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NMSKP Exam II > MSK: Pharm of Osteoporosis and Gout > Flashcards

MSK: Pharm of Osteoporosis and Gout Flashcards

1
Q

What are the two forms of VitD? D2 and D3

A

D2=Ergocalciferol
-plants

D3=Cholecalciferol
-dairy and sun

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2
Q

Effect of calcitonin-salmon?

A

Decreases bone resorption

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3
Q

Clinical applications for calcitonin-salmon?

A

Only for ESTABLISHED osteopororsis, not for prevention

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4
Q

Suffix of all bisphosphonates?

A

-dronate

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5
Q

MOA of bisphosphonates (alendronate)

A

Structural analog of pyrophosphate

-binds hydroxyapetite and osteoclasts, which decreases osteoclasts and causes apoptosis

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6
Q

Clinical use of bisphosphonates? (3)

A

First line for:

  • osteoporosis
  • Paget disease
  • Hypercalcemia of malignancy
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7
Q

Adverse effects of bisphosphonates

A

Esophagitis
Osteonecrosis of jaw
Atypical femur fractures

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8
Q

Which bisphosphonate is most associated with osteonecrosis of jaw?

A

Zolendronic acid (IV)

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9
Q

MOA of raloxifene

A

SERM

  • agonist of estrogen receptors at bone
  • antagonist of estrogen at uterus and breast
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10
Q

Clinical use of raloxifene

A

Can try to slow postmenopausal osteoporosis

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11
Q

Adverse effects of raloxifene

A

DVT, PE, stroke

Estrogen and OCPs can cause these too, so it makes sense

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12
Q

What is the only drug that increases the formation of NEW bone for osteoporosis?

A

Teriparatide

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13
Q

MOA of teriparatide

A

Analog of PTH

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14
Q

ROI of teriparatide?

A

Once-daily injection as pulsed therapy

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15
Q

How does PTH work?

A

Increases phosphate excretion and increases calcium resorption
-also stimulates kidneys to make 1,25-OHVitD

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16
Q

MOA of denosumab

A

RANKL monoclonal antibody

-decreases formation of osteoclasts

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17
Q

ROI of denosumab?

A

Injected every 6 months, SubQ

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18
Q

Adverse effects of denosumab?

A

Delays fracture healing

Osteonecrosis of jaw**

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19
Q

What treatment is used for men with hypogonadism to reduce risk of osteoporosis?

A

Testosterone replacement

20
Q

What meds can manage hypercalcemia?

A

Bisphosphonates*
Furosemide
Glucocorticoids
inorganic phosphates

21
Q

MOA of cinacalcet

A

Sensitizes Ca Sensing receptors on parathyroid gland

-decrease PTH

22
Q

Clinical use of cinacalcet

A

Primary hyperparathyroidism

Secondary Hyperparathyroidism (CKD)

23
Q

Osteoarthritis management

A
  • Weight loss and exercise
  • NSAIDs
  • Capsaicin
24
Q

What drugs are used for resistant pain in Osteoarthritis?

A
  • Duloxetine (SNRI)
  • Opoids
  • Intra-articular glucocorticoids
25
Q

What antibiotics are used for osteomyelitis?

A

Clindamycin
Rifampin
TMP-SMX
Fluoroquinolone

26
Q

How long do you treat osteomyelitis?

A

4-6 weeks

27
Q

What type of foods/drinks worsen or increase the amount of uric acid?

A

Legumes
Red Meats
Leafy Greens
Alcohol

28
Q

What condition is due to a decrease in HGPRT purine salvage pathway and can have severe gout associated with it?

A

Lesch-Nyhan

29
Q

Which drugs treat the over excreters of uric acid?

A

Allopurinol

Febuxostat

30
Q

What drugs treat the underexcreters of uric acid?

A

Pegloticase

Probenecid

31
Q

What drugs are used for acute gout?

A
  1. NSAIDs (naproxen, indomethacin)
  2. Colchicine
  3. Glucocorticoids (if 2+ joints)
32
Q

What drug is used if there are more than two gouty joints and NSAIDs and Colchicine are not cutting it?

A

Glucocorticoids

33
Q

MOA of Colchicine

A

Binds tubulin and blocks formation of microtubules

-inhibits leukocyte migration and phagocytosis

34
Q

MOA of Allopurinol

A

Purine-Competitive inhibitor of Xanthine Oxidase

35
Q

What drugs causes increased excretion of hypoxantine and xanthine?

A

Allopurinol and febuxostat

36
Q

Adverse reactions of allopurinol?

A

SJS and DRESS syndrome

37
Q

MOA of Febuxostat

A

Non-purine competitive inhibitor of xanthine oxidase

38
Q

When would febuxostat be used?

A

Gout, in those who cannot tolerate allopurinol

39
Q

What is more costly: febuxostat or allopurinol?

A

Febuxostat

40
Q

MOA of Pegloticase

A

Recombinant uricase that converts uric acid to allantoin

41
Q

What is pegloticase attached to?

A

Methoxy polythylene glycol

42
Q

Adverse effects of pegloticase?

A

Infusion reactions

43
Q

What drug is a nonpegylated recombinant uricase?

A

Rasburicase

-used to prevent renal failure in tumor lysis syndrome

44
Q

MOA of probenecid?

A

Organic acid that blocks urate reabsorption more than urate secretion

45
Q

Can you prescribe probenecid if pt has nephrolithiasis?

A

No, contraindicated

NMSKP Exam II (4 decks)

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