bone + mineral homeostasis Flashcards
What overall effects does PTH have?
inc. bone resorption
inc. Ca
dec. PO4
what overall effects does Vitamin D have?
inc. bone mineralization
inc. Ca
inc. PO4
what overall effect does calcitonin have?
dec. bone resorption
What are the effects of PTH?
GIT: inc. absorption
kidney: inc. reabsorption of Ca, dec. reabsorption of PO4, inc. production of Vitamin D metabolite
Bone (@ high conc.): binds to osteoblasts and stimulates RANKL
what are the effects of Vitamin D?
GIT: inc. absorption
what are the effects of calcitonin?
bone: inhibit osteoclast activity
Distinguish between hormonal and non-hormonal drugs involved in bone/mineral homeostasis
hormonal = PTH, Vit D, Calcitonin, estrogen non = bisphosphonates, denosumab
What is the MOA of teriparatide?
(recombinant PTH)
binds PTH R on osteoblasts; in the low doses used clinically, this will inc. bone formation (w/o xs osteoclasts) from more OPG>RANKL signaling
what are uses for teriparatide?
osteoporosis
what AEs and CI are associated with teriparatide?
AEs = hypercalcemia, osteosarcoma
CI: (BBW) osteosarcoma
What are uses for vitamin D?
dietary supplement; osteoporosis - USE with calcium supplements
what is the MOA of calcitonin?
agonist at R to inhibit bone resorption by directly acting on osteoclasts
what are uses for calcitonin?
(intranasal, IM, SC) osteoporosis
(IM, SC): hypercalcemia, Paget’s disease
what AEs are associated with calcitonin?
malignancy
intranasal: rhinitis, allergic reaction (if allergic to SALMON)
IM, SC: allergic reaction, flushing of face/hands
What is the MOA of Raloxifene?
SERM - estrogen modulator that inc. bone formation and dec. resorption
(+) effects on bone
(-) effects on breast, uterus, brain
what are uses for raloxifene?
osteoporosis
what AEs and CIs are associated with raloxifene?
hot flashes, night sweats; inc. risk of thromboembolism
CI:
(BBW): thromboembolitic disease
(BBW): stroke
what is the MOA of bisphosphonates?
bind to hydroxyapatite in bone to inhibit osteoclast resorption (also prevents osteoblast apoptosis)
What are uses for bisphosphonates?
osteoporosis; hypercalcemia; Paget’s disease
What AEs are associated with bisphosphonates?
(PO): upper GI (reflux, esophagitis)
(IV): flu-like (fever, myalgias)
rare: hypocalcemia, SKM pain, osteonecrosis of jaw, atypical femur fractures
what CI for bisphos?
renal impairment
esophageal disorders
what DDI with bisphos?
dont’ take with other cation-containing drugs! (antacids, mineral supplements)
What is the MOA and uses for denosumab?
mAB to RANKL
uses: osteoporosis, hypercalcemia
what AEs are associated with denosumab?
back pain
osteonecrosis of jaw (ONJ)
atypical femur fracture
