ic14 osteoporosis pharmacology Flashcards

1
Q

moa of biphosphonates

A

slow bone loss by increasing osteoclast cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

sources of calcium

A

PTH is released when low plasma calcium levels are detected
1) dietary = PTH increases vit D synthesis in kidney = increase calcium absorption from intestines
2) kidney = affected by parathyroid hormone = increase calcium reabsorption in the urine
3) bone = increase calcium release from bones (activate osteoclasts) via PTH + vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

vit D source

A

skin and UVB
convert 7 dehydrocholesterol = vit d3 (cholecalciferol) = stored in liver
= activated by kidney to 25(oh)vitD

PTH stimulates activation of vit D3 to 1,25 dihydroxyvitD by increasing 1-alpha hydroxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is denosumab

A

human monoclonal antibody against RANKL, required for binding with RANK receptors on osteoclasts for its formation, differentiation, activation, survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

some adr of denosumab

A

MSK: muscle, back, bone or joint pain
GI: n/v, constipation or diarrhoea

slight tiredness

increased cholesterol levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

why do not discontinue denuosumab?

A

increased risk of spinal column fractures when discontinued

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

pregnancy status for denosumab

A

X for pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

place in thrapy for oestrogen in osteoporosis?

A

can help to maintain bone density
BUT
increased risk of breast cancer ,blood clots, stroke.

used for
(i) bone health in younger women
(ii) women with other menopausal sx requiring tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is raloxifene

A

selective oestrogen receptor modulator
- mixed oestrogen receptor agonism and antagonism
- mimc effets of oestrogen on bone density in postmenopausal women

lowers risk of some breast cancers but still increases risk to blood clots
- also causes hot flashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

role of calcitonin (moa and indication)

A

reduces BLOOD calcium and opposes effects of PTH
= inhibit osteoclast activity in bones

HOWEVER, not frequently used

naturally released by thyroid glands to regulate ca2+ lv in blood by decreasing it.

UPTODATE: Osteoporosis, postmenopausal (intranasal or injection): Treatment of osteoporosis in patients >5 years postmenopause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

adr of calcitonin

A

red streaks on skin; redness of face, neck, arms, and occasionally upper chest

feeling of warmth

injection site reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

contraindications of calcitonin

A

hypersx and hypocalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MOA of romosozumab (and what it is)

A

humanised mouse monoclonal antibody against sclerostin

removes sclerostin inhibition of canonical Wnt signalling pathway that regulates bone growth in osteoblasts (allows for differentiation of pre osteoblast to osteoblast) = increase bone formation and decrease bone resorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

indication of romosozumab

A

women at high risk of fracture
OR
who have failed or are intolerant to other osteoporosis therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

directions for use of romosozumab

A

once monthly for 12 months (SC injection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

adr of romosozumab

A

MI, increased risk of CV death, stroke

hypersensitivity reactions (angioedema, erythema multiforme, urticaria, dermatitis, rash)

transient hypocalcemia

may also cause ONJ and atypical femur fractures

17
Q

contraindications of romosozumab

A

hypersx
uncorrected hypocalcaemia
history of mI or stroke (within the last year)

18
Q

what are the parathyroid hormone therapies and what is the direction of use?

A

parathyroid hormone similars EG teriparatide
intermittent high dose exposure to PTH has the opposite effect, suppressing bone resorption and favouring bone growth = increase bone strength

SC injection OD (once daily)
max 24 months

19
Q

adr of PTH therapy

A

serious calciphylaxis
worsening of previous stable cutaneous calcification
transient and minimal elevations of serum Ca or hypercalcemia

transient orthostatic hypotension

20
Q

c/i of PTH therapy

A

1) hypersensitivity

2) pre-existing hypercalcaemia

3) previous implant or external beam radiation therapy to the skeleton

4) other metabolic bone diseases (Paget’s disease, hyperparathyroidism)

5) skeletal malignancies, bone metastases
6) hereditary disorders predisposing to osteosarcoma

7) unexplained elevations of alkaline phosphatase
8) severe renal impairment

9) pregnancy

21
Q

when to use teriparatide?

A

when biphosphonates contraindicated or not effective?

women at high risk of fractures?

22
Q

what are the anabolic agents and what are the antiresorptive agents

A

anabolic:
- PTH therapies
- sclerostin inhibitors

antiresorptive
- bisphosphonates
- RANKL inhibitors
- ostrogen agonist/antagonist
- calcitonin