Osteoarthritis

Question 0

Salmon calcitonin

Answer 0

-Helps regulate serum calcium levels by inhibiting osteoclast function
-salmon source is more potent and longer lasting
-last line of medication, not used often
ADE
-local nasal irritation

Question 1

Teriparatide

Answer 1

-treats osteoarthritis
-34 AA with the same activity as PTH (anabolic)
-daily subcutaneous injection
MOA: normally osteoclast>osteoblast but if given in lower amounts with pulse secretion, then osteoblast>osteoclasts
ADE
-risk of osteosarcoma; max lifetime tx 2 years

Question 2

Estrogen

Answer 2

-Hormone replacement therapy (HRT) post menopause
-Risk>benefit?=fewer fractures seen
-FDA warning to use HRT at lowest dose and for the shortest duration
ADE
-increased risk of cardiovascular risks

Question 3

Raloxifene

Answer 3

-Selective estrogen receptor modulator (SERM)
-MOA: agonist effect on bone to inhibit osteoclast activity; antagonist at estrogen receptors on breast and uterine tissues.
-not very effective
ADE
-risk of blood clots and causes menopausal symptoms

Question 4

Denosumab

Answer 4

-Monoclonal antibody against RANK-L
-MOA: inhibits osteoclast activation and formation; decrease osteoclast survival
-subcutaneous injection but very expensive
ADE
-hypocalcemia, infections, osteonecrosis of jaw

Question 5

Biphosphonates

Answer 5

-“dronate”
-N-BP=nitrogen containing biphosphonates
-MOA: inhibits enzyme farnesyl pyrophosphate synthase; makes the osteoclast unable to resorb bone and die
-very low oral bioavailability
ADE
-esophageal irritation, osteonecrosis of jaw, hypocalcemia, renal insufficiency
-don’t use oral bisphophonates if you have GERD symptoms

Question 6

Zoledronic Acid

Answer 6

-MOA: inhibits enzyme farnesyl pyrophosphate synthase; makes the osteoclast unable to resorb bone and die
-not recommended with renal failure
-very low oral bioavailability
ADE
-acute renal failure, esophageal irritation, osteonecrosis of jaw, hypocalcemia, renal insufficiency
-don’t use oral bisphophonates if you have GERD symptoms

Question 7

Alendronate

Answer 7

-MOA: inhibits enzyme farnesyl pyrophosphate synthase; makes the osteoclast unable to resorb bone and die
-estimated 10 years for terminal elimination half life
-very low oral bioavailability
ADE
-esophageal irritation, osteonecrosis of jaw, hypocalcemia, renal insufficiency
-don’t use oral bisphophonates if you have GERD symptoms