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KG - Pharmacology 2 > KG - Pharm 2 Exam 3, Osteoporosis > Flashcards

KG - Pharm 2 Exam 3, Osteoporosis Flashcards

1
Q

which cells are responsible for bone resorption?

A

osteoclasts

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2
Q

which cells are responsible for bone formation?

A

osteoblasts

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3
Q

what is key to osteoporosis tx and why?

A

DECREASING BONE RESORPTION

  • 3 wks to dig resorption pit, but 3-4 months to complete new bone unit
  • bone remodeling = RESORPTION DOMINANT
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4
Q

gen info PTH?

A
  • stim when blood Ca2+ low

increases Ca2+ by:

  • increases osteoclast activity & # (RANK LIGAND)
  • increase renal ability to reabsorb Ca2+ (decr Ca2+ excretion, incr PO4 excretion)
  • stim production Vit D
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5
Q

gen info Vit D?

A

increases Ca2+ by:

  • stim collagen synthesis in osteoblasts
  • stim osteoclast activity via RANK LIGAND
  • incr intestinal absorption
  • decr renal excretion

*works w/ PTH

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6
Q

gen info Calcitonin

A
  • secreted when Ca2+ too high
  • DECREASE Ca2+ by inhibiting osteoclasts to decrease resorption
  • maintain bone in pregnancy/lactation (stim by estrogen)
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7
Q

gen info osteoporosis?

A
  • AMT BONE DECREASED
  • STRUCTURAL INTEGRITY TRABECULAR BONE IMPAIRED
  • CORTICAL BONE BECOMES POROUS, THINNER
  • makes bone WEAKER, MORE LIKELY TO FRACTURE
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8
Q

osteoporosis - complications

A
  • hip fractures (14% DEATH RATE)

- spinal compression fractures (60% don’t realize it)

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9
Q

osteoporosis - risk factors

A
  • POSTMENOPAUSAL WOMEN
  • LONG TERM GLUCOCORTICOID USE
  • THYROTOXICOSIS
  • ALCOHOLISM
  • MALABSORPTION SYNDROME
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10
Q

osteoporosis - tx options?

A
  • Ca2+, vit D (ALWAYS)
  • HRT (estrogen, SERMS)
  • Ca2+ regulating hormones (PTH, Calcitonin)
  • bisphosphonates = DOC
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11
Q

DOC for osteoporosis?

A

BISPHOSPHONATES

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12
Q

why use Calcium and Vit D to treat osteoporosis?

A
  • can’t prevent or treat osteoporosis alone bc CALCIUM AND VIT D ALWAYS NEEDED FOR OTHER Txs TO WORK!
  • Calcium chewables work best
  • VITAMIN D MUST BE ADEQUATE FOR OPTIMAL CALCIUM ABSORPTION
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13
Q

calcitonin - gen info?

A
  • DECREASES BONE RESORPTION of Ca2+
  • ANTAGONIST OF PTH
  • decrease bone pain/loss
  • increase bone density
  • decrease fractures
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14
Q

calcitonin - pharmacokinetics?

A
  • NASAL SPRAY

- INJECTION

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15
Q

calcitonin - adverse effects?

A
  • allergic rxns (esp FISH)
  • nasal RHINITIS/SINUSITIS (nasal spray)
  • NAUSEA/VOMITING (injection)
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16
Q

calcitonin - indications

A
  • osteoporosis (not 1st line)

- Paget’s dz

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17
Q

Teriparatide - info?

A

RECOMBINANT PTH

  • INTERMITTENT ADMIN produces bone GROWTH
  • -> protects weight bearing bones, decr new fractures, incr bone mass/strength
  • actions diminish w/ time
  • ANABOLIC
18
Q

Teriparatide - indications?

A
  • osteoporosis

- hypoPTH

19
Q

Teriparatide - pharmokinetics?

A

SC injection

- INTERMITTENT (1-2 x weekly)

20
Q

Teriparatide - adverse effects?

A
  • hyperCa2+
  • hypercalciuria
  • injection site rxns
  • dizziness, cramps
21
Q

Teriparatide - contraindications/precautions?

A
  • DO NOT USE w/ OSTEOSARCOMA (or those susceptible to osteosarcoma)
22
Q

Denosumab - info?

A
  • antibody against RANK ligand

- DENsity, OSteo, hUman, Monoclonal AntiBody

23
Q

Denosumab - MOA?

A
  • inhibits bone resorption

- ANTIBODY TO RANK LIGAND (FACTOR MADE BY OSTEOBLASTS THAT IS NECESSARY FOR FORMATION OF OSTEOCLASTS)

24
Q

Denosumab - indications/therapeutic effects?

A
  • SEVERE OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN & MEN AT HIGH FRACTURE RISK
  • INCREASE BONE MASS & STRENGTH IN BOTH CORTICAL AND TRABECULAR BONE
25
Q

Denosumab - pharmacokinetics?

A
  • SC injection, once/q 6 months
26
Q

Denosumab - adverse effects?

A
  • OSTEONECROSIS of jaw in cancer studies
27
Q

Denosumab - contraindications, absolute?

A
  • HYPOCALCEMIA - fix this first

- pregnancy

28
Q

Denosumab - contraindications, relative?

A
  • chronic kidney dz

- pts at risk for infection

29
Q

bisphosphonates - FDA approved?

A
  • Alendronate
  • Risedronate
  • Ibandronate
  • Zoledronic Acid
30
Q

bisphosphonates - off label use?

A
  • Etidronate

- Pamidronate

31
Q

bisphosphonates - oral only?

A
  • Risedronate

- Alendronate

32
Q

bisphosphonates - IV only?

A
  • Pamidronate (slow IV)

- Zoledronate

33
Q

bisphosphonates - IV and oral?

A
  • Ibandronate

- Etidronate

34
Q

bisphosphonates - info?

A
  • SUBSTITUTES for PO4 in Ca2+ BINDING
  • INCORPORATES INTO BONE
  • INHIBITS BONE RESORPTION
  • reduce incidence fractures
35
Q

bisphosphonates - MOA?

A
  • inhibit osteoclast activity & bone resorption
  • strengthen bone
  • mechanism unclear
36
Q

bisphosphonates - indications?

A
  • DOC FIRST LINE POST MENOPAUSAL OSTEOPOROSIS

- paget’s dz

37
Q

bisphosphonates - pharmacokinetics

A
  • ORAL prep absorption VERY POOR
  • TAKE ON EMPTY STOMACH
  • 1/2 GLASS WATER & STAY UPRIGHT 30 MIN
  • ALSO IV
38
Q

bisphosphonates - adverse effects, oral?

A
  • ABD PAIN
  • UPPER GI IRRITATION
  • ESOPHAGEAL ULCERATION
  • CONSTIPATION
  • DIARRHEA
  • FLATULENCE
39
Q

bisphosphonates - adverse effects, IV?

A
  • RENAL TOXICITY IF GIVEN TOO FAST
40
Q

bisphosphonates - adverse effects (all)?

A
  • NAUSEA, VOMITING
  • mild hypoCa2+
  • possible Afib
  • incr incidence OSTEONECROSIS OF JAW after dental work

KG - Pharmacology 2 (10 decks)

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