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Calcium and Bone Drugs Flashcards

1
Q

Calcium supplements

A

Calcium carbonate

Calcium citrate

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2
Q

Calcium supplements - MoA

A

Important for: Bone remodeling, nerve, muscle function, gland secretion, blood coagulation, enzyme activities

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3
Q

Calcium supplements - Clinical use

A

Hypocalcemia, osteoporosis

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4
Q

Calcium supplements - Adverse effects

A

Modestly increased risk of MI

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5
Q

Calcium supplements - Interactions

A

Decreased absorption of ciprofloxacin, fluoride, phenytoin, levothyroxine, tetracycline

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6
Q

Vitamin D supplements

A

Cholecalciferol (Vitamin D3)

Ergocalciferol (Vitamin D2)

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7
Q

Cholecalciferol - MoA

A

Increased synthesis of calcium-binding protein
increases calcium absorption.
Stimulation of bone resorption

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8
Q

Ergocalciferol - MoA

A

Activated in liver and kidneys to form calcitriol. Increases Ca and phosphorous absorption from the gut

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9
Q

Vitamin D supplements - Clinical use

A

Prevention and treatment of rickets (vit D-dependant and -resistant).
Prevention of osteoporosis.
Hypocalcemia (by hypoparathyroidism)
Tetani (post-op and idiopathic).
Prevention of vit D deficiency in chronic renal failure

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10
Q

Vitamin D supplements - Adverse effects

A

Hypercalcemia

Hypercalciuria

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11
Q

Vitamin D supplements - Interactions

A

Cholestyramine inhibits absorption.

Phenytoin and barbiturates: increased vit D metabolism and deficiency.

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12
Q

Bisphosphonates - Classification

A

Bone resorption inhibitors

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13
Q

Bisphosphonates - MoA

A

Absorb hydroxyapatite and become permanent parts of the bone structure (terminal half life is 10 years). Inhibits osteoclast activity by preventing them to attach to bone

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14
Q

Bisphosphonates - Clinical use

A

Osteoporosis, Paget disease of the bone, hypercalcemia, osteolytic bone lesions in metastatic cancer

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15
Q

Bisphosphonates - Contraindications

A

Dull, aching pain in the thigh or groin

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16
Q

Bisphosphonates - Adverse effects

A

Espohageal erosion, GI distress.

Long-term use: atypical (subtrochanteric & diaphysial) femur fractures. Poor oral health: Osteonecrosis of the jaw

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17
Q

Bisphosphonates reduces the risk of?

A

Breast cancer

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18
Q

Bisphosphonates - Interactions

A

Calcium supplements & antacids: decreases absorption of bisphosphonate

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19
Q

1st generation bisphosphonate

A

Etidronate

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20
Q

2nd generation bisphosphonates

A

Alendronate
Pamidronate
Risedronate
Tiludronate

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21
Q

2nd generation bisphosphonates - Clinical use

A

ALL: Paget disease of the bone (symptomatic/candidates for surgery)

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22
Q

Alendronate - Clinical use

A

Osteoporosis (all forms)

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23
Q

Alendronate - Adverse effects

A

GI distress only with high doses, mild and transient nausea, dyspepsia, constipation, diarrhea

24
Q

Pamidronate - Clinical use

A

Hypercalcemia associated with cancer.

25
Risedronate - Clinical use
Prevention and treatment of osteoporosis in postmenopausal women.
26
Tiludronate - MoA
Decreases tyrosine phosphase activity in osteoclasts, causing osteoclast detachment from bone. Inhibits osteoclastic proton pumps
27
3rd generation bisphosphonates
Ibandronate | Zoledronic acid
28
Ibandronate - Clinical use
Prevention and treatment of osteoporosis in postmenopausal women
29
Zoledronic acid - Clinical use
Hypercalcemia associated with cancer
30
Estrogen + related drugs
Estrogen | Raloxifene
31
Estrogen - MoA
Inhibits production of bone cell cytokines (IL-1, TNF, IL-6, ect.), causing reduced bone resorption by decreasing formation and activation of osteoclasts.
32
Estrogen - Clinical use
Relief of menopausal symptoms
33
Estrogen - Contraindications
high doses in treatment for osteoporosis (increased risk of breast cancer and cardiovascular events)
34
Raloxifene - MoA
Activates estrogen receptors in bone while having antiestrogen effects in breast and uterine tissues
35
Raloxifene - Clinical use
Postmenopausal osteoporosis
36
Raloxifene - Adverse effects
Intensify hot flashes, increased risk of stroke, pulmonary emboli, DVT
37
Calcitonin - MoA
Binds to osteoclastic receptors, increases cAMP levels. | Short-term effect: inhibits osteoclast activity, decreases bone resorption, decreases serum Ca concentrations
38
Calcitonin - Clinical use
Osteoporosis: women who cannot tolerate other treatments: parenterally/nasal adm. Paget disease of bone, hypercalcemia (adm subcut/IM)
39
Denosumab - Classification
Human immunoglobulin G2 monoclonal antibody, RANKL antibody
40
Denosumab - MoA
Inactivation of osteoclastic gene transcription by inhibition of RANKL (transmembrane protein).
41
Denosumab - Clinical use
Osteoporosis, prevention of skeletal-related events in breast, prostate cancer + other tumors
42
Denosumab - Adverse effects
Back, extremity, musculoskeletal pain, hypercholesterolemia, cystitis, skin reactions, hypocalcemia, slight increase in malignancies (not established)
43
Teriparatide - Classification
Recombinant form of human PTH
44
Teriparatide - MoA
Increase bone formation (short-term). | Long-term: stimulate bone resorption
45
Teriparatide - Clinical use
Osteoporosis (postmenopausal women and hypogonadal men at high risk bone fracture)
46
Teriparatide - Contraindications
Rapid cessation of the drug, treatment should be followed by bisphosphatonates Not given to people at increased risk for osteosarcoma (Paget disease of the bone)
47
Teriparatide - Adverse effects
Increased incidence of osteosarcoma
48
Strontium ranelate - MoA
Decreases osteoclastic activity & bone resorption in newly formed bone. Induces proliferation of osteoblasts
49
Strontium ranelate - Clinical use
Prevention of osteoporosis | Prevent vertebral and non vertebral fractures
50
Strontium ranelate - Adverse effects
Minor GI distress | Increased risk or venous and pulmonary thromboembolism and MI
51
Sodium fluoride - MoA
Stored in bone and teeth. Replaces the hydroxyl group in calcium phosphate salts and form fluorapatite (more resistant to erosion)
52
Sodium fluoride - Clinical use
Prevention of tooth decay and caries. Potential application for osteoporosis
53
Sodium fluoride - Adverse effects
Excessive hardening of the bone (osteosclerosis), formation of demineralized bone, GI distress, interfere with Ca and Mg absorption
54
Cinacalet - MoA
Increase the sensitivity of calcium-sensing receptors in the parathyroid gland to extracellular calcium, leading to decreased secretion of PTH and lowering of serum calcium levels
55
Cinacalet - Clinical use
Hyperparathyroidism in adult patients with chronic kidney disease who are on dialysis Hypercalcemia in patients with parathyroid cancer.

Pharmacology (55 decks)

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