B6-048 Drugs: Bone Mineral Homeostasis Flashcards
oral glucocorticoids are a major risk factor for
osteoporosis
calcium and phosphorus regulation is regulated by [2 main ones she mentioned]
1,25-dihydroxvitamin D3
Parathyroid hormone
PTH and vitamin D stimulate […] proliferation and differentiation
preosteoblast
PTH and vitamin D stimulate differentiation and activation of […]
osteoclasts
used as prophylaxis treatment of osteoporosis
calcium
used to treat hypocalcemia due to dietary insufficiency or malabsorption states
calcium
oral preparations of calcium [2]
calcium carbonate
calcium citrate
IV preparation of calcium
calcium gluconate
most likely calcium supplement to cause gas, bloating, and constipation
calcium carbonate
which calcium MUST be taken with food
calcium carbonate
oral calcium that is cheapest
calcium carbonate
oral calcium that causes fewer GI problems and can be taken without food
calcium citrate
used to treat osteoporosis and osteomalacia in combination with calcium
vitamin D
prophylaxis and treatment of nutritional rickets
vitamin D
which vitamin D has the longest half life?
cholecalciferol (D3)
which vitamin D requires bioactivation?
cholecalciferol (D3)
most active form of vitamin D
requires prescription
calcitriol
vitamin D used for metabolic rickets, hypothyroidism, secondary HyperPTH due to kidney failure
calcitriol
vegetarian option for vitamin D, but is less physiological overall
ergocalciferol
which form of vitamin D is OTC?
cholecalciferol
suppress the activity of osteoclasts inhibits bone resorption
bisphosphonates
bisphosphonates are primarily used to treat
osteoporosis
instructions for taking bisphosphonates
take with full glass of water on an empty stomach and remain upright for 30 min
most common adverse effect of bisphosphonates
esophageal and gastric irritation
long term use (5+ years) of bisphosphonates can cause
osteonecrosis of the jaw
a “drug holiday” from bisphosphonates is recommended after […] years
3-5
etidronate is administed [time]
daily
alendronate is administered [time]
weekly
risendronate is administered [time]
monthly
IV bisphophonate administered annually
zoledronic acid
bisphosphate that is available in oral and IV preparations
ibandronate
**monthly or quarterly
etidronate is only used to treat
Paget’s
stimulates new bone that is structurally normal, structurally analogous to PTH
teriparatide
not recommended for use > 2 years d/t black box warning for osteosarcoma
teriparatide
how is teriparatide administered?
sub q
works to increase bone mass, but is not as effect as bisphosphonates or teriparatide
calcitonin
RANKL inhibitor that suppresses bone resorption
denosumab
sclerostin inhibitor
suppresses bone resorption and increases bone formation
romosozumab
should be administered with calcium and vitamin D
romosozumab
acts as an agonists in bone and liver
antagonist in breast and uterus
raloxifene
SERM
raloxifene
reduces bone-resorbing effects of PTH
but not recommended for postmenopausal osteoporosis
estrogen
**increased risk of cancer
activates the calcium sensing receptor (CaSR) in parathyroid gland
cinacalcet
used to treat secondary hyperparathyroidism in renal disease and parathyroid carcinoma
cinacalcet
stabilizes hydroxyapatite crystal in bone and teeth
used to prevent dental caries
fluoride
increase Ca+ reabsorption in the DCT
used to treat hypercalciuria
thiazide diuretic
decrease Ca++ absorption
increase Ca++ excretion
block bone formation
glucocorticoids
**lead to osteporosis
recombinant PTH analog
teriparatide
osteonecrosis of the jaw is an adverse effect of
bisphosphonates
slow the formation and dissolution of hydroxyapatite crystals
bisphosphonates
bisphosphonate that is administered once yearly
zoledronic acid
calcimimetic
cinacalcet
treatment for hypocalcemic tetany
calcium gluconate
thiazide diuretics increase […] at the distal tubule
calcium resorption
activates CaSR and is used to treat secondary hyperparathyroidism
cinacalcet
RANKL inhibitor used to treat osteoporosis
denosumab
how do glucocorticoids (prednisone) cause osteoporosis?
decreases Ca++ absorption
increases Ca++ excretion
blocks bone formations
[…] are sometimes used in hypogonadal men with low bone density
androgens