Osteoporosis and Gout Drugs Flashcards
Alendronate
Bisphosphonate
Pyrophosphate analog => inhibits osteoclast
Alendronate treats
osteoporosis in post-menopausal, male, glucocorticoid-induced, Paget, malignancy hypercalcemia
Alendronate form
IV
Alendronate side effect
Esophagitis, osteonecrosis of jaw, atypical femur fractures, afib
Raloxifene
“Ralax that estrogen”
SERM
Raloxifene MOA
Estrogen blocked in breast and uterus, activating bones to prevent/treat post-menopausal osteoporosis
Raloxifene side effects
DVT, PE, stroke, pregnancy risk X, hot flashes
Raloxifene form
Oral, excreted in poop
Denosumab
“The den is RANK”
RANKL inhibitor
Denosumab MOA
“Dense those bones”
Increases bone density and strength; decreases formation of osteoclasts
Denosumab treats
post-menopausal women w/ high fracture risk and prevents skeletal events w/ bone metastases
Need to take Ca2+ and vitamin D to prevent hypocalcemia
Denosumab forms
Inject every 6 months SubQ
Bone mets req. 120 mg injected subQ every 4 weeks
Denosumab side effect
Jaw osteonecrosis, MSK pain, hypercholestermia, UTI
Teriparatide
PTH
Teriparatide MOA
Truncated version of endogenous 1-84 PTH made by recombinant DNA retaining full activity of PTH
Teriparatide is special because
“Terry builds bones”
this is only drug for osteoporosis that increases bone formation
Teriparatide administration
Pulsed therapy
NOT continuous
Zolendronic acid
“Zoe is a bish”
Bisphosphonate, IV once per year
Avoids GI issues, associated with osteonecrosis of jaw, dose-dependent kidney damage
Treatment of osteoporosis in men
- Bisphosphonates
- Denosumab
Need testosterone replacement
Drugs for hypercalcemia
- Furosemide
- Glucocorticoids
- Gallium nitrate (nephrotoxic)
- Bisphosphonates
- Inorganic phosphates (IV)
- Edetate disodium (Ca2+ chelator)
Cinacalcet
Calcimimetic drug
Cinacalcet MOA
binds CaSR to increase sensitivity to extracellular Ca2+, decreases PTH
Cinacalcet treats
primary hyperparathyroidism, secondary hyperparathyroidism due to CKD
How to manage osteoarthritis
NSAIDs
Osteomyelitis treatment
Clindamycin, rifampin, TMP-SMX, fluoroquinolone
Gout treatment
NSAIDs: naproxen, indomethacin, celexocib
Effective if initiated <48 hours
Gout glucocorticoid treatment
Betamethasone, methylprednisone, triamcinolone
Colchicine
“Cold stop the traffic”
Microtubule formation disrupter
diffuses into cells to bind tubulin and block microtubule formation => stops migration
Colchicine treats gout for patients who are intolerant to
NSAIDs
Colchicine warning
Do not give to renal, hepatic, GI pts
Febuxostat
Xanathine oxidase inhibitor
Xanathine oxidase inhibitor treats
recurrent gout, cancer chemo induced hyperuricemia
Side effects of XO inhibitors
SJS
increased risk for HLA-B*5801 positive pts like chinese/thai
Febuxostat is used for
pts who cannot tolerate Allopurinol
non-competitive inhibitor of xanthine oxidase
Pegloticase and rasburicase
Recombinant uricase
Pegloticase and rasburicase MOA
recombinant mammalian uricase - attached to methoxypolyethylene glycol
converts uric acid to far more soluble allantoin
treats chronic gout
Rasburicase special because
Non-pegylated recombinant uricase that prevents acute uric acid nephropathy due to tumor lysis syndrome in patients w/ high risk lymphoma or leukemia
Recombinant uricase forms
IV every 2 weeks
Probenecid and sulfinpyrazone
uricosurics
Probenecid
“I am pro-bending the kidney”
organic acid blocking urate reabsorption in renal tubule
What increases urate reabsorption for probenacid?
Low dose ASA
Probenecid MOA
increases urate fractional excretion
Treats underexcretion of urate w/ GFR > 60 mL/min
No stones to decrease pool of urate
Probenecid treats
Hyperurecemia and tophi attacks
Probenecid side effects
gouty arthritis flare, kidney stones, sulfa drug
