Bone Drugs Flashcards
What cells in what organ produce calcitonin?
parafollicular C cells of thyroid
What cells in what organ release PTH?
Chief cells of the parathyroid gland
What are the effects of PTH on plasma phosphate and calcium?
Decrease phosphate
Increase calcium
What are the effects of calcitonin on serum phosphate and calcium?
Decrease phosphate
Decrease calcium
(opposite of vit D)
moderate decline in what ion enhances PTH secretion?
Mg+2 - but if severe decrease -> decrease in PTH
What are the effects of active vitamin D on serum phosphate and calcium?
increase phosphate
increase calcium
(opposite of calcitonin)
What are the effects on bone of pulsatile PTH vs continued secretion?
pulsatile: bone formation
excess: bone resorption
which drug is a PTH analog and is used in the treatment of osteoporosis. How must it be given?
Teriparatide
give pulsatile to stimulate bone growth
Which drug is a RANKL inhibitor and is used in osteoporosis? How does it work? 1 Adverse effect?
Denosumab - monoclonal Ab binds RANKL and prevents it from stimulating osteoclasts
AE: increased risk of infections (same with all monoclonal Abs)
What is the difference between type I and type II Rickets?
Type I: defective 1alpha hydroxylase (dec calcitriol)
Type II: defective vit D receptor
Which drug is used to treat secondary hyperparathyroidism in patients with chronic renal disease and liver disease?
Calcitriol - vitamin D
What topical drug is used to treat psoriasis?
Calcipotriol - vitamin D
Overdose of vitamin D leads to what two major symptoms?
Hypercalcemia
Hyperphosphatemia
What are the two generic drug names for vit D3 and vit D2? what are they used for?
D3: Cholecalciferol
D2: Ergocalciferol
commonly added to calcium supplements and dairy products
What drug is given to patients with hyperphosphatemia in chronic renal failure? how does it work?
Sevelamer - binds dietary phosphate and prevents absorption
Which drug can be given IV to treat hypocalcemic tetany?
IV calcium gluconate
Which drug can be given to counteract overdose of magnesium sulfate used in eclampsia?
Calcium gluconate
What are the two important adverse effects of calcium gluconate? (1 when given IM, 1 when given IV)
IM: injection can cause necrosis and abscess
IV: can cause thrombophlebitis
Which drug used to treat osteoporosis has been shown to increase bone mass and reduce spine fractures? How is it given?
Calcitonin
injection or nasal spray
Which SERM is estrogen antagonistic in breast, but agonistic in bone and uterus? AE?
Tamoxifen (selective estrogen receptor modulator)
increased risk of endometrial cancer
Which SERM is estrogen antagonistic in breast, agonist in bone and has no effect on endometrium?
Raloxifene (selective estrogen receptor modulator)
Which SERM is approved for treatment of osteoporosis in post-menopausal women?
Raloxifene
Which class of drugs is useful in treating osteoporosis, malignancy associated hypercalcemia, and Paget’s disease of the bone?
Bisphosphonates (the -dronates)
What class of drugs inhibits osteoclastic activity by decreasing farnesyl pyrophosphate synthesis? How are they given?
Bisphosphonates (the -dronates)
IV or orally (less than 10% bioavailability orally)
What drugs used to treat osteoporosis can cause erosive esophagitis?
Bisphosphonates (the -dronates)
oral ones: Alendronate and Risedronate
Which drug is a calcium receptor agonist that leads to suppression of PTH synthesis and release in secondary hyperparathyroidism (chronic renal disease) and in patients with parathyroid carcinoma?
Cinacalcet
Exposure to what can lead to new bone synthesis that is denser, but brittle?
Fluoride
Which drug inhibits bone resorption in cancer-related hypercalcemia, but is nephrotoxic?
Gallium nitrate
Which cytotoxic anticancer drug can be used to treat cancer-related hypercalcemia, but is hepatic and renal toxic?
Plicamycin
Which class of drugs can prevent renal stones by decreasing the renal excretion of calcium?
thiazide diuretics
what are the major signs of hypercalcemia?
Stones (renal stones) Bones (bone pain) Groans (abdominal cramps) Thrones (polyuria) Psych overtones (fatigue, depression, anxiety)
Which drug is used to treat osteoporosis, but if used long term can lead to osteomalacia?
Etidronate (>12 mo use) (bisphosphonate)
Name 5 drugs that can cause osteoporosis
Corticosteroids Heparin Lithium Anastrazole Alcohol
