Bone/Calcium Pharm

Question 1

hydrocholorthiazide

Answer 1

avoid in hypercalcemia

b/c increases Ca++ resorption from DCT

Question 2

furosemide

Answer 2

increases Ca++ excretion from TAL

Question 3

aledronate

Answer 3

fosamax
for osteoporosis/hypercalcemia, oral bisphosphanate
inhibits bone resorption
causes GI irritation

Question 4

zoledronate

Answer 4

reclast, zometa
for osteoporosis/hypercalcemia, injectable bisphosphante
inhibits bone resorption
given 1x year
avoids GI probs of fosamax
SE: transient flu-like sx w/ first dose, nephrotoxicity, jaw necrosis

Question 5

calcitonin

Answer 5

for severe hypercalcemia and osteoporosis
inhibits bone resorption + increases calcium excretion in urine + ANALGESIC (great for bone pain)
effect wears off after a couple weeks
SC, IM, nasal

Question 6

cinacalcet SEs

Answer 6

hypocalcemia
nausea
vomiting

Question 7

cinacalcet

Answer 7

calcimimetic
allosteric regulator of CaSR –> signals that there is calcium around –> decreased production of PTH
indications: secondary hyperparthyroidism in CKD, hyperparathyroidism in parathyroid carcinoma

Question 8

calcitriol

Answer 8

fully activated form of vitamin D
more expensive, but ideal vit D supplement for pts w/ renal failure
less lipid soluble than other vitamin D, doesn’t build up in adipose tissue. rapid but shorter duration of action.

Question 9

raloxifene

Answer 9

evista
decreases bone resorption (agonist effect at bone, antagonist at breast and uterus)
not very effective, out of favor

Question 10

teriparatide

Answer 10

forteo - recombinant PTH
increases bone formation - UNIQUE
paradoxical effect of PTH - w/ intermittent exposure build bone mass
very effective - use for pts w/ high fracture risk

Question 11

teriparatide MOA

Answer 11

1. activates osteoblast PTH receptor –> produces more RANKL –> binds to RNAK receptor on osteoclast to activate
2. something with OPG that I need to ask about

Question 12

denosumab

Answer 12

mAb that acts like OPG to block RANKL –> prevents osteoclast activation

Question 13

teriparatide ROA

Answer 13

daily SC injection

approved for 2 yrs of use

Question 14

tx for hypocalcemia

Answer 14

mild: oral calcium supplement, may need Vit D to enhance absorption
acute/symptomatic: calcium gluconate or calcium chloride (IV) - watch out for extravasation burns

Question 15

calcium supplements

Answer 15

calcium carbonate and calcium citrate
- don’t use calcium carbonate if there is not enough acid in the stomach (ex. heartburn meds)
these won’t work if there isn’t adequate it D (ex. renal failure)

Question 16

vit D supplements

Answer 16

ergocalciferol, cholecalciferol - increase GI absorption of calcium
longer duration of action than calcitriol and fat soluble –> can’t turn it off in the case of vit D toxicity
needs to be activated in intestines and kidney

Question 17

action of Vit D

Answer 17

1,25 OH Vit D binds intracellular receptor –> receptor binds response elements on promoter of DNA –> alters phenotype of small bowel lining cells to enhance expression of genes need for absorption of calcium from gut into circulation