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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
What drug is injected subcutaneously every 6 months?
denosumab
26
- Back pain, pain in extremities, hypercholesterolemia, UTI, and MSK pain - bone metastasis patients - delayed fracture healing, increased
Denosumab
27
What is a major risk for men being treated for osteoporosis?
hypogonadism-- need testosterone replacement
28
What hypercalcemia drug works in thick ascending limb of Henle?
furosemide
29
How do glucocorticoids treat hypercalcemia?
reduce Ca2+ intestinal absorption
30
What treats hypercalcemia of malignancy?
Bisphosphonates
31
What is nephrotoxic and used to prevent bone resorption and treat hypercalcemia of malignancy?
gallium nitrate
32
What IV use is life threatening and is limited to patients with severe hyper calcemia?
Inorganic phosphates - oral is milder
33
What is a calcium chelating agent that can cause profound hypocalcemia with tetany, convulsion, dysrhythmias and death
EDTA
34
What type of drug is cinacalcet?
calcimimetic -binds to calcium sensing receptors on the parathyroid change to increase sensitivity to extracellular calcium and decrease PTH secretion
35
What drug is used to treat primary hyperparathyroidism and secondary hyperparathyroidism due to CKD?
cinacalcet- calcimimetic drug
36
Clindamycin, rifampin, Trimethoprim-sulfamethoxazole, and fluoroquinolone whole be used to treat what for how long?
Osteomyeltis for 4-6 weeks
37
What is the tx for acute gout?
anti inflammatory drugs
38
What is tx for recurrent gout?
- increase uric acid renal excretion | - reduce uric acid production
39
What are the recommended NSAIDS for gout?
- Naproxen (non selective) - Indomethacin (COX1>COX2 - Celecoxib (COX-2) NIC --> has gout
40
What gout treatment diffuses into cells to bind to tubular and blocks formation of microtubules
Colchicine
41
What are the effects of colchicine?
inhibition of leukocytosis migration and phagocytosis
42
What drug is used in gout patients with an NSAID intolerance or an absolute contraindication to NSAIDS?
Colchicine
43
When is colchicine contraindicated?
advanced renal or hepatic impairment
44
What is a competitive inhibitor of xanthine oxidase?
allopurinol
45
What are the effects of allopurionol and febuxostat?
without conversion to urate because of xanthine oxidase inhibition, hypoxanthine and xanthine will be excreted
46
What drug is indicated in recurrent gout and cancer chemotherapy induced hyperuricemia (tumor lysis syndrome)
allopurinol
47
what drug can cause : - skin rash, - acute gout attack - N/V - increased liver enzymes - Fatal severe hypersensitivity
allopurinol
48
What drug is a non-purine/non-competetive inhibitor of xanthine oxidase that spares other enzymes in the purine metabolic pathway
Febuxostat
49
When is fubuxostat used?
- in those who can't tolerate allopurinol | - Same reasons as allopurinol --> recurrent gout and tumor lysis syndrome
50
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?
pegloticase
51
What drug converts uric acid to a more soluble allantoin?
pegloticase
52
What recombinant mammalian uricase gout tx is given IV every 2 weeks and given if the patient is refractory to conventional therapy?
pegloticase - does not need to have dosage adjusted if there is kidney or liver impairment
53
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?
Rasburicase
54
What organic acid blocks urate reabsorption more than rate secretion in the anionic transport sites of the renal tubule
probenecid
55
What organic acid drug increases the fractional excretion urate of rate to decrease the plasma urate concentration in the body?
probenecid
56
What drug is indicated for patients that under excrete urate with a GFR >60 and no stones, hyperuricemia, and frequent attacks tophi
Probenecid
57
What are the acute gout tx in order?
1. NSAIDs- naproxenand indomethacin 2. colchicine 3. glucocorticoids (intra-articular if few joints)
58
What is required for the prevention of recurrent gout?
urate lowering!!! | through life style changes or drugs( allopurinol, febuxostat, probenecid)
59
How is acute gout treated?
anti-infla

NMSP (14 decks)

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