bone + mineral homeostasis

Question 1

What overall effects does PTH have?

Answer 1

inc. bone resorption
inc. Ca
dec. PO4

Question 2

what overall effects does Vitamin D have?

Answer 2

inc. bone mineralization
inc. Ca
inc. PO4

Question 3

what overall effect does calcitonin have?

Answer 3

dec. bone resorption

Question 4

What are the effects of PTH?

Answer 4

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

Question 5

what are the effects of Vitamin D?

Answer 5

GIT: inc. absorption

Question 6

what are the effects of calcitonin?

Answer 6

bone: inhibit osteoclast activity

Question 7

Distinguish between hormonal and non-hormonal drugs involved in bone/mineral homeostasis

Answer 7

hormonal = PTH, Vit D, Calcitonin, estrogen
non = bisphosphonates, denosumab

Question 8

What is the MOA of teriparatide?

Answer 8

(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

Question 9

what are uses for teriparatide?

Answer 9

osteoporosis

Question 10

what AEs and CI are associated with teriparatide?

Answer 10

AEs = hypercalcemia, osteosarcoma

CI: (BBW) osteosarcoma

Question 11

What are uses for vitamin D?

Answer 11

dietary supplement; osteoporosis - USE with calcium supplements

Question 12

what is the MOA of calcitonin?

Answer 12

agonist at R to inhibit bone resorption by directly acting on osteoclasts

Question 13

what are uses for calcitonin?

Answer 13

(intranasal, IM, SC) osteoporosis

(IM, SC): hypercalcemia, Paget’s disease

Question 14

what AEs are associated with calcitonin?

Answer 14

malignancy
intranasal: rhinitis, allergic reaction (if allergic to SALMON)
IM, SC: allergic reaction, flushing of face/hands

Question 15

What is the MOA of Raloxifene?

Answer 15

SERM - estrogen modulator that inc. bone formation and dec. resorption
(+) effects on bone
(-) effects on breast, uterus, brain

Question 16

what are uses for raloxifene?

Answer 16

osteoporosis

Question 17

what AEs and CIs are associated with raloxifene?

Answer 17

hot flashes, night sweats; inc. risk of thromboembolism

CI:
(BBW): thromboembolitic disease
(BBW): stroke

Question 18

what is the MOA of bisphosphonates?

Answer 18

bind to hydroxyapatite in bone to inhibit osteoclast resorption (also prevents osteoblast apoptosis)

Question 19

What are uses for bisphosphonates?

Answer 19

osteoporosis; hypercalcemia; Paget’s disease

Question 20

What AEs are associated with bisphosphonates?

Answer 20

(PO): upper GI (reflux, esophagitis)
(IV): flu-like (fever, myalgias)
rare: hypocalcemia, SKM pain, osteonecrosis of jaw, atypical femur fractures

Question 21

what CI for bisphos?

Answer 21

renal impairment

esophageal disorders

Question 22

what DDI with bisphos?

Answer 22

dont’ take with other cation-containing drugs! (antacids, mineral supplements)

Question 23

What is the MOA and uses for denosumab?

Answer 23

mAB to RANKL

uses: osteoporosis, hypercalcemia

Question 24

what AEs are associated with denosumab?

Answer 24

back pain
osteonecrosis of jaw (ONJ)
atypical femur fracture

Question 25

which drugs can be used for prevention?

Answer 25

bisphosphonates

raloxifene

Question 26

which drugs can be used to treat men?

Answer 26

bisphosphonates
teriparatide
denosumab