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Pharm 6 > Calcium and Osteoporosis > Flashcards

Calcium and Osteoporosis Flashcards

1
Q

Cortex vs medulla of bone

A

Cortex-very dense, outer layer, strength

Medulla-spongy, contains marrow, remodeling

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2
Q

What are the weakest bones?

A

With a lot of medullary tissue:

Spinal vertebrae

Radius of arm

Neck of femoral bone

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3
Q

Senile osteoporosis

A

Most common

Primary osteoporosis

After early adulthood

Decrease in bone density

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4
Q

Post-menopausal osteoporosis

A

Primary osteoporosis

Lack of estrogen.

4-6 yrs after menopause

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5
Q

Secondary osteoporosis

A

Due to Ca deficiency

  • Renal disease-decrease in vit D, decrease dietary Ca abs
  • Drugs-tobacco, alcohol, GCs, heparin
  • Multiple myeloma-uncontrolled overgrowth of white cells in marrow→osteoclast activation
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6
Q

Pagets disease

A

Uncontrolled osteoclast activity w/ no corresponding increase in osteoblast activity

Genetic disorder

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7
Q

Bisphosphonates

A

Tiludronate

Etidronate

Bisphosphonates are less potent

Tx: Ca disorder

Mech: Enzyme inhibitor

Cause formation of abnormal ATP→inh ATP requiring enzymes

Pyrophosphates have an affinity for Ca and are incorporated into bone

When ingested by osteoclasts→decrease activity and apoptosis

T1/2: Many years

Use: 1st line tx for osteoporosis and pagets

Used in tx of MM too

SE:

  • GI upset, peptic ulcers
  • Inflammation of eye
  • IV infusions cause 1st dose effect (flu-like symptoms)
  • Osteonecrosis of jaw
    • Decrease blood flow to area
    • Esp in pts w/ lost of dental disease/surgery
    • Bone w/ bisphosphonates may be more susceptible to infections

Belly ache and peptic ulcers

Infections/Infarcts

Swollen eye

First dose eff (IV)→Flu-like symptoms

Osteonecrosis of jaw

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8
Q

Aminobisphosphonates

A

other -dronates

Aminobisphosphonates are more potent

Tx: Ca disorder

Mech: Enzyme inhibitor (farnesyl pyrophosphate synthetase)

Inh. enzyme in mavalonic acid synthesis pathway→abnormal cytoskeletal structure in osteoclasts

Pyrophosphates have an affinity for Ca and are incorporated into bone

When ingested by osteoclasts→decrease activity and apoptosis

T1/2: Many years

Use: 1st line tx for osteoporosis and pagets

Used in tx of MM too

SE:

  • GI upset, peptic ulcers
  • Inflammation of eye
  • IV infusions cause 1st dose effect (flu-like symptoms)
  • Osteonecrosis of jaw
    • Decrease blood flow to area
    • Esp in pts w/ lost of dental disease/surgery
    • Bone w/ bisphosphonates may be more susceptible to infections

Belly ache and peptic ulcers

Infections/Infarcts

Swollen eye

First dose eff (IV)→Flu-like symptoms

Osteonecrosis of jaw

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9
Q

Teriparitide

A

Tx: Ca disorders

Mech: PTH analog

Increase osteoblast activity

Daily subQ injections for short periods

High doses→osteoclast stimulation so only given in short bursts

SE-increase incidence of osteosarcoma

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10
Q

Cinecalcet

A

Tx: Ca disorders + hyperparathyroidism

Mech: Calcium mimetic

Sensitizes parathyroid Ca receptors to Ca→Decrese PTH secretion

Like there is a lot of Ca around

SE

  • Hypocalcemia
  • Nausea
  • Diarrhea
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11
Q

Raloxifene

A

Tx: Ca disorders +estrogen dependent breast cancer

Mech: Activates estrogen receptors in bone

Blocks estrogen receptors in breasts

Estrogen analog

SERM-selective estrogen receptor modulator

Inh. osteoclast activity

SE

  • Pulmonary embolisms
  • Stroke
  • Preg. cat X
  • Raloxifene like Tamoxifene affect estrogen receptor*
  • SE=SEX*

Stroke

Embolism (pulmonary)

X (preg cat.)

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12
Q

Ergocalciferol (D2)

A

Tx: Ca disorders

Mech: Vit D analog

Less potent than calcitriol

SE: Hypothyroidism

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13
Q

Paracalcitrol

A

Tx: Ca disorders

Mech: Vit D analog

Less potent than calcitriol

SE: Hypothyroidism

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14
Q

Pathway of Vit D production

A

7 dehydrocholesterol in skin

*UV light*

Cholecalcitrol (Vit D3)

*liver*

25(OH) cholecalciterol (OH Vit D3)

*kidney*

1,25 dihydroxycholecalciferol (calcitriol)

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15
Q

Denosumab

A

Tx: Ca disorders

Mech: Blocks a receptor (RANKL)

RANKL required for osteoclast production, activity, and survival

Given every 6 mnths

SE:

  • Hypocalcemia
  • Osteonecrosis of jaw
  • Skin inf.

Deno- SHO

Skin inf.

Hypocalcemia

Osteonecrosis

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16
Q

Fluoride

A

Tx: Ca disorders

Effects: Increase osteoblasts

Makes bone harder but more brittle

Not for osteoporosis

17
Q

Calcitonin

A

Tx: Ca disorders

Mech: Binds to and inh. osteoclasts

Effects opposite of PTH

Secreted by thyroid gland

1st line of defense for Paget’s disease

SE:

  • Increase risk of cancer
18
Q

Glucocorticoids

A

Effects: Inh. osteoblasts

So bone loss

19
Q

Heparin

A

Effects: Act. osteoclasts

So bone loss

20
Q

Order of efficacy

A

Teriparitide>Etidronate>Raloxifene>calcitonin

Pharm 6 (7 decks)

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