >65
Pregnant/nursing

Back 11

Young: 1200-1200mg
Men: 1000mg
Men >65 1500
Women 25-50 - 1000
Postmenopausals
-On HRT 1000mg
-No HRT 1500mg
Women >65 1500mg
Pregs/nursing - 1200-1500

Front 12

Recommended Vit D intake(IU)
Less than 50
51-70
>70
High-risk individuals

Back 12

<50 - 200IU
51-70 - 400IU
>70 - 600IU
High Risk - 800IU

Front 13

Name 3 Bisphosphanates for OP:

Back 13

Aledronate(postmenopausal or OP in men, Gluco-induced)

Ibandronate(Treat/prevent postmeno. OP)

Risendronate(OP or Gluco-induced)

Front 14

SERM used in OP. MOA? Why not good for Deep Vein Thrombosis?

Back 14

Raloxifene(Evista). reduce bone resoption and decrease bone turnover. Increase Risk of Thromboembolic RFs. May reduce breast cancer

Front 15

Calcitonin MOA?

Back 15

Natural hormone that inhibits bone resprption by binding to osteoclast receptors. Nasal. Weaker than BIS.

Front 16

This med is good for one year after one 5mg IV infusion. Can cause pyrexia, myalgia, HA, extremity pain.

Back 16

Zoledronate

Front 17

This inhibitor blcoks osteoclast activity and reduces NEW vertebral and hip fractures.

Back 17

RANKL inhibitor

Front 18

Only drugs effective in reducing fracture risk. Including 1st fracture.

Back 18

Bisphosphonates

Front 19

How does HRT of estrogen and progestin(Medroxygprogesterone acetate) affect OP?

Back 19

Recues risk of vertebran and nonvertebral fractures. BUT, not recommended due to risk of breast cancer and venous throboembolism.

Front 20

What drug might be used if you still fracture after a year of primary tx.

Back 20

The recombinnat human PTH Terparitide(Forteo)

Front 21

Common sources of Vitamin D?

Back 21

Diet: salmon, cod liver oil, milk
Sunlight exposure
Supplementation(PO)

Front 22

Difference b/w VIt D deficient and insufficient?

Back 22

It's hard to determine. Sounds as if insuffiency deals more with low Vit D levels because of intrinsic mechanisms and feedback where a deficiency is due to diet.

Front 23

Indications for BMD testing?

Back 23

NAMS recommends that BMD be measured in the
following populations:

-All women age 65 and over, regardless of clinical risk
factors
- Postmenopausal women with medical causes of bone loss
(eg, steroid use, hyperparathyroidism), regardless of age
- Postmenopausal women age 50 and over with additional
risk factors (see below)
- Postmenopausal women with a fragility fracture (eg,
fracture from a fall from standing height)
Testing should be considered for postmenopausal women
age 50 and over when one or more of the following risk
factors for fracture have been identified:
- Fracture (other than skull, facial bone, ankle, finger, and
toe) after menopause
- Thinness (body weight G127lb[57.7kg]orBMI G21 kg/m2)
- History of hip fracture in a parent
- Current smoker
- Rheumatoid arthritis
- Alcohol intake of more than two units per day (one unit is 12 oz of beer, 4 oz of wine, or 1 oz of liquor)

Front 24

What is FRAX?

Back 24

A total of 10 risk factors used to calculate the 10-year risk of major osteoporotic fracture.
-Age
Sex
weight
heigh Low femoral neck BMD
Prior fragility fracture
Parental hx of hip fracture
Current smoke
Long-term use of Glucos
RA
More than 2drinks/day

Front 25

What organs are involved with vitamin D generation, metabolism, and activation?

Back 25

Skin. Lymphatic system to venous circulation. Stored in fat cells. Liver Vit D converted to 250hydroxyvit D. Inactive form excetreted in kidneys

Front 26

1 However, most
experts agree that without adequate sun exposure,
children and adults require approximately __ to
__ IU per day

Back 26

800-1000

Front 27

For correcting vitamin Deficiency, what regimen is recommended?

Back 27

Alternatively, either 1000 IU of vitamin D3
per day (available in most pharmacies) or 3000
IU of vitamin D2 per day is effective.

Front 28

How would Vit D intoxication present itself?

Back 28

Associated with Hypercalcemia nd hyperphospatemia

Front 29

Most common form of Vitamin D comes from...

Back 29

sunlight

Front 30

Lab tests only good for secondary causes of OP. What are these tests?

Back 30

1,25-hydroxyvitamin D leves, TSH, PTH, testosterone

Front 31

Pateint-related variables for:
Bisphosphonates
Terinaparitide
Calcitonin
Raloxifene
Calcium + D

Back 31

Bisphosphonates: Esophageal problems, dysphagia, inability to be upright for 30 minutes, poor renal function(CrCl <35mL/min.
Terparitide - hypercalcemia
Calcitonin: allergies
Raloxifene: h/o VTE, pregnant, breast feeding
Calcium + D: constipation, h/o kidney stones

Front 32

Agent-related vairables of:
Bisphosphonates
Terinaparitide
Calcitonin
Raloxifene
Calcium + D

Back 32

Bisphosphonates: First line, hip fracture, prevention except Boniva, Internittemnt dosing schedules available, Interacts w/ NSAIDs.

Terinaparitide: PTH, anabolic reserved for severe bisPHOS resistant cases, inj, $$$

Calcitonin: Vertebral fracture, analgesia

Raloxifene: Vertebral fracture

Calcium + D: Carbonate with foods, citrate requires more tabs, chews available, liquid

Front 33

Indices of Toxicology:
Bisphosphonates
Terinaparitide
Calcitonin
Raloxifene
Calcium + D

Back 33

Bisphosphonates: GI upset
Terinaparitide: Nausea, HA, leg cramps, hypercalcemia
Calcitonin: Allergic rhinitis, hypersensitive
Raloxifene: Hot flashes, leg cramps, increased VTE risk
Calcium + D: constipation

Front 34

What are the Biomarkers for FOrmation(all others will be resorption)

Back 34

Bone ALkaline Phophatase
Osteocalcin
Collagen Type I propeptides
(pro N, pro C)

Front 35

Are the biomarkers for resporption or formation first to decrease

Back 35

resorption

Front 36

most common fracture site?

Back 36

hip

Front 37

Which calcium is good if previously had kidney stones?

Back 37

calcium carbonate

Front 38

Benefit of VItamin D

Back 38

Reduce rate of bone loss
reduce falling, improve muscle strengh
Can reduce hip and novertebral fractures in older adults.