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NMSP > Osteoporosis and Gout > Flashcards

Osteoporosis and Gout Flashcards

1
Q

Ergocalciferal and Cholecalcideral are what?

A

Vitamin D compounds

  • Ergocalciferol is D2
  • Cholecalciderol is D3
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2
Q

What has a longer half life and greater potency than human calcitonin?

A

Calcitonin Salmon

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3
Q

What are the effects of calcitonin salmon?

A
  1. inhibits the activity of osteoclasts to decrease bone resorption
  2. inhibits renal tubular reabsorption of calcium to increase calcium excretion
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4
Q

Can calcitonin-salmon be used to prevent osteoprosis?

A

NO! it is used for the tx of established osteoporosis

  • also used in Pagets disease
  • can be used in hypercalcemia but not preferred
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5
Q

How is calcitonin-salmon admisterd?

A
  • intranasal spray

- parenteral for SC or IM injection

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6
Q

What drug class is structural analogs of pyrophosphate?

A

bisphosphonates ( alendronates)

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7
Q

How is the bisphosphonate alendronate administered?

A

PO

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8
Q

How is the bisphosphonate risedronate administered?

A

PO

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9
Q

How is the bisphosphonate ibandronate administered?

A
  • PO
  • IV

I-bandronate= I for IV

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10
Q

How is the bisphosphonate tiludronate administered?

A

PO

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11
Q

How is the bisphosphonate zolendronic acid administered?

A

IV- 1x/year

  • avoids GI problems
  • commonly associated with osteonecrosis of the jaw
  • does dependent kidney damage (rarely afib)
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12
Q

what are the effects of bisphosphonates?

A
  • incorporated into bone then inhibit bone resorption by decreasing the number and activity of osteoclasts
  • microfracture healing is also impaired
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13
Q

A drug class used for :

  1. Postmenopausal osteporosis
  2. osteoporosis in men
  3. glucocorticoid induced osteoporosis
  4. Paget disease of bone
  5. hypercalcemia of malignancy
A

bisphosphonates

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14
Q

Serious side effects of what drug include:

  1. esophagitis +/- ulceration
  2. Osteonecrosis of the jaw
  3. atypical femur fractures
A

Bisphosphonates (alendronate)

  • overall are generally very safe
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15
Q

What is Raloxifene?

A

Selective estrogen receptor modulator (SERM)

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16
Q

What drug is an estrogen blocker in breast and uterus and estrogen agonist in bone?

A

Raloxifene

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17
Q

What drug is used to prevent and treat postmenopausal osteoporosis as an estrogen agonist and reduce the risk of breast cancer as an anti estrogen?

A

Raloxifene

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18
Q

What are the toxicities associated with Raloxifene?

A
  • DVT
  • Pulmonary embolism
  • Stroke

discontinue at least 48 hours before planned/prolonged immobilization

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19
Q

What drug is a truncated (1-34) version of endogenous 1-84 PTH made by recombinant DNA that has full PTH activity?

A

Teriparatide (PTH 1-34)

-paratide sounds like Teri’s -para(thyroid) medications

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20
Q

What is the only osteoporosis drug that increases bone formation?

A

teriparatide (PTH 1-34)

  • can work by stimulating osteoclasts or blasts

–> continuous tx= osteoclast stimulation and bone resorption

–> given daily as pulsed therapy causes osteoblast responses to predominate

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21
Q

How is teriparatide administered?

A

once daily using refilled injectors

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22
Q

What drug is a first in class monoclonal ab RANKL inhibitor?

A

denosumab

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23
Q

What is RANKL?

A

Receptor activator of nuclear factor kappa beta ligand

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24
Q

Denosumab binds to RANKL, what does this do?

A

decreases the formation and function of osteoclasts to decrease bone resorption with increased bone mass density and strength

25
Q

What drug is injected subcutaneously every 6 months?

A

denosumab

26
Q
  • Back pain, pain in extremities, hypercholesterolemia, UTI, and MSK pain
  • bone metastasis patients
  • delayed fracture healing, increased
A

Denosumab

27
Q

What is a major risk for men being treated for osteoporosis?

A

hypogonadism– need testosterone replacement

28
Q

What hypercalcemia drug works in thick ascending limb of Henle?

A

furosemide

29
Q

How do glucocorticoids treat hypercalcemia?

A

reduce Ca2+ intestinal absorption

30
Q

What treats hypercalcemia of malignancy?

A

Bisphosphonates

31
Q

What is nephrotoxic and used to prevent bone resorption and treat hypercalcemia of malignancy?

A

gallium nitrate

32
Q

What IV use is life threatening and is limited to patients with severe hyper calcemia?

A

Inorganic phosphates

  • oral is milder
33
Q

What is a calcium chelating agent that can cause profound hypocalcemia with tetany, convulsion, dysrhythmias and death

A

EDTA

34
Q

What type of drug is cinacalcet?

A

calcimimetic

-binds to calcium sensing receptors on the parathyroid change to increase sensitivity to extracellular calcium and decrease PTH secretion

35
Q

What drug is used to treat primary hyperparathyroidism and secondary hyperparathyroidism due to CKD?

A

cinacalcet- calcimimetic drug

36
Q

Clindamycin, rifampin, Trimethoprim-sulfamethoxazole, and fluoroquinolone whole be used to treat what for how long?

A

Osteomyeltis for 4-6 weeks

37
Q

What is the tx for acute gout?

A

anti inflammatory drugs

38
Q

What is tx for recurrent gout?

A
  • increase uric acid renal excretion

- reduce uric acid production

39
Q

What are the recommended NSAIDS for gout?

A
  • Naproxen (non selective)
  • Indomethacin (COX1>COX2
  • Celecoxib (COX-2)

NIC –> has gout

40
Q

What gout treatment diffuses into cells to bind to tubular and blocks formation of microtubules

A

Colchicine

41
Q

What are the effects of colchicine?

A

inhibition of leukocytosis migration and phagocytosis

42
Q

What drug is used in gout patients with an NSAID intolerance or an absolute contraindication to NSAIDS?

A

Colchicine

43
Q

When is colchicine contraindicated?

A

advanced renal or hepatic impairment

44
Q

What is a competitive inhibitor of xanthine oxidase?

A

allopurinol

45
Q

What are the effects of allopurionol and febuxostat?

A

without conversion to urate because of xanthine oxidase inhibition, hypoxanthine and xanthine will be excreted

46
Q

What drug is indicated in recurrent gout and cancer chemotherapy induced hyperuricemia (tumor lysis syndrome)

A

allopurinol

47
Q

what drug can cause :

  • skin rash,
  • acute gout attack
  • N/V
  • increased liver enzymes
  • Fatal severe hypersensitivity
A

allopurinol

48
Q

What drug is a non-purine/non-competetive inhibitor of xanthine oxidase that spares other enzymes in the purine metabolic pathway

A

Febuxostat

49
Q

When is fubuxostat used?

A
  • in those who can’t tolerate allopurinol

- Same reasons as allopurinol –> recurrent gout and tumor lysis syndrome

50
Q

What drug is a recombinant mammalian uricase that covalently attaches to methoxy polyethylene glycol to prolong its circulating half life and diminish its immunologic response?

A

pegloticase

51
Q

What drug converts uric acid to a more soluble allantoin?

A

pegloticase

52
Q

What recombinant mammalian uricase gout tx is given IV every 2 weeks and given if the patient is refractory to conventional therapy?

A

pegloticase - does not need to have dosage adjusted if there is kidney or liver impairment

53
Q

What drug is a non pegylated recombinant uricase used for prevention of acute uric acid neuropathy due to tumor lysis syndrome in a patient with high-risk lymphoma or leukemia?

A

Rasburicase

54
Q

What organic acid blocks urate reabsorption more than rate secretion in the anionic transport sites of the renal tubule

A

probenecid

55
Q

What organic acid drug increases the fractional excretion urate of rate to decrease the plasma urate concentration in the body?

A

probenecid

56
Q

What drug is indicated for patients that under excrete urate with a GFR >60 and no stones, hyperuricemia, and frequent attacks tophi

A

Probenecid

57
Q

What are the acute gout tx in order?

A
  1. NSAIDs- naproxenand indomethacin
  2. colchicine
  3. glucocorticoids (intra-articular if few joints)
58
Q

What is required for the prevention of recurrent gout?

A

urate lowering!!!

through life style changes or drugs( allopurinol, febuxostat, probenecid)

59
Q

How is acute gout treated?

A

anti-infla

NMSP (14 decks)

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