L10: drugs in the management of musculoskeletal disorders Flashcards
iatrogenic=
relating to illness caused by medical examination or treatment
osteoblast=
cell that makes bone
osteoclast=
a multinucleate cell that breaks down bone
pharmacokinetics=
the process by which a drug is absorbed, distributed, metabolised and eliminated
outer shell of bone=
cortical bone
inner bone=
trabecular mesh
osteoporosis =
thinning of bone
most commonly affected bones in osteoporosis (3)
wrist
hip
spine
osteoclasts sit in
Howship lacunae
how do osteoclasts form
formed by fusion of many cells derived from monocytes
how do osteoblasts form
differentiation of osteogenic cells in the periosteum
how do osteoblasts and osteoclasts communicate
cytokines
what do osteoblasts produce
RANKL
what does RANK L do
binds to RANK receptor on the osteoclast precursor cell to initiate maturation of the osteoclast
what produces OPG
osteoblasts and stromal cells
what is OPG
a soluble ligand which mops up the RANK L so it can no longer act as a signal
when osteoclasts bind to bone what do they form
a celling zone
what mineral is released when bone is broken down
calcium
what are bisphosphonates
enzyme-resistant analogues of pyrophosphate (which normally inhibits mineralization of bone)
how do BPs work
decrease osteoclast activity by decreasing osteoclast progenitor development + increase osteoclast apoptosis
what binding sites do BPs attach to
hydroxyapatite
2 types of BPs
- non nitrogen containing
- nitrogen containing
e.g of Non-N containing BP
Etidronate
e.g of nitrogen containing BP
alendronate
widest adverse effect of BP therapy
osteonecrosis of the jaw
SERM=
selective estrogen receptor modulator
e.g of SERM
raloxifene
SERM used for breast cancer
Tamoxifen
HRT that increase risk in 2 types of breast cancer
breast cancer
ovarian cancer
where is calcitonin released from
thyroid
what does calcitonin do (3)
- increases osteoblast activity
- decrease intestine Ca2+ absorption
- Decrease Ca2+ renal absorption
what does PTH do
increase osteoclast activity
4 ways to target Rheumatoid arthritis
NSAIDs
Steroids
DMARDs
Biological agents
used for severe RA
immunosuppression
COX-2=
inflammation
COX-1=
- gastrointestinal tract
- renal tract
- platelet function
- macrophage differentiation
steroidal anti-inflammatory drugs target ____ to decrease
nuclear receptors to decrease expression of inflammatory cytokines
e.g of a SAID
prednisolone
what gland shrinks when patients are on steroids
adrenal gland
DMARDs=
disease modifying anti-rheumatic drugs
what do DMARDs do
reduce damage to joints
3 DMARDS
- hydroxychloroquine
- methotrexate
- sulfasalazine
MOA of methotrexate
affects dihydrofolate reductase
what are biological therapies based on
monoclonal antibodies
3 biological therapies
adalimumab
etanercept
infliximab
what do adalimumab, etanercept and infliximab all target
tumour necrosis factor alpha
immunosuppressant agent of last resort
ciclosporin
