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Pharm 2 - Exam 3 > Lecture 4 - Bone Drugs > Flashcards

Lecture 4 - Bone Drugs Flashcards

1
Q

Calcium Supplements

A

clinical application: Ca2+ deficiency

MOA: increase bone mineralization and decrease PTH release

SE: 
constipation
urolithiasis
prostate cancer
GI upset

Contraindications:
Hypercalcemia
Ventricular fibrillation (Ca-gluconate only)

give Ca-carbonate with food because stomach H+ secretion is needed to free Ca2+

Ca-citrate for pts taking a PPI

subcutaneous infiltration of IV infusion is less toxic with Ca-gluconate than CaCl2

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2
Q

What are the SE of Ca2+ supplements?

A

constipation
urolithiasis
prostate cancer
GI upset

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3
Q

What is the MOA of Ca2+ supplements?

A

increase bone mineralization and decrease PTH release

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4
Q

What are the contraindications of Ca2+ supplements?

A 
Hypercalcemia
Ventricular fibrillation (Ca-gluconate only)
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5
Q

What are the different types of Ca2+ supplements?

A

Ca2+ gluconate (IV)
Ca2+ chloride (IV)
Ca2+ carbonate (PO)
Ca2+ citrate malate (PO)

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6
Q

What should you tell pts who you prescribe ca-carbonate in regards to timing of taking the medication?

A

take with food because stomach H+ secretion is needed to free Ca2+

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7
Q

When prescribing Ca2+ supplements to pts, what must you do?

A

also prescribe Vitamin D when osteoporosis medicines are taken

Ca2+ + Vitamin D = vertebral fracture decreased up to 16% and hip fx by up to 30%

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8
Q

What are the different vitamin D supplements?

A 
Cholecalciferol (VtD3) 
Ergocalciferol (VtD2) 
Calcifediol (25-OH D3) 
Calcitriol (1,25 OH D3) 
Doxercalciferol (A alpha OH D2) 
Paricalcitol
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9
Q

What is the MOA of Vitamin D supplements?

A

increase Gl Ca2+ and PO4 absorption

decrease PTH gene transcription

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10
Q

What are the indications for vitamin D supplements?

A 
Vt D deficiency 
Hypoparathyroidism 
Rickets
Ostemalacia
Osteoporosis 
Secondary hyperparathyroidism
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11
Q

What are the adverse effects of Vitamin D supplements?

A 
hypervitaminosis D
Hypercalcemia
Hypophosphatemia
Hypercalciuria
GI hemorrhage 
Angioedema 
Abnormal lipids, GI upset, edema, HA
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12
Q

What are the contraindications for Vitamin D supplements?

A

hypersensitivity to drug

hypercalcemia

hypervitaminosis D

malabsorption syndrome

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13
Q

Which vitamin D supplement is most commonly used?

A

calitriol is often the preferred agent due to fast onset and offset (12h) and faster approach to steady state (72-96h)

calcitriol may cause more hypercalcemia than either paricalcitol or doxercalciferol

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14
Q

hPTH 1-34

A

teriparatide

indications:
severe osteoporosis
(only in pts at high risk of fx)

SE: 
angina
hypotension
rash
swelling
hyperuricemia
GI upset
asthenia
dizziness
cough 
rhinitis
contraindications:
hypersensitivity to teripartide 
Paget's disease 
open epiphyses (kids and adolescents) 
prior radiation 
bone malignancy 
hypercalcemia

long term use casues osteosclerosis and osteosarcomas in rodents

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15
Q

What are the indications for teriparatide?

A

severe osteoporosis

only in pts at high risk of fx

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16
Q

What are the SE of teriparatide?

A 
angina
hypotension
rash
swelling
hyperuricemia
GI upset
asthenia
dizziness
cough 
rhinitis
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17
Q

What are the contraindications of teriparatide?

A 
hypersensitivity to teripartide 
Paget's disease 
open epiphyses (kids and adolescents) 
prior radiation 
bone malignancy 
hypercalcemia
18
Q

Calcimemetics

A

cinacalcet

increases sensitivity of Ca2+ sensing receptors to Ca2+ in parathyroid cells
decreases PTH release

19
Q

Cinacalcet

A

a calcimemtic

indications:
hyperthyroidism
hypercalcemia associated with parathyroid carcinoma

SE: 
cardiac arrythmia 
heart failure
seizure 
electrolyte imbalance 
anemia 
bone fx
paresthesia
GI upset
arthralgia
myalgia
asthenia
HA
depression
dehydration
fatigue

contraindications:
hypocalcemia

sometimes used off label to treat forms of secondary hyperparathyrodisim

20
Q

What are the indications for cinacalcet?

A

hyperthyroidism
hypercalcemia associated with parathyroid carcinoma

sometimes used off label to treat forms of secondary hyperparathyrodisim

21
Q

What are the SE of cinacalcet?

A 
cardiac arrythmia 
heart failure
seizure 
electrolyte imbalance 
anemia 
bone fx
paresthesia
GI upset
arthralgia
myalgia
asthenia
HA
depression
dehydration
fatigue
22
Q

What are the contraindications of cinacalcet?

A

hypocalcemia

23
Q

SERMs

A

replace continuous estrogen-progestin that increases the risk of breast cancer, pulmonary embolism, stroke, and coronary heart disease
estrogen receptor agonist in bone, while estrogen receptor antagonist in endometrium and breast
reduce breast cancer, but not stroke or embolism

24
Q

Raloxifene

A

SERM

indication:
prevention and treatment of osteoporosis
prophylaxis of invasive breast cancer

SE:
retinal vascular occlusion, venous thromboembolism (d/t increase in hepatic clotting factor production)
hot flashes
leg cramps

contraindications:
pregnancy
hx of venous thromboembolism

decreases breast cancer incidence

25
Q

What are the indications for raloxifene?

A

prevention and treatment of osteoporosis

prophylaxis of invasive breast cancer

26
Q

What are the SE of raloxifene?

A

retinal vascular occlusion, venous thromboembolism (d/t increase in hepatic clotting factor production)
hot flashes
leg cramps

27
Q

What are the contraindications of raloxifene?

A

pregnancy
hx of venous thromboembolism

decreases bre

28
Q

Which bisphosphonates are used?

A 
alendronate (PO) 
risedronate (PO) 
pamidronate (PO) 
ibandronate (PO or IV) 
zoledronate (IV)
29
Q

Bisphonphonates

A

indications:
prevention and treatment of osteoporosis (except Pamidronate)
Padget’s disease (except Ibandronate)
Osteolytic lesions of multiple myeloma and breast cancer (excpet pamidronate and zoledronate)
hypercalcemia associated with malignancy (Pamidronate and zoledronate ONLY)

SE: 
arthralia
myalgia
jaw osteonecrosisprimarily in cancer pts 
atypical femur fx 
esophageal ulcer 
nephrotoxicity 
GI upset

Contraindications:
hypersensitivity to drug
hypocalcemia
esophageal disease unable to sit up for 30 minutes after taking drug orally

adequate renal function is necessary for use of intravenous BPs
30% of pts initial transient flu-like illness

“drug holidarys” after 5 years due to atypical femur fx

30
Q

What is the indication for bisphosphonates?

A

prevention and treatment of osteoporosis (except Pamidronate)
Padget’s disease (except Ibandronate)
Osteolytic lesions of multiple myeloma and breast cancer (excpet pamidronate and zoledronate)
hypercalcemia associated with malignancy (Pamidronate and zoledronate ONLY)

31
Q

What are the SE of bisphosphonates?

A 
arthralia
myalgia
jaw osteonecrosisprimarily in cancer pts 
atypical femur fx 
esophageal ulcer 
nephrotoxicity 
GI upset
32
Q

What are the contraindications of bisphosphonates?

A

hypersensitivity to drug
hypocalcemia
esophageal disease unable to sit up for 30 minutes after taking drug orally

33
Q

Denosumab

A

a fully monoclonal human antibody produced against RANKL

indication:
prevention and treatment of osteoporosis
bone metastases from solid tumors

SE: 
endocarditis
cellulitis
electrolyte imbalance 
pancreatitis 
hypersensitivity reaction 
Jaw osteonecrosis in cancer pts 
atypical femur fxs
GI upset
asthenia
URI
fatigue
dyspnea

Contraindications:
hypocalcemia
pregnancy

injected SubQ every 6 months for osteoporosis and monthly for malignancy

34
Q

What are the indications for denosumab?

A

prevention and treatment of osteoporosis

bone metastases from solid tumors

35
Q

What are the SE of denosumab?

A 
endocarditis
cellulitis
electrolyte imbalance 
pancreatitis 
hypersensitivity reaction 
Jaw osteonecrosis in cancer pts 
atypical femur fxs
GI upset
asthenia
URI
fatigue
dyspnea
36
Q

What are the contraindications of denosumab?

A

hypocalcemia

pregnancy

37
Q

Calcitonin

A

decreases serum calcium by:
decreasing absorption in the gut
decreasing reabsorption in the kidney
increasing deposition in bone (directly inhibiting osteoclast; activating osteoblasts)

38
Q

Salmon calcitonin

A

longer half life than human

nasal spray or subQ injections

indication:
hypercalcemia
padget’s disease
osteoporosis

SE:
hypocalcemia
hypersensitivity 
seizure
cancer
flushing
nausea
39
Q

What is the indication for salmon calcitonin?

A

hypercalcemia
padget’s disease
osteoporosis

40
Q

What are the SE of salmon calcitonin?

A 
hypocalcemia
hypersensitivity 
seizure
cancer
flushing
nausea

Pharm 2 - Exam 3 (6 decks)

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