Therapeutics - Osteoporosis 1

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kyleannkelsey
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281377
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Therapeutics - Osteoporosis 1
Updated:
2014-08-26 17:09:12
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Therapeutics Osteoporosis
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Therapeutics - Osteoporosis 1
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  1. Who should be assessed for screening needs for osteoporosis?
    All postmenopausal women and men over 50 years
  2. What are the medications that increase osteoporosis risk?
    • Anticoagulants
    • Anticonvulsants
    • Lithium
    • Armoatase inhibitors
    • Barbituates
    • Corticosteroids
    • Depo-Provera
    • Cyclosporine
    • Tacrolimus
    • GNRH Agonists
    • Chemo drugs
    • PPIs
    • TZDs
    • SSRI’s
    • Thyroxine
  3. What is the recommended calcium intake for a 19-50 year old male or female?
    1000 mg/day
  4. What is the recommended calcium intake for a 51-70 year old male?
    1000 mg/day
  5. What is the recommended calcium intake for a 51-70 year old female?
    1200 mg/day
  6. What is the recommended calcium intake for a 71+ year old male or female?
    1200 mg/day
  7. What are the non-drug interventions for osteoporosis?
    • Calcium supplementation
    • Vitamin D supplementation
    • Weight bearing/resistance exercise
    • Fall prevention (assess vision/neuro deficits, add assistive devices)
    • Limit alcohol, tobacco and Caffeine
  8. Does Calcium supplementation increase BMD?
    Slightly
  9. Does Calcium supplementation decrease fracture risk?
    No
  10. Why should Viactiv be cautioned in patient’s taking warfarin?
    It contains vitamin K
  11. Which Calcium salt requires stomach acid for absorption?
    Carbonate
  12. Which Calcium salt does NOT require stomach acid for absorption?
    Gluconate or Citrate
  13. How much Calcium can be given at once?
    500-600 mg
  14. What is the goal 25(OH) Vitamin D levels in a patient?
    30-60 ng/mL
  15. What is the recommended dose of Vitamin D?
    800-1000 IU Cholecalceferol (D3) daily
  16. Which type of Vitamin D is not used as much and why?
    Ergocalciferol (D2) because of decreased absorption, especially with intermittent dosing
  17. What type of Vitamin D would you use in renally compromised patients?
    Calcitrol (D1)
  18. What group of patients needs a higher than normal Vitamin D dose?
    Homebound, chronically ill and Renally impaired
  19. What is the dose of Replesta?
    • 50,000 IU wafer
    • 1-2 wafers per week for up to 12 weeks
  20. What is the dose of Ergocalceferol (D2)/Cholecalceferol?
    • 50,000 capsule
    • 1-2 capsules per week at first
    • Then, once monthly
  21. What is the dose of Calcitrol?
    0.25 mcg/day orally
  22. What type of vitamin D would you use in a patient with CKD or is on Dialysis?
    Calcitrol
  23. What is the general repletion dose of Vitamin D?
    50,000 IU per week for 8-12 weeks
  24. What is the general maintenance dose of Vitamin D?
    50,000 IU monthly or 800-1000 IU daily
  25. When should you recommend pharmacological treatment of osteoporosis?
    • Hip or vertebral fracture
    • T-score less than or = to 2.5 at neck
    • Osteopenia and FRAX greater than or = to 3% at hip or greater than or= to 20% risk of major OP fracture
  26. What is the MOA of bisphosphonates?
    Inhibit bone reabsorption and osteoclastic activity
  27. What are the Bisphosphanates?
    • Alendronate
    • Ibandronate
    • Risedronate
    • Zoledronic acid
  28. What benefit do bisphosphonates impart?
    • 4-6.2% increase in BMD
    • Best effect on BMD and greatest reduction in fracture rates
  29. What dosage forms is Alendronate (Fosamax and Binosto) available in?
    • Oral
    • With Vitamin D3
    • Effervescent
  30. What dosage forms is Ibandronate (Boniva) available in?
    Oral and IV
  31. What dosage forms is Risedronate (Actonel) available in?
    • Oral
    • Available with Calcium
  32. What dosage forms is Zoledronic acid (Reclast) available in?
    IV only
  33. Alendronate brand name
    Fosamax and Binosto
  34. Ibandronate brand name
    Boniva
  35. Risedronate brand name
    Actonel
  36. Zoledronic acid brand name
    Reclast
  37. What is the indication for Bisphosphanates?
    • Alendronate, Risedronate and Reclast = Treatment and Prevention of PM, Male and GC induced OP
    • Ibandronate = treatment and prevention of PM OP
  38. What is the bioavailability of bisphosphonates?
    <1%
  39. What decreases absorption of bisphosphonates?
    Food or drinks other than water
  40. How should you take bisphosphonates?
    • With a full glass of water on an empty stomach upon waking
    • Sit upright for 30 minutes for all except ibandronate
    • Ibandronate = sit upright for 60 minutes after taking
  41. How can you prevent acute reactions to bisphosphonates?
    APAP or IBU
  42. What are the AE of bisphosphonates?
    • Esophagitis
    • Osteonecrosis of the jaw
    • Visual disturbances
    • Bone pain
    • Atypical fracture
    • Atrial fibrillation (zoledronic acid)
    • Atypical fractures after 5 years of use

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