AdPharm - mod 1 + 2

What is the first line of treatment for osteoporosis?

Biphosphosphates

What is a contraindication for prescribing biphosphonates? Or who is excluded?

Patients with renal disease GFR < 35 due to by phosphates clearing via urine

What Dexa scan number qualifies for treatment for osteoporosis? Osteopenia?

A DEXA scan of -2.5

A DEXA scan of -2.4 to -1

What is frax score?

Determines the risk of fracture in a patient

What is the second line of treatment in osteoporosis?

Estrogen which is typically used for younger healthy women for short duration

besides estrogen, what is another second line agent for osteoporosis?

Selective estrogen receptor blockers

What is a selective estrogen, receptor blocker and give me a name of a medication?

Raloxifene (exists)

Acts like estrogen to the bones and estrogen antagonist for breast and endometrium - can be used in women who are at risk for breast cancer

What is a contraindication when prescribing raloxifene (evista)?

Women who have prior history of DVT and stroke

What is the main side effect to selective estrogen receptor blockers?

Hot flashes

What is Duavee? Dose? Contraindications?

Estrogen and bazedoxifene - used in menopausal and prevents osteoporosis

.45/20 tablet daily

Contraindicated in those with intact, uterus, and history of reproductive cancers

ADE - thromboembolism

What is miacalcitonin? (Calcitonin)

My Calcione is used for acute pain after fractures, can be used for osteoporosis in women five years after menopause

Calcitonin can treat what type of osteoporosis?

vetebral - NOT HIP

IT IS A NASAL SPRAY cannot treat hip osteoporosis through the nose

Nasal spray once a day, one nostril alternating every day

What is teriparatide (forteo)

Not a reabsorptive, it’s stimulates osteoblasts

Can be used in both men and women subcutaneous injection daily for two years

What is the therapy regimen recommended for teriparatide (forteo)?

Patient is recommended to do two years worth of subcutaneous injections daily, followed by a phosphate regimen

Contraindicated in patients who have received skeletal radiation

What does Denosumab (prolia) do?

RANK inhibitor, which blocks RANKL, which stops osteoclasts from breaking bone down

Who is the target for denosumab?

Post menopausal women who failed other treatment, pts who have renal insufficiency

ADE - derm issues, hypocalcemia

What is osteomalacia and what causes it?

Mushy or soft bone, architecture is fine, but strength is impaired. Caused by vitamin D deficient.

What is the treatment for osteomalacia

Replenish vitamin D -800 IU daily + sun exposure

What are the normal vitamin D levels?

20 to 80 is normal however 40 is the normal minimum

What to do if a patient’s vitamin D level is below 10?

Calcitriol 0.5 mcg (vit d3) weekly (start) or biweekly until range is normal

Inactive for of vit d?

Vitamin d 2 50,000 units daily until level is 40

What should you monitor when giving vitamin d?

Calcium, phosphorus, and vitamin d obvi

What is pagats disease?

Disorganized bone formation leads to fractures and deformities

What supplement can you prescribe for someone with packets disease?

Calcium carbonate 500mg BID + vitamin D3 400 daily

What is the primary medication or drug class used for pagats disease?

Biphosphanates

What is the second line for a pagats disease?

Calcitonin only if biphosphates can’t be used

What is the primary medication used for erectile dysfunction? Or drug class?

PDE 5 inhibitors

How does PDE 5 inhibitors work?

Causes smooth muscle to relax, which increases blood flow

What are the contraindications for PDE 5 inhibitors?

Patients who are on vasodilators like nitrates and isosorbide

When should you dose reduce PDE inhibitors

When patients have liver and kidney disease

What can PDE5 inhibitors do to the cardiovascular system?

It can potentiate hypotension, so take caution prescribing to people with CV disease or who are at risk for CV disease

If a patient is on tadalifil (Cialis), what other kind of medication should you be aware of if they’re on?

Alpha blockers because alpha blockers can lower blood pressure

What other medication besides PDE 5 inhibitors can you give for erectile dysfunction?

Prostaglandin E1

what is aloprostadil?

It is a intraurethral suppository or entrepreneur injection used for ED

What are the adverse drug reactions to PDE5 inhibitors

Flushing, headaches, nasal stuffiness, blue and green disturbances - think that is causes vasodilation

What are the three types of medication’s used to treat BPH?

1 alpha blockers

2 PDE 5 inhibitors

3. 5 alpha predicate inhibitors