pharma II test IV osteo

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pharma II test IV osteo
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2013-05-01 18:29:41
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pharma II test IV osteo
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  1. 3 causes of high turnover bone loss
    • increased osteoclast activity
    • postmenopausal women
    • 2-5% bone loss per year
  2. 3 causes of low-turnover bone loss
    • decreasd osteoblast function
    • >35 yo
    • 0.5 - 1% bone loss per year
  3. gold standard for diagnosing bone density
    central dual energy X-ray absorptiometrt DEXA
  4. compares bone density with that of an average healthy, sex-matched, young adult (20-29 yrs reference population)
    T-score
  5. compares the bone mass with that of someone of the same age and sex
    Z-score
  6. what would a low z-score indicate
    there is bone loss from other reasons other than normal aging
  7. what would a t-score be use for
    show normal bone loss due to aging
  8. normal T-score
    0 to -1
  9. osteopenia T-score
    -1.1 to -2.4
  10. osteoporosis T-score
    < -2.5
  11. severe osteoporosis T-score
    < -2.5 + fracture
  12. 7 risk factors for osteoporosis
    • gender, race
    • body stature
    • family history
    • age, menstrual history
    • lifestyle, environmental, physical activity
    • medications
    • disease
  13. normal daily calcium intake and when is the max intake required (age)
    • 500-600mg
    • 9-18yo
  14. calcium product
    40% calcium
    500-600 mg
    take with food - active transport
    PPI, H2-antagonists reduce absorption
    tablets, chewable or liquid
    calcium carbonate
  15. calcium product
    21% calcium
    300-315 mg
    can be taken with or without food
    calcium citrate
  16. childhood deficiency of Vit D
    rickets
  17. adult deficiency of Vit D
    osteomalacia
  18. 3 calcium regulation process's and where they happen
    • absorption - intestine
    • excretion - kidney
    • resorption - bone
  19. 3 regulators of calcium
    • vitamin D
    • parathyroid hormone
    • calcitonin
  20. vitamin D effects on calcium levels and 3 mechanisms
    • increases plasma calcium
    •   
    • increases Ca absorption from the intestine
    • decreases renal Ca excretion
    • increases Ca resorption from bone
  21. daily requirement of Vitamin D
    • 600 IU/d
    • 800-1000 IU/d (>50yo)
  22. level for vitamin D deficiency
    serum 25-hydroxyvitamin D < 10ng/mL (25nmol/L)
  23. level for vitamin D insufficiency
    serum level 25-hydroxyvitamin D 10-30 ng/mL (25-75 nmol/L)
  24. path of vitamin D through the skin
    7dehydrocholesterol -->cholcalciferol --> broken down by 25-hydroxylase in the liver -->calciferol--> broken down by 1a-hydroxylase in the kidney-->calcitriol
  25. pathway of vitamin D in the diet
    ergosterol -->ergocalciferol --> broken down by 25-hydroxylase in the liver-->25-hydroxyergocalciferol-->broken down by 1a-hydroxylase in the kidney-->1,25-dihydroxyergocalciferol
  26. 3 criteria to treat for osteoporosis in postmenopausal women and men age > 50
    • hip or vertebral fracture
    • T-score < -2.5 at the femoral neck or spine by central DEXA
    • low bone mass (T-Score between -1.0 and -2.5) and a 10 yr probability of a hip fracture > 3% or a 10 year probability of a major osteoporosis related fracture > 20% (WHO FRAX alogorithym
  27. 1st line agent for prophylaxis or treatment of osteoporosis
    bisphosphonates
  28. bisphosphonate
    ind - post menopausal osteoporosis and glucocorticoid-induced osteoporosis in men and women
    reduces fractures by 50 & 48% over 3yr
    alendronate - fosamax
  29. bisphosphonate
    prevention and treatment
    post-menopausal osteoporosis and GIO
    take immediately after breakfast with 4 oz of water
    keep upright for 30 min
    enteric coated
    risedronate - actnoel
  30. delayed release risedronate
    take immediately after breakfast with a full glass of water
    atelvia
  31. bisphosphonate
    treatment and prevention
    can be dosed daily, monthly or every 3 months
    ibandronate - boniva
  32. bisphosphonate
    prevention and treatment
    IV infusion over 15min once yearly for treatment
    IV infusion once every 2 years for prevention
    long T 1/2
    70% 5yr reduction in fractures
    zoledronic acid - zometa
  33. MOA of bisphosphonates
    • structural analog of pyrophosphate
    • incorporated in bone matrix
    • remains until remodeling occurs
    • acid from osteoclasts dissolve matrix and release BP
    • internalized decrease maturation of osteoclast and leads to apoptosis
  34. 4 AE/CI of bisphosphonates
    • esophagitis
    • hypocalcemia
    • CI - pregnancy
    • osteonecrosis of jaw
  35. SERM
    oral
    estrogen agonist of bone
      prevention and treatment, post-menopausal
    estrogen antagonist of breast and uterus
      decrease risk of invasive breast cancer
      doesn't cause endometrial hyperplasia
    raloxifene - evista
  36. AE of raloxifene 3
    • hot flashes
    • increase risk of thrombolic events
    • pregnancy catergory X
  37. produced by thyroid
    moa
      inhibits osteoclast activity
      stimulates urinary excretion of Ca & PO4
    third line agent
    treatment only for women >5yr postmenopause
    • calcitonin - miacalcin
    •                 fortical
  38. PTH
    ind - treatment of osteo
    intermittent low dose SC,INJ
    moa - increases BMD by stimulating bone formaiton
    FDA approval for 2yr use
    give in combo with BPs
    not first line
    rhPTH 1-34 - teriparatide - forteo
  39. teriparatide - forteo AE/CI 3
    • dizziness
    • BBW - osteosarcoma
    • CI - paget's disease & open epiphysis
  40. RANK ligand
    OPG decoy
    moa - inhibits osteoclast formation
    ind - pts with T-score <-3.5 and resistant to BP's
    effects reversible upon discontinuation
    denosumab - prolia, xegva

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