Osteoperosis

Question 1

What type of calcium deficiencies do we use oral and parenteral calcium supplements for?

Answer 1

Mild low calcium

Rapidly increase severe low calcium

Question 2

3 main effects of PTH to raise calcium levels?

Answer 2

Increase osteoclast active to get bone to release it
Intestinal absorption through vitamin D
Increases calcium reabsorption in distal tubule

Question 3

3 ways vitamin D raises calcium levels?

Answer 3

Absorption in intestine
Reabsorption in kidney
Gets blood to raise it

Question 4

2 differences between human calcitonin and calcitonin salmon?

Answer 4

Salmon has a longer half life and much more potent

Question 5

2 effects of using calcitonin salmon?
3 clinical uses?
Adverse effect profile?

Answer 5

Blocks osteoclast activity which blocks breaking down of bone
Encourages calcium excretion

Osteoporosis, Paget’s disease of bone, and high calcium

Very safe

Question 6

MOA of bisphosphonates, alendronate?
Effect?
5 clinical uses?
3 adverse effects?

Answer 6

Analog of pyrophosphate which is normally found in bone
Lowers number and activity of osteoclasts
Postmenopausal osteo, osteo in men, gluco induced osteo, pagets, and hypercalcemia of malignancy.
Esophagitis, osteonecrosis of jaw, atypical femoral fractures.

Question 7

Which bisphosphonate is most commonly known for causing osteonecrosis of the jaw?

Answer 7

Zolendronic acid

Question 8

MOA of raloxifene?
Effect?
2 clinical uses?
3 adverse effects?

Answer 8

SERM
Anti estrogen in breast and uterus and agonist in bone
Prevent/treat PM osteo and reduce risk of breast cancer
DVT, PE, and stroke

Question 9

MOA of teriparatide?
1 effect?
Clinical use?

Answer 9

PTH
Only drug that can actually increase bone formation
Osteo in PM, men and gluco induced

Question 10

MOA of Denosumab?
Effect?
2 clinical uses?
What must be taken with it?

Answer 10

Antibody against RANKL
Blocks osteoclast activity
Osteo and solid tumors that have spread to bone
Calcium and vitamin D

Question 11

What is the drug of choice for treating osteo in men?
What is important to take with it and why as part of therapy?
2 major causes of osteo in men?

Answer 11

Bisphosphonates (denosumab is alternative)
Testosterone because hypogonadism is major risk
Glucos and androgen deprivation therapy for prostate cancer

Question 12

MOA of cinacalcet and its effect?
2 clinical applications?
3 adverse effects?

Answer 12

Binds to the calcium sensing receptors of the parathyroid gland and increases sensitivity to calcium and lowers pth secretion. Essentially resets the gland.
Primary and secondary hyper parathyroidism
N, V and D

Question 13

Drug or treatment of choice for osteoarthritis?

Answer 13

Nothing

Question 14

4 dietary supplements and 4 herbal remedies for osteoarthritis?

Answer 14

Glucosamine, chondroitin, DMSO, and SAME

Devils claw, stinging nettle, rose hips, and avocado soybean

Question 15

3 meds to treat pain and inflammation in OA?

Answer 15

Tylenol if no inflammation
NSAID if pain and inflammation
Topical NSAIDS or capsaicin

Question 16

What is the overall problem with treating osteomyelitis?

Answer 16

Often, the bacteria are in such small places that neither WBCs or antibiotics can reach them. Also, after the bone is dead from infection, new bone is fairly a vascular so the antibiotic cannot travel to the infection. Basically, we are waiting for the bone to be broken/destroyed to get to the pathogen.

Question 17

Osteomyelitis treatment is based on what?
4 drugs effective most of the time?
How long do we give a course of antibiotics for osteomyelitis?

Answer 17

Based on pathogen found in bone culture
Clindamycin, rifampin, TMP/SMX, fluoroquinolone
4-6 weeks