Ch 36 Calcium and bone drugs

Question 1

calcium carbonate

Answer 1

• electrolyte supplement
• indications: osteoporosis, hypocalcemia
• ADE: constipation
• calcium carbonate does require stomach acid for absorption = be mindful GERD, elderly

Question 2

calcium citrate

Answer 2

• calcium salt
• does not require stomach acid for absorption
• indications: osteoporosis, hypocalcemia
• ADE: constipation
• requires Vit D for absorption

Question 3

Vitamin D3 (cholecalciferol)

Answer 3

• inactive until hydroxylation in the liver and kidneys
• indications: prevent rickets & osteoporosis
• ADE: >5000 IU/day hypercalcemia, hypercalciuria

Question 4

Vitamin D2 (ergocalciferol)

Answer 4

-indications: vit D deficiency in CKD patients, osteoporosis, rickets, hypoparathyroidism

Question 5

calcitriol

Answer 5

-vit D deficiency treatment for patients in renal failure

Question 6

alendronate (fosamax)

Answer 6

• 2nd generation bisphosphonate (100 more potent than 1st)
• inhibit bone resorption by osteoclasts
• adsorbs to hydroxyapatite to become permanent part of bone and prevent osteoclast attachment
• indications: osteoporosis, Paget’s disease, hypercalcemia, osteolytic bone lesions of metastatic cancer
• ADE: esophageal erosion, GI issues, osteonecrosis of jaw
• use >5 yrs increase risk of atypical femur fracture
• calcium supplements and antacids block absorption

Question 7

Ibandronate (boniva)

Answer 7

• 3rd generation bisphosphonate (1000 more potent than 1st)
• inhibit bone resorption by osteoclasts
• adsorbs to hydroxyapatite to become permanent part of bone and prevent osteoclast attachment
• indications: osteoporosis, Paget’s disease, hypercalcemia, osteolytic bone lesions of metastatic cancer
• ADE: esophageal erosion, GI issues, osteonecrosis of jaw
• use >5 yrs increase risk of atypical femur fracture
• calcium supplements and antacids block absorption

Question 8

tiludronate (skelid)

Answer 8

• 2nd generation bisphosphonate (100 more potent than 1st)
• inhibit bone resorption by osteoclasts
• adsorbs to hydroxyapatite to become permanent part of bone and prevent osteoclast attachment
• indications: osteoporosis, Paget’s disease, hypercalcemia, osteolytic bone lesions of metastatic cancer
• ADE: esophageal erosion, GI issues, osteonecrosis of jaw
• use >5 yrs increase risk of atypical femur fracture
• calcium supplements and antacids block absorption

Question 9

risedronate (actonel)

Answer 9

• 2nd generation bisphosphonate (100 more potent than 1st)
• inhibit bone resorption by osteoclasts
• adsorbs to hydroxyapatite to become permanent part of bone and prevent osteoclast attachment
• indications: osteoporosis, Paget’s disease, hypercalcemia, osteolytic bone lesions of metastatic cancer
• ADE: esophageal erosion, GI issues, osteonecrosis of jaw
• use >5 yrs increase risk of atypical femur fracture
• calcium supplements and antacids block absorption

Question 10

pamidronate (aredia)

Answer 10

• 2nd generation bisphosphonate (100 more potent than 1st)
• inhibit bone resorption by osteoclasts
• adsorbs to hydroxyapatite to become permanent part of bone and prevent osteoclast attachment
• indications: osteoporosis, Paget’s disease, hypercalcemia, osteolytic bone lesions of metastatic cancer
• ADE: esophageal erosion, GI issues, osteonecrosis of jaw
• use >5 yrs increase risk of atypical femur fracture
• calcium supplements and antacids block absorption

Question 11

zoledronic acid (zometa)

Answer 11

• 3rd generation bisphosphonate (1000 more potent than 1st)
• inhibit bone resorption by osteoclasts
• adsorbs to hydroxyapatite to become permanent part of bone and prevent osteoclast attachment
• indications: osteoporosis, Paget’s disease, hypercalcemia, osteolytic bone lesions of metastatic cancer
• ADE: esophageal erosion, GI issues, osteonecrosis of jaw
• use >5 yrs increase risk of atypical femur fracture
• calcium supplements and antacids block absorption

Question 12

teriparatide (forteo)

Answer 12

• recombinant PTH
• increases bone formation
• long term use: can stimulate resorption over formation
• short term use: stimulate new trabecular and cortical bone formation by stimulating osteoblasts
• indication: postmenopausal women with osteoporosis and high risk for bone fracture, hypogonadal men at high risk for fracture
• ADE: may increase osteosarcoma risk (avoid in Paget’s), unexplained high serum alkaline phosphatase
• cessation may cause rapid bone loss so follow treatment with bisphosphonate

Question 13

cinacalcet (sensipar)

Answer 13

• decreases secretion of PTH
• treat primary and secondary hyperparathyroidism
• lowers serum calcium levels
• approved for patients with CKD on dialysis

Question 14

denosumab (prolia, xgeva)

Answer 14

• monoclonal antibody
• decreases bone resorption by inhibiting osteoclasts
• xgeva indicated for prevention of skeletal events in patients with bone metastases
• use: osteoporosis
• SQ injection every 6 month
• not 1st line for osteoporosis
• AE: skin reaction, hypocalcemia (supplement Ca and Vit D), musculoskeletal pain

Question 15

calcitonin (calcimar, miacalcin)

Answer 15

• parental injection or nasal
• <2 year use inhibits osteoclast activity, decreases bone resorption, lowers serum calcium, reduces bone pain
• uses: osteoporosis, paget’s, hypercalcemia
• reserved for those who can’t tolerate other treatment
• preferred post fracture for bone pain reduction
• supplement Ca and Vit D if needed

Question 16

raloxifene (evista)

Answer 16

• estrogen receptor agonist
• increases bone mineral density and decreases vertebral fractures in osteoporosis
• anti estrogen effect on breast and uterine tissue
• can cause hot flashes and other estrogen withdrawal symptoms
• increase blood clot risks

Question 17

fluoride

Answer 17

• prevent tooth decay and dental caries
• stored in bone and teeth
• increases resistance to erosion