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NBME 24 Answers

nbme24/Block 4/Question#36

A 68-year-old woman comes to the emergency ...

Alendronate

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submitted by mousie(88),

"dronates" are Bisphosphonates, commonly used to prevent/treat osteoporosis. Most common adverse effects are Esophagitis (patients should take with water and be upright for at least 30minutes), Osteonecrosis of the jaw, and atypical femoral stress fractures. -taken right from FA 2018 pg 471





pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - ADMEs = esophagitis, ONJ, atypical femoral stress fractures

  3. pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  4. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)

  5. denosumab (mab against RANKL i.e. mimics OPG)

  6. rarely calcitonin

sunshinesweetheart  IGNORE ALLLLL MY OTHER POSTS lol I just learned text boxes. brb will continue helping no one/jumping out a window +1  




pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm - Ca2+/Vit D supplementation (prophylaxis) - bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt) - SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism) - denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin





pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm

  1. Ca2+/Vit D supplementation (prophylaxis)

  2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt)

  3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism)
  4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin
sunshinesweetheart  GOT IT IN LIST FORM #procrastinating +  




pharm causes of pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

bisphosphonates MOA = bind hydroxapatite to reduce osteoclast activity (used in osteoporosis, Paget disease of bone, osteogenesis imperfecta, hypercalcemia and mets to bone)

osteoporosis pharm 1. Ca2+/Vit D supplementation (prophylaxis) 2. bisphosphonates - pulsatile PTH analogs (teriparatide) = only one that incr bone growth (stimulates osteoblasts) --> transient hypercalcemia, also incr risk of osteosarcoma (dont give to paget dz of bone or any cancer pt) 3. SERM (raloxifene = antagonist at breasts and uterus, AGONIST at bone = no incr risk of endometrial hyperplasia...but still incr risk of thromboembolism) 4. denosumab (mab against RANKL i.e. mimics OPG) - rarely calcitonin

sunshinesweetheart  ha I am bad at using websites and can't make this a list that doesn't transform into a paragraph :( sorry +