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Pharmacology > Chapter 31: Bone Mineral Homeostasis > Flashcards

Chapter 31: Bone Mineral Homeostasis Flashcards

1
Q

Estrogen + progestin

A

MOA: suppreses transcription of RANKL genes = inhibits osteoclasts = prevent bone breakdown

TX: KIND OF osteoporosis, also relieves symptoms of menopause like hot flashes

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2
Q

Estrogen + progestin

A

Suppresses transcription of RANKL genes so that osteoclasts are inhibited

Used for osteoporosis and treatment…kind of…also menopausal symptoms

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3
Q

What are the risks of using estrogen+progestin hormone replacement therapy?

A

Significantly increased risk of breast cancer!

Vaginal bleeding and breast tenderness also possible

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4
Q

What drug would you use to prevent and treat osteoporosis in a woman with a familiar history of breast cancer?

A

Raloxifene

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5
Q

Raloxifene MOA?

A

HRT - estrogen receptor AGONIST in bone but estrogen receptor ANTAGONIST in the breast and endometrium

Prevents those nasty vertebral fractures

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6
Q

When would you not use Raloxifene for osteoporosis tx?

A

If the pt had a history or risk for thromboembolus….raloxifene can increase this risk

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7
Q

MOA for biphosphonates?

A

These inhibit the mevalonate pathway in osteoclasts, leading to decreased osteoclast function and eventual apoptosis

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8
Q

Which biphosphonates would you use to treat osteoporosis specifically?

A

ARIZ

Alendronate
Risedronate
Ibandronate
Zoledronate

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9
Q

Which biphosphonates would you use to treat Paget’s Disease specifically?

A

ARPZ (P for paget!)

Alendronate
Risedronate
Pamidronate
Zoledronate

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10
Q

Which biphosphonates would you use to treat hypercalcemia assc. with malignancy?

A

Pamidronate

Zoledronate

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11
Q

Which biphosphonates would you use to treat Osteolytic lesions in myeloma or breast cancer?

A

Pamidronate

Zoledronate

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12
Q

Serious side effects of biphosphonate use?

A

Bone remodeling will STOP

Jaw osteonecrosis in cancer patients! Eek.

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13
Q

Which biphosphonates are only available by IV?

A

pamidronate and zoledronate

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14
Q

What is the special consideration associated with oral biphosphonates?

A

They must be taken after an overnight fast.

Take only with water.

Nothing for 30-60 minutes.

Must Sit UP/ Stand UP for 30-60 minutes after taking the pill!!!!

WHY? Because of poor intestinal absorption.

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15
Q

Denosumab

A

MOA: RANKL antagonist - so osteoclasts do not bind to RANKL and mature.

TX: osteoporosis prevention and treatment for the spine, nonspine, and hip especially

“Occupy RANKL,” said the Mab (Denosumab)

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16
Q

Salmon Calcitonin MOA

A

Calcitonin inhibits osteoclasts by binding to and activating a G protein receptor

17
Q

What drug would you use to target osteoporosis in the spine, nonspine, and hip especially?

A

Denosumab

18
Q

What drug would you use to combat hypercalcemia?

A

Salmon calcitonin

19
Q

What drug would you give for osteoporosis that only has to be injected every 6 months or once a month?

A

Denosumab

20
Q

Describe the use of salmon calcitonin to treat Paget and Osteoporosis

A

Can do both, but:
biphosphonates are better

If patient can’t tolerate other options for osteoporosis, Salmon Calcitonin comes in a nasal spray that may be easier on the patient.

21
Q

What is the ONLY drug approved for those who already have low bone mass?

A

Once daily PTH

22
Q

Which drugs INCREASE bone formation by osteoblasts?

What are the contraindications for these drugs?

A

hPTH 1-34
hPTH 1-84 (investigational)
Fluoride (investigational)

Do not use these if patient has Paget’s, hypercalcemia, radiation therapy, or open epiphysis

23
Q

hPTH 1-34 is used only for ___?

A

Patients with a high high risk of fracture…severe osteoporosis

24
Q

Aluminum hydroxide MOA

A

MOA: decreases GI absorption of dietary inorganic phosphate

Not used anymore because of aluminum toxicity

25
Q

What is the difference between intermittently or continuously used hPTH?

A 
intermittent = increase bone production
continuous = decrease bone production
26
Q

Calcium carbonate
Calcium acetate

MOA, TX, risk?

A

MOA: Bind to dietary phosphate to decrease GI absorption

TX: chronic kidney disease

Risk: Can cause hypercalcemia

27
Q

Sevelamer MOA, TX, downfall?

A

MOA: binds to dietary phosphate and also bile salts
TX: hyperphosphatemia-hyperostosis syndrome
Downfall: Super $$$

28
Q

What would you use calcitriol for?

A

Rickets

29
Q

What do vitamin D analogues do? MOA?

A

Increase dietary absorption of calcium

Decrease PTH transcription

30
Q

Cinacalcet MOA, TX

A

MOA: increase senstivity of calcium sensing receptor….causes decreased secretion of PTH

TX: secondary hyperparathyroidism
hypercalcemia

DOES NOT REVERSE OR STOP BONE LOSS

31
Q

Calcium Carbonate

and Calcium gluconate, calcium citrate malate

A

Helps with hypocalemic states like Rickets, osteomalacia, hypoparathyroidism
Tums
Must be taken with food

32
Q

Cinacalcet MOA, TX

A

MOA: increase senstivity of calcium sensing receptor….causes decreased secretion of PTH

TX: secondary hyperparathyroidism
hypercalcemia

DOES NOT REVERSE OR STOP BONE LOSS

33
Q

Calcium Carbonate

and Calcium gluconate, calcium citrate malate

A

Helps with hypocalemic states like Rickets, osteomalacia, hypoparathyroidism
Tums
Must be taken with food

34
Q

What drug would you give for a patient with severe hypophosphatemia?

A

Potassium phosphate

can cause diarrhea

35
Q

What are the risks/concerns/adverse health effects for HRT with estrogen?

A

There is a significantly increased risk for breast cancer! Yikes!

also, vaginal bleeding and breast tenderness

36
Q

Raloxifene

A

MOA: estrogen receptor AGONIST in bone
but is an estrogen receptor ANTAGONIST in endometrium and breast

Tx: prevent vertebral fractures

Pharmacology (22 decks)

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