B6.052 - CBCL Osteoporosis Prework 6 Pharmacology

Question 1

prevention and treatment of post menopausal osteoporosis

Answer 1

appropriate calcium and vit D intake (especially prior to achieving peak bone mass)
exercise
pharmacologic agents

Question 2

calcium and vitamin D for tx

Answer 2

clinical trials report benefit

1000 vit d + 1000 Ca for adults >65

Question 3

bisphosphonates

Answer 3

alendronte (w)
risedronate (w,m)
ibandronate (m, IV)
zolendronic acid (IV ann)

Question 4

mechanism of bisphosphonates

Answer 4

direct inh of bone resorption
concentrate at sites of active remodeling, remains in matrix until bone is remodeled
released in acid environment of resorption lacunae and induces apoptosis in osteoclasts
also inh cholesterol biosynthetic pathway contributing to resorptive activty

Question 5

AEs of bisphosphonates

Answer 5

hypocalcemio
osteonecrosis of the jaw
atypical femur fractures
GI sx

Question 6

denosumab

Answer 6

fully human mab to RANKL
binds/inhibits ability of RANKL to mature osteoclasts from osteoclast precursors (similar to OPG)
reduces survival of osteoclasts

Question 7

how is denosumbab administeredand AEs

Answer 7

2x yearly inj
if stopped bone lost rapidly if another agent not used 
osteonecrosis of jaw
atypical femur fractures
hypocalcemia
skin infx
dermatitis

Question 8

raloxifene

Answer 8

SERM
not pure agonists of estrogen receptor, have diff effect on diff tissues
produce diff structural changes in receptor upon bidning, alters cofactros with which ER interacts
partially replaces missing estrogen post menopause with respect to bone remodeling
no effect on heart disease or other rfx
65% reduction in invasive breast cx

Question 9

what does PTH do

Answer 9

stimulates osteoclasts , bone resorption, Ca++ mobilized, inhibits osteoblasts
increases Ca resorption in distal tubules
calcitrol release, calcium absorption in intestine

Question 10

what does calcitonin do

Answer 10

stimulates osteoblast activity
inhibits osteoclasts
transient increase in Ca secretion

Question 11

teriparatide

Answer 11

AA 1-34 of PTH
stimulates osteoblastic bone formation
PTH on a longer time scale stimulates both osteoblasts and osteoclasts
bone formation is stimulated more than resorption

Question 12

teriparatide impact on bone

Answer 12

increases predominantly trabecular bone at lumbar spine and femoral neck
administered once a day sub q

Question 13

calcitonin MOA and administration

Answer 13

injection or nasal spray stimulates osteoblast activity and inhibits osteoclast activity