Drugs of bone formation- Teriparatide, vitamin D, cinacalcet, sevelamer

Question 1

PTH MOA

(“PTHd student”)

Answer 1

-high serum calcium levels inhibit PTH production and secretion
(“PthD stuck behind bones”)
——————————————————————————–
-PTH stimulates osteoblasts to release receptor activator of nuclear factor kappa-B ligand (RANKL) → activates osteoclasts
(“PthD convincing osteo-builder to give up crank-drill”)

• RANKL binds to RANK on the osteoclast surface → increased differentiation and activity → increased bone resorption
  (“Classmate receiving crank-drill”)

-PTH stimulates maturation of osteoblasts → increased bone formation
(“PthD teaching osteo-builders”)

-PTH increases calcium resorption by the kidney and increases phosphate excretion
(“PthD gathering bones and dropping P fossils”)

-PTH increases activity of 1-alpha-hydroxylase in the kidney → increased production of 1,25-dihydroxyvitamin D (calcitriol)
(“PthD adding final piece to Calci-TRON”)

Question 2

Teriparatide MOA

(“PTHd TA”)

Answer 2

-intermittent doses of teriparatide stimulates maturation of osteoblasts → increased bone formation
(“TA teaching osteo-builders”)

-teriparatide increases calcium resorption by the kidney and increases phosphate excretion
(“TA gathering bones and dropping P fossils”)

-teriparatide increases activity of 1-alpha-hydroxylase in the kidney → increased production of 1,25-dihydroxyvitamin D (calcitriol)

(“TA adding final piece to Calci-TRON”)

Question 3

Teriparatide can be used to treat ...

(“PTHd TA”)

Answer 3

-to treat osteoporosis (increase bone density)
(“Fresh piece of calcified chalk”)

Question 4

Calcitriol MOA

Answer 4

Synthesis
D3 (sun) / D2 ( plant) → 25hydroxyvitamin D [Liver] → 1alpha hydroxylase →1,25 dihydroxyvitamin D /Calcitriol [Kidney]
——————————————————————————–
-calcitriol stimulates reabsorption of calcium AND!!!! phosphate by the kidney

(“Calci-TRON gathering bones and fossils from dump site”)

-calcitriol stimulates intestinal absorption of calcium AND!!! phosphate

(“Calci-TRON gathering bones and fossils from GI truck”)

-calcitriol stimulates osteoblasts to release RANKL → activates osteoclasts
(“Calci-TRON delivering crank-drills”)

-calcitriol inhibits PTH production by the parathyroid gland
(“Calci-TRON collapsing PthD lab”)

-calcitriol stimulates maturation of osteoblasts → increased bone formation
(“Calci-TRON teaching osteo-builders”)

Question 5

Calcitriol is useful in treatment of …

(“Calci-TRON”)

Answer 5

-can be used to treat osteoporosis (increase bone density)
(“Fresh piece of calcified chalk”)

-can be used to treat Rickets in children and osteomalacia in adults (increase bone density)
(“Calci-TRON stabilizing rickety tower”)

-calcitriol can be useful in chronic kidney disease (prevent hypocalcemia)
(“Calci-TRON stabilizing broken kidney”)

-topical vitamin D can be used to treat psoriasis
(“Scaly knee and elbow pads”)

• calcitriol is useful in the long term management of hypocalcemia (e.g. hypothyroidism)
  (“Calci-TRON saving falling calcified bones”)

Question 6

Hypocalcemia symptoms

Answer 6

-Hypocalcemia is commonly caused by hypoparathyroidism (decreased production of calcitriol by the kidney)

• Thyroid surgery can cause hypoparathyroidism and hypocalcemia
  (“Undone bowtie on PthD”)

-hypocalcemia can cause seizure
(“Shaking structure”)

-hypocalcemia can cause
(“Tense fist”)

• paresthesias,
• muscle cramps,
• ​trismus, and tetany

(“Falling PthD”)

Question 7

Teriparatide / Calcitriol Side Effects

Answer 7

-can cause hypercalcemia
(“TA and CalciTRON raising Calcium Ice cream”)

-

Question 8

Cinacalcet MOA

(“Calculator at the calcified bone receptor”)

Answer 8

a Calcimimetic. mimics the action of calcium on tissues

• Cinacalcet activates the calcium sensing receptor on the parathyroid gland → decreased production of PTH
  (High calcium inhibits PTH Secretion”)

Question 9

Cinacalcet is useful in treatment of …

(“Calculator at the calcified bone receptor”)

Answer 9

-Hypercalcemia due to hyperparathyroidism
(“Calculating pile of calcified bones”)

Question 10

Sevelamer MOA

(“Shoveler”)

Answer 10

-a Phosphate Binding Polymer decreases absorption of phosphate in the GI tract
(“Shoveling fossils in the GI truck”)

Question 11

Sevelamer is useful in the treatment of…

(“Shoveler”)

Answer 11

-hyperphosphatemia due to Chronic Kidney Disease

(“Shoveling pile of fossils”)