Pharmacotherapeutics for Advanced Practice Nurse Prescribers: Chapter 21. Drugs Affecting the Bones and Joints

Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss that results in major impairment are:

1. Cortical bones

2. Femoral neck bones

3. Cervical vertebrae

4. Pelvic bones

ANS: 2

Bisphosphonates treat or prevent osteoporosis by:

1. Inhibiting osteoclastic activity

2. Fostering bone resorption

3. Enhancing calcium uptake in the bone

4. Strengthening the osteoclastic proton pump

ANS: 1

Prophylactic use of bisphosphonates is recommended for patients with advancing osteopenia related to long-term use of which of the following drugs?

1. Selective estrogen receptor modulators

2. Aspirin

3. Glucocorticoids

4. Calcium supplements

ANS: 3

Besides osteoporosis, intravenous (IV) bisphosphonates are also indicated for:

1. Paget's disease

2. Early osteopenia

3. Renal cancer

4. Early closure of cranial sutures

ANS: 1

What is the role of calcium supplements when patients take bisphosphonates?

1. They must be restricted to allow the medication to work.

2. They must be taken in sufficient amounts to provide foundational elements for bone growth.

3. They must be taken at the same time as the bisphosphonates.

4. They only work with bisphosphonates if daily intake is unrestricted.

ANS: 2

Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide to Angela about her risk?

1. She is correct, black women do not have much risk of developing osteoporosis due to their dark skin.

2. Black women as a group are at risk of developing osteoporosis due to their lower calcium intake when young.

3. If she doesn't drink alcohol, her risk of developing osteoporosis is low.

4. If she has not lost more than 10% of her weight lately, her risk is low.

ANS: 2

Drugs that increase the risk of osteoporosis include:

1. Oral combined contraceptives

2. Carbamazepines

3. Calcium channel blockers

4. High doses of vitamin D

ANS: 2

Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:

1. Inhibiting magnesium resorption in the kidneys

2. Increasing calcium absorption from the gastrointestinal (GI) tract

3. Acting on the bone to inhibit osteoblast activity

4. Acting on the estrogen receptors in the bone

ANS: 4

How do bisphosphonates treat osteoporosis?

1. By selectively activating estrogen pathways in the bone

2. By reducing bone resorption by inhibiting parathyroid hormone (PTH)

3. By reducing bone resorption and inhibiting osteoclastic activity

4. By increasing PTH production

ANS: 3

Inadequate vitamin D intake can contribute to the development of osteoporosis by:

1. Increasing calcitonin production

2. Increasing calcium absorption from the intestine

3. Altering calcium metabolism

4. Stimulating bone formation

ANS: 2

The drug recommended as the primary treatment for osteoporosis in women over age 70 is:

1. Alendronate (Fosamax)

2. Premarin (estrogen)

3. Calcium carbonate

4. Raloxifene (Evista)

ANS: 1

The drug recommended as treatment for osteoporosis in men over age 70 is:

1. Alendronate (Fosamax)

2. Ibandronate (Boniva)

3. Calcium carbonate

4. Raloxifene (Evista)

ANS: 1

The ongoing monitoring for patients over age 65 taking alendronate (Fosamax) or any other bisphosphonate is:

1. Annual dual-energy x-ray absorptiometry (DEXA) scans

2. Annual vitamin D level

3. Annual renal function evaluation

4. Electrolytes every three months

ANS: 3

Bisphosphonate administration education includes:

1. Taking it on a full stomach

2. Sitting erect for at least 30 minutes afterward

3. Drinking it with orange juice

4. Taking it with H2 blockers or proton pump inhibitors (PPIs) to protect the stomach

ANS: 2

IV forms of bisphosphonates are used for all of the following except:

1. Severe gastric irritation with oral forms

2. Known cancer metastasis into the bone

3. Advancing renal dysfunction

4. Progression of bone loss with oral formulations

ANS: 3

What is the established frequency of repeating DEXA imaging for a patient on bisphosphonates?

1. Every two years

2. Every five years

3. There is no evidence-based time line for monitoring after the first two years

4. There should be annual exams

ANS: 3