MSK: Pharm of Osteoporosis and Gout

Question 1

What are the two forms of VitD? D2 and D3

Answer 1

D2=Ergocalciferol
-plants

D3=Cholecalciferol
-dairy and sun

Question 2

Effect of calcitonin-salmon?

Answer 2

Decreases bone resorption

Question 3

Clinical applications for calcitonin-salmon?

Answer 3

Only for ESTABLISHED osteopororsis, not for prevention

Question 4

Suffix of all bisphosphonates?

Answer 4

-dronate

Question 5

MOA of bisphosphonates (alendronate)

Answer 5

Structural analog of pyrophosphate

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

Question 6

Clinical use of bisphosphonates? (3)

Answer 6

First line for:

• osteoporosis
• Paget disease
• Hypercalcemia of malignancy

Question 7

Adverse effects of bisphosphonates

Answer 7

Esophagitis
Osteonecrosis of jaw
Atypical femur fractures

Question 8

Which bisphosphonate is most associated with osteonecrosis of jaw?

Answer 8

Zolendronic acid (IV)

Question 9

MOA of raloxifene

Answer 9

SERM

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

Question 10

Clinical use of raloxifene

Answer 10

Can try to slow postmenopausal osteoporosis

Question 11

Adverse effects of raloxifene

Answer 11

DVT, PE, stroke

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

Question 12

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

Answer 12

Teriparatide

Question 13

MOA of teriparatide

Answer 13

Analog of PTH

Question 14

ROI of teriparatide?

Answer 14

Once-daily injection as pulsed therapy

Question 15

How does PTH work?

Answer 15

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

Question 16

MOA of denosumab

Answer 16

RANKL monoclonal antibody

-decreases formation of osteoclasts

Question 17

ROI of denosumab?

Answer 17

Injected every 6 months, SubQ

Question 18

Adverse effects of denosumab?

Answer 18

Delays fracture healing

Osteonecrosis of jaw**

Question 19

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

Answer 19

Testosterone replacement

Question 20

What meds can manage hypercalcemia?

Answer 20

Bisphosphonates*
Furosemide
Glucocorticoids
inorganic phosphates

Question 21

MOA of cinacalcet

Answer 21

Sensitizes Ca Sensing receptors on parathyroid gland

-decrease PTH

Question 22

Clinical use of cinacalcet

Answer 22

Primary hyperparathyroidism

Secondary Hyperparathyroidism (CKD)

Question 23

Osteoarthritis management

Answer 23

• Weight loss and exercise
• NSAIDs
• Capsaicin

Question 24

What drugs are used for resistant pain in Osteoarthritis?

Answer 24

• Duloxetine (SNRI)
• Opoids
• Intra-articular glucocorticoids

Question 25

What antibiotics are used for osteomyelitis?

Answer 25

Clindamycin Rifampin TMP-SMX Fluoroquinolone

Question 26

How long do you treat osteomyelitis?

Answer 26

4-6 weeks

Question 27

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

Answer 27

Legumes Red Meats Leafy Greens Alcohol

Question 28

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

Answer 28

Lesch-Nyhan

Question 29

Which drugs treat the over excreters of uric acid?

Answer 29

Allopurinol | Febuxostat

Question 30

What drugs treat the underexcreters of uric acid?

Answer 30

Pegloticase | Probenecid

Question 31

What drugs are used for acute gout?

Answer 31

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

Question 32

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

Answer 32

Glucocorticoids

Question 33

MOA of Colchicine

Answer 33

Binds tubulin and blocks formation of microtubules | -inhibits leukocyte migration and phagocytosis

Question 34

MOA of Allopurinol

Answer 34

Purine-Competitive inhibitor of Xanthine Oxidase

Question 35

What drugs causes increased excretion of hypoxantine and xanthine?

Answer 35

Allopurinol and febuxostat

Question 36

Adverse reactions of allopurinol?

Answer 36

SJS and DRESS syndrome

Question 37

MOA of Febuxostat

Answer 37

Non-purine competitive inhibitor of xanthine oxidase

Question 38

When would febuxostat be used?

Answer 38

Gout, in those who cannot tolerate allopurinol

Question 39

What is more costly: febuxostat or allopurinol?

Answer 39

Febuxostat

Question 40

MOA of Pegloticase

Answer 40

Recombinant uricase that converts uric acid to allantoin

Question 41

What is pegloticase attached to?

Answer 41

Methoxy polythylene glycol

Question 42

Adverse effects of pegloticase?

Answer 42

Infusion reactions

Question 43

What drug is a nonpegylated recombinant uricase?

Answer 43

Rasburicase | -used to prevent renal failure in tumor lysis syndrome

Question 44

MOA of probenecid?

Answer 44

Organic acid that blocks urate reabsorption more than urate secretion

Question 45

Can you prescribe probenecid if pt has nephrolithiasis?

Answer 45

No, contraindicated