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28 Cards in this Set
- Front
- Back
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in the treatment algorithm for osteoporosis, what is the first thing that should be considered? |
if there is a vertebrae or hip fracture |
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what defines osteopenia? |
t score -1.1 to -2.4 and probability of hip fracture risk less than 3% and all other fractures less than 20% |
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what defines osteoporosis? |
t score less than or equal to -2.5 or tscore -1.1 to -2.4 and a 10 year probablility of hip fracture greater than or equal to 3% or risk for all major fractures greater than or equal to 20% |
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why should you not recommend excess calcium? |
can lead to kidney stones, constipation, CVD, stroke |
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how many mg's of calcium in carbonate? phosphate? Citrate? Lactate? Gluconate? |
260 150 137 85 59 |
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How much ca should a 51-70 year old male take a day? how much vitamin D? |
1000-2000 mg 600-4000 IU |
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How much ca should a 51-70 year old female take a day? how much vitamin D? |
1200-2000 mg 600-4000 IU |
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what are all the bisphosphonates? which ones are injectables? |
alendronate, risedronate, ibandronate, zoledronic acid zoledronic acid and ibandronate oral is always first, ask if they tried oral if prescribed an injectable |
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what bisphosphonate is always considered second line? what type of fractures are the bisphosphonates good for? how long can you use them what is the exception? |
ibandronate vertebral and nonbertebral 3-5 years ibandronate is only for vertebral |
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what are the side effects of bisphophonates? what drug combo can cause misleading cause of side effects? |
Gi, musculoskeletal pain, onj, esophageal caner musculoskeletal pain from both statin and bisphos |
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how should bisphosphonates be taken? what is the exception? what bisphophonate should you wait longer on? |
take in morning with full glass of water on empty stomach, stay upright for 30-60 minutes, could take levo after that time risedronate delayed release, take with food ibandronate, must wait for 60 minutes |
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what should you do if you are on a bisphohonate and have a dental appointment coming up what effect does ranitidine do if combined with bisphos? aspirin? |
stop taking 3 months prior to dental appointment and restart one month after increase concentrations more gi side effects |
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what are bisphos contraindicated in? |
pregnancy and certain renal impairment, gi dysfunction |
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alendronate prevention dose? treatment dose? what crcl is contraindicated? what is unique about alendronate with vit d? |
5 mg daily, or 35 mg once a week 10 mg daily or 70 mg a week less than 35 ml/min only for treatment |
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what is the treatment dose of risedronate? what is treatment dose of risedronate with ca? what crcl is contra? |
5 mg daily, 35 weekly, or 150 mg once a month 35mg/150mg once weekly 30 ml/min |
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what is the treatment dose of ibandronate? what crcl is contra? |
2.5 mg dailys or 150 mg once a month, or 3 mg iv every 3 months less than 30 ml/min |
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what is the dose of zoledronic acid for treatment? for prevention? what crcl is contr? |
5 mg iv every years 5 mg iv every 2 years less than 35 ml/min |
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what kind of factures is raloxifene good for? when would this be a great choice to use? what are the side effects of raloxifene? dose for treatment? |
vertabral only hisotry of breast cancer or family history hot flash, leg cramp, vte 60 mg daily |
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what is raloxifene contra in? can you take thyroid hormones with this? how does this drug affect lipids? |
vte and pregnancy, cvd yes, but seperate by 12 hours lowers tc and ldl, no change in chd risk |
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what is the preferred estrogen to use? is it for treatment of prevention? |
prempro prevention only |
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what does duavee consist of? treatment or prevention? dose? |
a serm and a estrogen prevention only estrogen 0.45 mg daily and bazedoxifene 20 mg |
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what are some contras for duavee? what are the cyp inhibitors? what are the cyp inducers? |
pregnancy, vte, liver impairment G PAC MAN (grapfruit, protease inhibitor, azoles, cimatdine, macrolides, amidarone, non dhp ccb) barbies car goes really really phast (barbituates, carbamaipine, st jons wort, rifampin, phenytoin) |
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what is unique when considering the use of raloxifene? |
can bypass all other first line bisphosphonates if there is a history of breast cancer |
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what is the indication for calcitonin? what is it most used for? |
treatment of osteoporosis after 5 years of menopause never as monontherapy but for bone pain in vertebral fracture only |
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how is calcitonin dosed? side effects? counseling point? |
200 IU/day in one nostril, alternate daily nasal- rhinitis, epistaxis,dryness injection- arthralgia do not pick nose |
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when is teriparatide indicated? what is it? dose? black box? |
bmd less than -3.0 and history of fracture, last line PTH 20 ug daily for 2 years osteosarcoma in rats after 2 years |
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what are the side effects of teriparatide?
contras? how many doses in a pen? |
nauses, orthostatic hypotension
hypercalcemia, bone metastases, pagets disease 28, must discard after the 28th day |
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how is teriparatide stored? what is the dose of denosumab? can you self administer? side effects? |
refrigerate, not freeze 60 mg sq every 6 months only by a health care provider back and extemity pain, opportunisitic infection, hypocalcemia |
