MSK: Pharm of Osteoporosis and Gout Flashcards
What are the two forms of VitD? D2 and D3
D2=Ergocalciferol
-plants
D3=Cholecalciferol
-dairy and sun
Effect of calcitonin-salmon?
Decreases bone resorption
Clinical applications for calcitonin-salmon?
Only for ESTABLISHED osteopororsis, not for prevention
Suffix of all bisphosphonates?
-dronate
MOA of bisphosphonates (alendronate)
Structural analog of pyrophosphate
-binds hydroxyapetite and osteoclasts, which decreases osteoclasts and causes apoptosis
Clinical use of bisphosphonates? (3)
First line for:
- osteoporosis
- Paget disease
- Hypercalcemia of malignancy
Adverse effects of bisphosphonates
Esophagitis
Osteonecrosis of jaw
Atypical femur fractures
Which bisphosphonate is most associated with osteonecrosis of jaw?
Zolendronic acid (IV)
MOA of raloxifene
SERM
- agonist of estrogen receptors at bone
- antagonist of estrogen at uterus and breast
Clinical use of raloxifene
Can try to slow postmenopausal osteoporosis
Adverse effects of raloxifene
DVT, PE, stroke
Estrogen and OCPs can cause these too, so it makes sense
What is the only drug that increases the formation of NEW bone for osteoporosis?
Teriparatide
MOA of teriparatide
Analog of PTH
ROI of teriparatide?
Once-daily injection as pulsed therapy
How does PTH work?
Increases phosphate excretion and increases calcium resorption
-also stimulates kidneys to make 1,25-OHVitD
MOA of denosumab
RANKL monoclonal antibody
-decreases formation of osteoclasts
ROI of denosumab?
Injected every 6 months, SubQ
Adverse effects of denosumab?
Delays fracture healing
Osteonecrosis of jaw**
What treatment is used for men with hypogonadism to reduce risk of osteoporosis?
Testosterone replacement
What meds can manage hypercalcemia?
Bisphosphonates*
Furosemide
Glucocorticoids
inorganic phosphates
MOA of cinacalcet
Sensitizes Ca Sensing receptors on parathyroid gland
-decrease PTH
Clinical use of cinacalcet
Primary hyperparathyroidism
Secondary Hyperparathyroidism (CKD)
Osteoarthritis management
- Weight loss and exercise
- NSAIDs
- Capsaicin
What drugs are used for resistant pain in Osteoarthritis?
- Duloxetine (SNRI)
- Opoids
- Intra-articular glucocorticoids
What antibiotics are used for osteomyelitis?
Clindamycin
Rifampin
TMP-SMX
Fluoroquinolone
How long do you treat osteomyelitis?
4-6 weeks
What type of foods/drinks worsen or increase the amount of uric acid?
Legumes
Red Meats
Leafy Greens
Alcohol
What condition is due to a decrease in HGPRT purine salvage pathway and can have severe gout associated with it?
Lesch-Nyhan
Which drugs treat the over excreters of uric acid?
Allopurinol
Febuxostat
What drugs treat the underexcreters of uric acid?
Pegloticase
Probenecid
What drugs are used for acute gout?
- NSAIDs (naproxen, indomethacin)
- Colchicine
- Glucocorticoids (if 2+ joints)
What drug is used if there are more than two gouty joints and NSAIDs and Colchicine are not cutting it?
Glucocorticoids
MOA of Colchicine
Binds tubulin and blocks formation of microtubules
-inhibits leukocyte migration and phagocytosis
MOA of Allopurinol
Purine-Competitive inhibitor of Xanthine Oxidase
What drugs causes increased excretion of hypoxantine and xanthine?
Allopurinol and febuxostat
Adverse reactions of allopurinol?
SJS and DRESS syndrome
MOA of Febuxostat
Non-purine competitive inhibitor of xanthine oxidase
When would febuxostat be used?
Gout, in those who cannot tolerate allopurinol
What is more costly: febuxostat or allopurinol?
Febuxostat
MOA of Pegloticase
Recombinant uricase that converts uric acid to allantoin
What is pegloticase attached to?
Methoxy polythylene glycol
Adverse effects of pegloticase?
Infusion reactions
What drug is a nonpegylated recombinant uricase?
Rasburicase
-used to prevent renal failure in tumor lysis syndrome
MOA of probenecid?
Organic acid that blocks urate reabsorption more than urate secretion
Can you prescribe probenecid if pt has nephrolithiasis?
No, contraindicated
