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Osteoporosis exam5
Fields&newaz
| Question | Answer |
|---|---|
| The flexible part of the matrix is made of _____ including gag's, proteoglycans, and glycoproteins | Collegen & carb polymers from osteoblast |
| The stable hard part of the matrix is made of _____ which is Calcium in its _____ form as well as flouride, magnesium, potassium, and calcium carbonate | Hydroapetite, unexchangable |
| Red bone marrow is found in _____ pts, it makes ______ and in ____ pts it makes ______ | peds, all RBC in all bones, adults, skull, spine, ribs, pelvis, thigh |
| Yellow bone marrow is found in ____ pts, it makes ____ and is made of ____ | Adults only, it does not make RBC, fatty bone |
| Bones that are fully grown are _____ because they are _____ because they ______ | Organs, metabolically active, exchange minerals w tissue & blood and grow and remodel |
| The flexible part of the matrix is made of _____ including gag's, proteoglycans, and glycoproteins | Collegen & carb polymers from osteoblast |
| The stable hard part of the matrix is made of _____ which is Calcium in its _____ form as well as flouride, magnesium, potassium, and calcium carbonate | Hydroapetite, unexchangable |
| Red bone marrow is found in _____ pts, it makes ______ and in ____ pts it makes ______ | peds, all RBC in all bones, adults, skull, spine, ribs, pelvis, thigh |
| Yellow bone marrow is found in ____ pts, it makes ____ and is made of ____ | Adults only, it does not make RBC, fatty bone |
| Bones that are fully grown are _____ because they are _____ because they ______ | Organs, metabolically active, exchange minerals w tissue & blood and grow and remodel |
| SrCa = _____mM or _____mg/dL | 2.5, 9.2-10.4 |
| SrCa is ___% of the body's calcium and bone is where the ___% of calcium is, total body calcium is _____g | 1, 99, 1100 |
| Calcium is exchanged btwn bones and blood at a rate of ___%q1y | 18 |
| ___% of blood SrCa is exchangeable and is floating around free, ___% is bound in plasma protein and is unexchangable | 45, 55 |
| Calcium is used in our bodies for neurons to fire, ______, _____, and exocytosis to occur | muscles to contract, blood to clot |
| Phosphate is used in our bodies for ______ synthesis and as a _____ | DNA, RNA, ATP, phospholipid, pH buffer |
| Hypocalcimia is SrCa <_____ or <_____ | 2.5mM, 9.2mg/dL |
| Hypocalcimia is the inability of muscles to _____ because Na enters cells ____ and _____ the nerves/muscles. S/sx? | relax, too easily, excites. Excess excitability of muscles, tremors, spasms, tetany |
| Which is more common hypo or hyper calcemia? | hypocalcimia |
| Hypocalcimia can be caused by what 4 things? | vitD deficiency/malnutrition, v/d, thyroid or parathyroid tumor, preggers/lactation |
| Hyper calcemia is SrCa >____ or >____ | 2.5mM, 10.4mg/dL |
| Hyper calcemia is Na channels being _____ and nerve/muscles ______. S/sx? | less responsive, less excitable than normal. Sluggish relflexes, depression |
| Newaz says calcium homeostasis is done by what 3 things? | Calcitriol, calcitonin, PTH |
| The sun gives ur skin vitD then the suns light turns it from _____ to _____. From there it goes to the liver using ____ enzyme to turn it into the liver storage form of calcium called _____. From the liver it can go to either kidney or bone. | 7dehydrocholesterol, cholecalciferol, 21hydroxylase, 25hydroxycholecalciferol |
| In kidney the enzyme ____ turns calcium from ____ to _____ | 1alphahydroxylase, 25OHcholecalciferol, calcitriol |
| In bone the use of ____ turns clacium from ___ to _____ or from ____ to _____ | phosphate, 25OHcholecalciferol, hydroxyapetite the storage form, 25OHcholecalciferol, free calcium the exchangeable form in bone |
| _____SrCa causes the thyroid gland Ccells to release _____ which does what? | increased, calcitonin, decreases osteoclasts by 70% and increases osteoblasts to deposit calcium into bones |
| _____SrCa causes the parathyroid gland to release _____ which does what? | decreased, PTH, binds and blocks osteoblasts (RANKL to RANK) thereby increasing levels of osteoclasts, stimulates the nephrons in kidney to reabsorb more calcium and excrete more phosphate, increases Calcitriol synthesis from kidney (cause pth is needed f |
| Osteoporosis mortality rate ____% because of secondary causes like falls or fractures. Osteoporosis itself ____ cause death | 10, cannot |
| Osteoporosis affects ____ bone the most because it's _____ | spongy, the most metabolically active |
| By 70yo u've lost ___% of ur bone mass. Females have ___% less bone mass then males @ age 35yo | 30,30 |
| Type ____ osteoporosis is most common. Type1 is in female >50 from menopause (____ fractures). Type2 is anyone >60 from senescent (____ fractures) | mixed1&2, spine or wrist, spine or hip |
| Exercise in pts <___y.o. increases their _____. It does not ____ but it does ____ | 30, peak bone mass, grow bone, stop bone breakdown |
| Osteoporosis is the ____ common type of bone prob | most |
| ____% females get osteo-related fractures, ___% of male | 50, 20 |
| Pts >80y.o. have a ___% risk of fracture. Pts >50yo who get a hip fracture have a ___% chance of dying within the next ____ years. | 50, 25, 1 |
| Glucocorticoids like _____ would inc risk of developing osteoporosis at a dose of ____ | progesterone, >5mg qd x >3m |
| ____% of pts taking glucocorticoids will get an osteo-related fracture | 30-50 |
| FRAX assesses the pts _____ to see if they have a _____ risk of developing an osteo-related fracture in their _____ | BMD bone mineral density, 10-yr future, hip & nonhip major areas (hip, thigh, wrist, spine) |
| A BMI >___ = obese | 30 |
| If the FRAX hip score is >____% then you must _____. If the FRAX nonhip score is >_____% then u must do that too | 3, start osteo Rx trx, 20 |
| Most common s/sx of osteoporosis is ___ | nothing, most common is asymptomatic, silent |
| Loss of height of ____ inches in a life is normal, if u loose more than that u might have osteo | 1-1.5 |
| Kyphosis is ___ | widows hump, humpback of Norte dame |
| Biochemical markers are used to ____ osteoporosis. Resorption markers are ____, formation markers are _____ | assess the possibility of (not to dx), CTX & NTX, OsteoCalcin & BSAP [SrCtelopeptide, UrineNtelopeptide, OsteoCalcin, SrAlkalinePhosphate] |
| Who should u test for osteo using DXA scan? Females >___yo + _____ & Males >_____yo + _____. Also test anyone >____yo +____ or anyone on ____ meds | 50, risk factors, 70, risk factors, 50, fracture, steroids/immunosuppressive, d/c HRT therapy |
| To dx osteoporosis u have to use the ____ test which measures ur _____ @ __&____ | DXA (dual energy X-ray absorptometer), BMD, hip & spine |
| DXA scan uses ___&___ tests reported in ____. Each does what and what is the dx of osteo w them? | T&Z score testes, standard deviation above and below the mean. T-score BMD <-2 = dx w osteoporosis. Tscore -1--2.5 = dx w osteopenia. Tscore BMD >-1=healthy |
| What is osteopenia? | low bone mass low enough to be @ high risk of developing osteoporosis. It's a FRAX score of >3% hip or >20% nonhip |
| Nonpharm trx and/or prevention of osteoporosis | 1) adequate diet 2) wt bearing exercise + strength training exercise x 30m qd (3) dec fall risk in envmt |
| Calcium + Vit D adults >__yo need >__mg elemental calcium qd + ___mg VitD qd if ___ | 50, 1200, 800-1000, always no matter what other meds ur on |
| Cut up the dose of calcium if it's >___ | 500mg qd |
| Calcium Ae (3) | constipation, gas, other GI sx |
| Calcium DDI | take all other meds 2 hr prior to ca. Take Levothyroxine 6 hrs prior to ca |
| Order of what works best to trx/prevent osteo via decreasing ___ & increasing ___ | Rx meds > ca+vitD > placebo, fractures, BMD |
| Goal if vit d trx is to increase ___ to be >____ | 25OHcholecalciferol, 30ng/mL |
| VitD can be found OTC as ___ or Rx as ___ | cholecalciferol 400-1000u qd, ergocalciferol 5000 u q1w, 1,25calcitriolOH 0.25-0.5 |
| Pharm trx/prevention of osteo fractures are what 6 drugs besides calcium? | (1) bisohosphates (2) calcitonin (3) HRT/EOT (4) SERMs (5) PTH (6) monoclonal antibody |
| Bisohosphates are ___ line therapy. They ____ osteoporosis in ____ pts. Reevaluate q ___ yrs after initiating them | 1st, trx & prevent, menopausal female & men & med-induced osteo, 5 |
| Bisohosphates decrease the risk of ____ fractures | spine, nonspine, hip |
| Admin bisohosphates along w _____ and take _____ prior to _____ and ____ after u take it | >6oz plain water!!!, 1hr, food/drink/med, sit up for 1hr. |
| What is ONJ and how r u supposed to prevent it when ur on bisohosphates | osteonecrosis of the jaw. Blackbox warning on bisphos. Prevent by getting a dental check up q6m. Worse if pt is on IV bisphos @ high doses or oral for >2y or if pt is also on chemo meds. |
| Is a drug holiday a good idea? | not recommended to d/c or hold bisphos for any reason other than allergic rxn |
| Bisphos contra (5) | (1) kidney CrCl < 35 (2) GI probs/peptic ulcers (3) hypocalcimia (4) preggers (5) breast cancer or hx of it |
| Bisphos Ae's (6) | (1) ONJ [rare, jaw lesions possibly from bacteria or microcracks] (2) kidney fail [with zoledronic acid only] (3) GI dysphasia, esophagitis, ulcer (4) severe muscle, joint, bone pain (5) thigh bone humerus fracture (6) may cause but they're not sure: thro |
| Why would u take bisphos 1hr prior to stuff and sit up for 1 hr? | cause it's only <1% bioavailable and it causes GI sx |
| What meds should u not take while on bisphos? | NSAIDs. May increase possibility of ulcers/GI bleeding |
| MoA of bisohosphinates (3) | it's a antiresorptive/antirestorative analog/mimic of pyrophosphate. (1) decreases formation of hydroxyapetite (2) shortens life of osteoclasts (3) blocks osteoclast activity and blocks bone breakdown |
| Bisphosphinate Drugs (4) | (1) PO Alendronate [fosamax] 5mg qd proph, 10mg qd trx (2) PO Risedronate[actonel] 5mg qd proph, 75mg x 2d q1m trx (3) PO/IV Ibandronate [Boniva] 150mg q1m proph&trx (4) PO/IV Zoledronic Acid [Reclast] 5mg q2y proph q1y trx |
| Antiresorptive ability from lowest to highest | Alendronate < Risedronate < Ibandronate < Zoledronic Acid (most potent) |
| Estrogen/HRT is used to _____ osteoporosis in _____pts. Intact uterus pts should be on ____, tubes tied (hysterectomy) pts should be on ____ | prevention only, menopausal + sx only, EE+P, EE only |
| Estrogen/HRT decreases risk of ____ fractures. MoA? Admin? | spine, hip, wrist, nonhip. Estrogen receptor stimulation causes osteoblast stimulation. Only admin lowest dose possible for shortest time possible until sx are gone then d/c. |
| Estrogen/HRT Ae besides the ones we already learned about | beast and endometrial cancer |
| Estrogen/HRT used to be 1st line until a study came out saying it causes ____ | CAD, Stroke, VTE, but still decreased hip fractures |
| SERMs stands for _____ and is a combo of what two things? | Selective estrogen receptor modulators, estrogen agonist + estrogen antagonist |
| SERMs are used to ____ osteoporosis in ______ and can also be used for _____ | trx & prevent, menopause, prevent breast cancer, decrease cholesterol |
| SERMs decrease ____ fractures | spine only |
| Admin ____ SERMs drug | Raloxifen [evista] 60mg qd |
| SERMs contra (3) | (1) preggers (2) CVD/hx of clot (3) extended immobility >3days! |
| SERMs Ae | menopause mimic sx & blackbox warning: fatal stroke |
| PTH is ____ line therapy if __&____ don't work. Decreases _____ fractures in _____ pts. | 2nd, bisphos & SERMs, spine & nonspine but does NoT dec hip fractures, menopause women, men, high risk of fracture, meds that cause fractures |
| What's special about PTH? | it's the only drug that directly increases bone formation by directly acting on osteoblasts to activate them! |
| PTH admin ___ | Teriparatide [forteo] 20mg SC qd. Store in the fridge! Take for less than 2yrs, $$$ |
| PTH contra: | Pagets dz |
| PTH Ae (3) | (1) blackbox warning: osteosarcoma (bone cancer) (only saw it in animals) (2) hypercalcemia (3) leg cramps |
| Monoclonal antibody is ____ line. It's blocks activation of ____ by _____. It's used to ____ osteoporosis by decreasing ____ fractures in ____ pts. | 3rd, osteoclasts, RANKL binding to RANK. Trx (not prevent), spine, hip, & nonhip, postmenopausal women @ high risk of fractures. |
| What's special about monoclonal antibody drugs? | no kidney prob dose adjustments are needed! Safe for kidney prob pts. |
| Monoclonal antibody admin ___ | Denosumab [prolia] 60mg SC q6m. Only can be admined by a physician. Store in fridge! Let stand in room temp 15min prior to use. |
| Monoclonal antibody contra | hypocalcimia |
| Monoclonal antibody Ae (4) | (1) hypocalcemea (2) cellulitis (3) ONJ (4) muscle pain |
| Monoclonal antibody DDI | none! |
| Calcitonin is a _____ derived product that comes from ____. It's used to ____ osteoporosis in ____ pts via decreasing ____ fractures & ____ | naturally, thyroid gland, trx (no prevention), >5y postmenopausal, spine only, relieves back pain. |
| Calcitonin admin ____ | Salmon Calcitonin [miacalcin] 200units qd in nose x <4wks |
| Monitoring pts on osteo drugs: reevaluate ____ using ____ q___yrs (Medicare pays for it q___yrs). Reevaluate bisohosphates pts q___yrs for dose adjustments & adherence. | BMD, DXA scan, 2, 2, 5. |
Created by:
tarameesu