Pharmacology Osteoporosis in Geriatrics
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| Age of peak bone mass | 25-30 years old
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| Osteoporosis T score | At or below -2.5
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| Osteopenia T score | between -1 and -2.5
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| Normal bone density T score | -1 and above
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| Lifestyle Risk factors for Osteoporosis | Low calcium intake, high caffeine intake, alcohol, smoking, vit D insufficiency, high salt intake, inadequate physical activity, falling, excess Vit. A, aluminum, immobilization, thinness
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| Medication Risk factors for Osteoporosis | anticoagulants, anticonvulsants, cyclosporine A and tacrolimus, gonadotropin releasing hormone agonists, barbituates, lithium, dep-medroxy-progesterone, chemotherapy, glucocorticoids
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| Who should be testing for BMD? | Women >65, and men >70 regardless of risk factors. Postmenopausal women or men with risks
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| Universal recommendations | Adequate intake of Calcium and Vit D. Weight bearing exercise, decreased smoking and decreased alcohol intake
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| AEs of Calcium | GI: constipation, bloating, cramps, flatulence, reduced absorption of some meds (levothyroxine, iron, tetracycline, FQs)
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| How much calcium should be taken per day | 1200mg/day. More can be connected with kidney stones
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| Approved tx for osteoporosis | bisphosponates, calcitonin, estrogens/hormone therapy, estrogen agonist/antagonis, parathyroid hormone
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| Name the bisphosphonates approved for Osteoporosis | Alendronate, Ibandronate, Risedronate, Zoledronic acid
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| ____ decrease osteoclastic bone resorption by binding to the bone matrix | Bisphosphonates
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| Most widely studied bisphosphonate | Alendronate
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| Notes with Alendronate and Risedronate | Poorly absorbed! Take after an overnight fast, with 8oz water, sit or stand straight for at least 30 minutes after. Do not take with other fluids, and do not chew or suck on tablet.
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| Bisphosphonate dosed once yearly via an IV infusion for 15 minutes | Zolendronic acid
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| AE's of Bisphosphonates | GI problems, rare osteonecrosis of jaw (rare)
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| What percentage of Bisphosphonates is absorbed? | 1-5%
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| What form of calcitonin is available in an injection | Miacalcin (Inj or Nasal spray). Fortical (nasal spray)
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| ______ reduces the number of osteoclasts and prevents resorptive activity of the bone resulting in reduced bone turnover rate | Calcitonin
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| Calcitonin AE's | Derm: flushin, edema at injection site. GI: nausea, diarrhea. Musculoskeletal: back/joint pain. Respiratory: rhinitis, nasal irritation
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| ______ prevents osteoporosis associated with the onset of menopause | Estrogens. Not recommended for osteoporosis by endocrine team.
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| Raloxifene is an | estrogen agonist/antagonist (EVISTA)
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| DVT, PE and stroke are AEs of | Estrogen and Estrogen agonists/antagonists (black box with Reloxifene)
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| ________ stimulates new bone formation of bone by stimulating osteoblastic activity over osteoclastic activity. WORKS ON OSTEOBLASTS | Parathyroid hormone (this is dose subQ)
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| AE's PTH | LOTS. Most severe: cardiovascular angina. Black box warning: increase incidence of osteosarcoma
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| PTH MOA | Stimulation of osteoblastic activity
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| Raloxifene MOA | Acting as an estrogen agonist in the bone
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| Which agent do you need to take after an overnight fast, with 8 oz plain water, sit or stand upright at least 30 minutes, not lie down for 30 minutes after administration and not take with other medications or fluids? | Alendronate and risendronate. (with Ibandronate it is 1 hour)
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