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Pharm final > Bine Mineral Homeostasis > Flashcards

Bine Mineral Homeostasis Flashcards

1
Q

drugs that cause Nephrotoxicity

A

Pilamycin (Mithracin) - also thrombocytopenia and hepatotoxicity

Gallium nitrate

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2
Q

Drugs causing osteoporosis

A 
–Corticosteroids
–Heparin
–Lithium
–Anastrozole
–Alcohol
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3
Q

Drugs causing osteomalacia

A

–Phenytoin

–Etidronate (More than 12 months use)

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4
Q

Etidronate AE

A

osteomalacia

Osteonecrosis of jaw and fractures

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5
Q

Bisphosphonates AE

A

Erosive esophagitis

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6
Q

Drugs preventing calcium excretion
USE?
Treat?

A
  • Thiazide diuretics decreases the excretion of calcium by increasing reabsorption.
  • Useful in prevention of renal stone formation
  • Treatment of hypertension in osteoporosis patient.
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7
Q

Treatment of hypercalcemia

A
  • Most cases are asymptomatic or may be mild.
  • Severe cases present with stones (nephrolithiasis); bones (bone pain, myalgias, arthralgias or fractures); abdominal groans (abdominal pain, nausea, vomiting), thrones (sits on throne for polyuria) and psychiatric overtones (fatigue, depression, anxiety, sleep disturbances)
  • Treatment:
  • Furosemide and saline infusion
  • Bisphosphonates
  • Calcitonin
  • Parathyroidectomy, if patient is symptomatic.
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8
Q

Parathyroid Hormone (PTH) MOA?

A
  • PTH increase both osteoclasts and osteoblasts activity in bone via ligand RANKL, a TNF cytokine.
  • PTH couple Gs receptors to increase cAMP in bone and renal tubular cells.
  • High levels of PTH present continuously causes sub-periosteal bone resorption
  • Low dose given intermittently increases new bone formation.
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9
Q

Teriparatide?
USE
AE

A

Recombinant PTH analog
•Pulsatile doses stimulate bone formation – in the form of intermittent S.C. injection.
•Whereas high doses causes resorption
•Useful in treatment of osteoporosis, provides significant intervention for restoring normal bone loss.
•AE: may cause transient hypercalcemia & hypercalciuria
- Used for less than 2-years –due to `increased risk of osteosarcoma.

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10
Q

Denosumab?

AE

A 
is a RANK Ligand (RANKL) inhibitor
•It is a monoclonal antibody. It binds with RANKL and prevents it from stimulating osteoclast differentiation and function.
•Inhibit bone resorption
•Used in osteoporosis
•AE: increased risk of infections
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11
Q

Vitamin D MOA?

Vit. dependedt rickets?

A

•Acts by activating steroidal nuclear receptor
•Deficiency causes rickets in children and osteomalacia in adults.
Vitamin –D dependent Rickets:
1.Type I –defective 1α hydroxylase enzyme – ↓calcitriol –> ↓Ca and ↓PO4
2.Type II –defective receptor for Vitamin

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12
Q

Vitamin D derivatives names and use?

A

•Calcitriol is approved for the treatment of secondary hyperparathyroidism in patients with chronic renal disease and liver disease.
•Calcipotriol is approved for the treatment of psoriasis (topical application).
•Vitamin D supplements are used in osteoporosis, chronic renal failure, nutritional rickets due to inadequate dietary intake, chronic liver disease
- Cholecalciferol & Ergocalciferol are commonly added to Ca supplements and dairy products.

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13
Q

Vitamin D Chemical names - Generic names?

A 
Vitamin D3 = Cholecalciferol
Vitamin D2 = Ergocalciferol
1,25-Dihydroxyvitamin D3 = Calcitriol
1α-Hydroxyvitamin D2 = Doxercalciferol
19-nor-1,25-Dihydroxyvitamin D2 = Paricalcitol
Calcipotriene = Calcipotriol
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14
Q

Sevelamer: USE

A

a phosphate binding drug used to prevent hyperphosphatemia in patients with chronic renal failure. Binds to dietary phosphate and prevents its absorption in GI.

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15
Q

Calcium preps

A
  • Oral: Ca carbonate, Ca citrate, and Ca lactate
  • I.V. Clacium gluconate for the treatement of hypocalcemic tetany
  • It is used to counteract overdose of Magnesium sulfate used in eclampsia.
  • AE: I.M. inj may cause necrosis and abscess formation. I.V. can result in thrombophlebitis.
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16
Q

Calcitonin
USE?
alternative form?
PK?

A
  • A peptide hormone
  • Approved for the treatment of osteoporosis and has been shown to increase bone mass and reduce spine fractures.
  • Salmon calcitonin has a longer half life and greater potency.
  • Available as injection and nasal spray.
17
Q

Estrogens USE

AE

A
  • Estrogens are effective in preventing the bone loss.
  • Useful in preventive treatment of osteoporosis in post menopausal women
  • Given as hormonal replacement therapy

Adverse effects:
–Thromboembolism
–Migraine
–Increased risk of breast and endometrial cancer.

18
Q

SERMs (selective estrogen receptor modulators)-
TAMOXIFEN
USE?
AE?

A

•Tamoxifen: Estrogen antagonistic action in breast, while agonistic effect in bone and uterus.
•Primarily used in treatment of breast cancer, has beneficial effect on bone.
ADR: Increased risk of endometrial Ca and thromboembolism and hot flushes.

19
Q

SERMs
- RALOXIFENE
USE
AE

A
  • Raloxifene: Estrogen antagonistic action on breast and agonist at bone. Has no estrogenic effect on endometrium.
  • It is approved for treatment of osteoporosis in post-menopausal women.
  • ADR: thromboembolism, hot flushes, etc.
20
Q

Bisphosphonates
MOA
PK

A

•MOA: They inhibit osteoclastic activity via ↓ farnesyl pyrophosphate synthesis by disrupting mevalonate pathway ↓ osteoclast H+ ATPase.
•1) They bind with hydroxyapatite in the bone and 2) Reduce resorption
Oral bioavailabality less than 10%
a) Etidronate –not for long-term use.
b) Alendronate c) Pamidronate (i.v), d) Risedronate,

21
Q

Chronic use of Etidronate and Pamidronate can lead to?

A 
may result in
bone
malformation
↓osteoblastic
activity.
22
Q

Bisphosphonates AE

A

AE:
1.Erosive esophagitis due to direct irritation to esophageal lining.
Prevented by
upright position after taking medication
Increase fluid intake
2. Etidronate associated with osteomalacia. Osteonecrosis of jaw & fractures

23
Q

Cinacalcet
USE?
AE?

A

It activates calcium-sensing receptors in parathyroid cells, leading to decrease in PTH synthesis and release.
•Used in secondary hyperparathyroidism in chronic renal disease and hyperparathyroidism in patients with parathyroid carcinoma.
•Adverse effects: Nausea, hypocalcemia

24
Q

Fluoride exposure?

A

–Chronic exposure can lead to new bone synthesis which is denser but brittle.

25
Q

•Plicamycin (Mithracin):
USE
AE

A

–Cytotoxic anticancer drug
–Useful in cancer-related hypercalcemia
–ADR: Thrombocytopenia, Hepatic and renal toxicity

26
Q

•Gallium nitrate
USE
AE

A

–Inhibits bone resorption, useful in cancer-related hypercalcemia
–Nephrotoxic

Pharm final (19 decks)

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