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RxPrep
Osteoporosis
| Question | Answer |
|---|---|
| Denosumab brand name? | Prolia or Xgeva |
| Raloxifene brand name? | Evista |
| When are teriparatide and abaloparatide used? | Only in high-risk patients (history of fractures, etc) |
| Teriparatide brand name? | Forteo |
| Abaloparatide brand? | Tymlos |
| Calcitonin brand? | Miacalcin |
| Romosozumab brand? | Evenity |
| Normal T-score? | ≥ −1 |
| Osteopenia range? | −1 to −2.5 |
| Osteoporosis range/score? | ≤ −2.5 |
| When treat regardless of BMD/t score? | If patient has a fragility fracture (high risk) |
| First-line drugs for osteoporosis? | Bisphosphonates (mainly alendronate, also risedronate, ibandronate) |
| Which bisphosphonate only reduces risk of vertebral fractures? | Ibrandronate |
| When use denosumab? | Alternative to bisphosphonates |
| High fracture risk preferred agents? | Teriparatide or abaloparatide |
| Bisphosphonates MOA? | Inhibit osteoclast activity |
| Bisphosphonates common ADRs? | GI irritation, esophagitis |
| Bisphosphonates rare ADRs? | ONJ, atypical femur fractures |
| Bisphosphonates common lab changes? | Hypocalcemia |
| Bisphosphonates : How are they taken? | With water, empty stomach, stay upright for 30 min (or 60 with ibandronate) |
| Can patients take vitamins/minerals with bisphosphonates? | NO, must wait 30-60 minutes between antacits/minerals and bisphosphonates |
| Oral bisphosphonate contraindications? | Unable to sit upright, Esophageal abnormalities |
| What would we want to check before starting bisphosphonates? | check for/correct hypocalcemia before starting, also ensure CrCl > 35 |
| Unique IV bisphosphonate ADR? | Acute phase reaction (flu-like) |
| Zolendronic acid renal requirement? | > 35 CrCl |
| Advantage of IV bisphosphonates? | no GI/esophageal issues |
| Drugs causing ONJ? | Bisphosphonates, denosumab |
| Risk factors for ONJ? | Dental procedures, poor hygiene, chemo, steroids |
| Denosumab MOA | RANKL inhibitor |
| Denosumab Dosing? | Every 6 months SC |
| Denosumab Boxed warning? | Severe hypocalcemia in CKD |
| Denosumab CI? | Hypocalcemia |
| Denosumab unique warning? | Rapid bone loss if D/C'd |
| Denosumab common ADRs? | Fatigue, edema, infections |
| Lab changes with denosumab? | Yes, hypocalcemia |
| teriparatide/abaloparatide MOA? | PTH analogs that increase bone formation |
| teriparatide/abaloparatide tx duration? | No more than 2 years |
| teriparatide/abaloparatide major warning? | Osteosarcoma risk |
| teriparatide/abaloparatide lab changes? | HYPERcalcemia (unlike the other osteo meds) |
| teriparatide/abaloparatide common ADRs? | orthostasis, dizziness |
| Raloxifine drug class? | SERM |
| Major risk of raloxifine? | VTE (contraindicated if history of VTE) |
| Common side effects of raloxifine? | Hot flashes, leg cramps |
| Counseling for raloxifine? | Stop before immobilization (dont take it if immobile for long periods, VTE risk) |
| Estrogen products boxed warnings? | VTE, stroke, cancer |
| Estrogen products CI? | Breast cancer, VTE, pregnancy |
| Estrogen products common ADRs? | Nausea, dyspepsia, edema |
| Estrogen products use in osteoporosis? | Prevention only |
| Calcitonin MOA? | Inhibits osteoclasts |
| Calcitonin effectiveness? | Less effective than other osteo drugs |
| Calcitonin major warning? | Malignancy risk long term |
| Calcitonin unique ADR? | Nasal irritation |
| Calcitonin common ADRs? | Back pain, myalgia |
| Romosozumab MOA? | Sclerostin inhibitor |
| Romosozumab duration of tx? | Max 12 months |
| Romosozumab box warning? | MI, stroke risk |
| Romosozumab CI? | Hypocalcemia (like literally all other osteoporosis meds) |
| Romosozumab common ADRs? | Arthralgia, headache |
| Calcium daily recommendation? | 1000-1200mg per day |
| Calcium max per dose? | 500-600mg max per dose |
| How to take calcium carbonate? | With food |
| How to take calcium citrate? | without food |
| Which calcium form has more elemental Ca? | Carbonate |
| Vitamin D purpose in osteo? | Increases Ca absorption |
| Vitamin D defciency lab value? | < 30 |
| Cholecalciferol dosing in deficiency? | 5000-7000 IU daily |
| Ergocalciferol dosing in deficiency? | 50,000 IU weekly |
| Generally, when would IV bisphosphonates be used instead of oral? | Cant tolerate oral |
| Lifestyle risk factors? | Smoking, alcohol, inactivity, low Ca intake in diet |
| Medication risks? | Steroids, PPIs, SSRIs, loop diuretics |
| Disease risk for osteo? | Hyperthyroidism |
| Drugs causing fall risk? | Sedatives, antihypertensives, opioids |
| Prevention measures for fall? | Strength, balance, vision correction |
| Which osteo med increases CV risk? | Romosozumab |
| Drugs with ONJ risk? | Bisphosphonates, denosumab |
Created by:
cdaughtry