Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 7 > osteoporosis and gout > Flashcards

osteoporosis and gout Flashcards

1
Q

risk factors for osteoporosis

A

controllable: dec physical activity, low body wt, poor Ca and vitD intake, caffeine EtOH or tobacco, glucocorticoids and other meds
out of control: female, age, white Hispanic or Asian, personal or fam hx of fractures, premature menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

meds that may cause osteoporosis

A
  • CYP inducing anti-epileptics (inc vit D catabolism)
  • aromatase inhibitors, medroxyprogesterone (dec estrogen activity)
  • PPIs (dec Ca absorption)
  • GnRH agonists (dec estrogen and testosterone)
  • glitazones, glucocorticoids, heparin (dec bone formation, unclear MOA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

effects of vitamin D

A 
increases bone formation and resorption
inc synthesis CBP/calcibindin
increases absorption of Ca and P from gut
dec urine Ca and P
inhibits production of PTH
stimulates FGF23 release from bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

effects of PTH

A

increase bone formation and resorption (stimulates osteoblasts and -clasts)
dec urine Ca
inc urine P
stimulates conversion from inactive to active vit D in kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

effects of calcitonin

A

decreases bone resorption (inactivates osteoclasts), promotes Ca deposition by blasts
inc urine Ca and P

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

effects of FGF23

A

increases urine P

inhibits conversion of inactive to active vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

effects of RANKL, MCSF, and OPG

A

RANKL: activates osteoclasts
MCSF: activates osteoclasts
OPG: physiologic antagonist of RANKL prevents activation of osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

calcium salts types and uses

A 
calcium carbonate (needs acid for absorption), calcium citrate (more bioavailable)
use in hypocalcemic state, and prevention/tx of osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ADRs calcium salts

A

constipation
dec absorption ciprofloxacin, phenytoin, levothyroxine, tetracyclines
MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

metabolism of vitamin D

A

sunlight: 7-DHC to cholecalciferol (D3) (also can be obtained in diet)
liver 25a-hydroxylase: D3 -> 25-hydroxy-D3
kidney 1a-hydroxylase: 25-H-D3 -> 1,25-DH-D3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ergocalciferol

A

vitamin D2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

cholecalciferol

A

vitamin D3, synthesized in skin exposed to UV rays

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

calcitriol

A

1,25-dihydroxy-vitamin D3

most active form of vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

calcifediol

A

25-hydroxycholecalciferol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

alfacalcidiol

A

a-hydroxycholecalciferol, a prodrug rapidly hydroxylated by liver to calcitriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

teriparatide use, MOA, and ADR

A

recombinant human PTH for osteoporosis
short-term use only - stimulates osteoblasts > clasts
long-term stimulates osteoclasts
ADR: inc risk osteosarcoma w use >2 y

17
Q

bisphosphonate names and MOA

A

“dronates” and “dronic acids”
analogues of pyrophosphate, replacing POP with PCP that is hydrolysis-resistant, stabilizing hydroxyapatite
also adsorb to hydroxyapatite, preventing resorption by inhibiting osteoclast activity

18
Q

uses of bisphosphonates

A

osteoporosis, Paget’s disease, hypercalcemia, osteolytic bone lesions of metastatic cancer

19
Q

ADRs of bisphosphonates

A 
m/c: esophagitis, erosion (esp. alendronate; take while upright with water)
osteomalacia (eti- and pami-)
GI distress
osteonecrosis of jaw or other bones
atypical subtrochanteric fx
20
Q

use of calcitonin

A

nasal spray
salmon calcitonin more potent and longer-acting than recombinant human calcitonin
tx of hyper-Ca states: post-meno osteoporosis, Paget’s dz
*short-term only (less than 6 h)

21
Q

denosumab

A

IgG2 monoclonal antibody that binds and inactivates RANKL, mimics OPG
inactivates RANKL-RANK-NF-kB pathway, inhibiting gene expression for osteoclast fxn
ADR: worsened hypo-Ca

22
Q

raloxifene

A

SERM that reduces risk of vertebral (? other) fractures, breast cancer, and coronary events
may worsen post-menopausal vasomotor sx

23
Q

causes of gout

A

overproduction or underexcretion of uric acid, or 2’ to leukemia or lymphoma (tumor lysis syndrome d/t tx)

24
Q

normal urinary excretion of uric acid

A

24 hours: ~750 mg

25
Q

meds for tx of acute gout

A

NSAIDs (indomethacin, naproxen, sulindac)

colchicine

26
Q

meds for tx of chronic gout

A

under-excretion: probenecid, rasburicase, lesinurad (SURI)

over-production: allopurinol, febuxostat

27
Q

MOA of gout pain

A

urate crystals accumulate, cause inflammation, granulocytes migrate into joint space and phagocytose crystals, release lysosomes that cause inflammation and joint destruction

28
Q

MOA of colchicine

A

decreases leukocyte activity primarily by inhibiting tubulin polymerization
*not analgesic or anti-inflammatory, specifically suppresses gouty inflammation

29
Q

ADRs of colchicine

A

diarrhea, BM suppression

GI pain, hematuria, alopecia, peripheral neuropathy

30
Q

MOA and uses of probenecid

A

inhibiting tubular reabsorption of uric acid, promoting excretion and reducing blood levels
use for chronic gout (under-excretors), tx of 2’ hyperuricemia, prolongs action of penicillins and cephalosporins (competes for secretion = inc t1/2)

31
Q

xanthine oxidase inhibitor MOA

A

decreases production of uric acid by preventing conversion of hypoxanthine to uric acid

32
Q

uses of XO inhibitors

A

in chronic gout (over-producers), prevents acute gouts (but may worsen during acute gout), 2’ hyperuricemia

33
Q

drug interactions of XO inhibitors

A

inhibits azathioprine and 6-mercaptopurine elimination - must decrease doses up to 75% or severe toxicity

34
Q

allopurinol

A

reversible XO inhibitor

35
Q

febuxostat

A

irreversible XO inhibitor

36
Q

rasburicase

A

synthetic urate oxidase (rodents)

converts uric acid to soluble allantoin, to dissolve uric acid and promote urinary excretion in resistant cases of gout

37
Q

drugs to avoid during acute gout attack

A

XO inhibitors - can cause flares (reduce serum uric acid level so quickly -> release from tissue stores)
ASA (dec urate excretion)
diuretics (volume depletion -> inc urate conc in blood)

Pharm 7 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions