Osteoporosis and Gout Drugs

Question 1

Alendronate

Answer 1

Bisphosphonate

Pyrophosphate analog => inhibits osteoclast

Question 2

Alendronate treats

Answer 2

osteoporosis in post-menopausal, male, glucocorticoid-induced, Paget, malignancy hypercalcemia

Question 3

Alendronate form

Answer 3

IV

Question 4

Alendronate side effect

Answer 4

Esophagitis, osteonecrosis of jaw, atypical femur fractures, afib

Question 5

Raloxifene

“Ralax that estrogen”

Answer 5

SERM

Question 6

Raloxifene MOA

Answer 6

Estrogen blocked in breast and uterus, activating bones to prevent/treat post-menopausal osteoporosis

Question 7

Raloxifene side effects

Answer 7

DVT, PE, stroke, pregnancy risk X, hot flashes

Question 8

Raloxifene form

Answer 8

Oral, excreted in poop

Question 9

Denosumab

“The den is RANK”

Answer 9

RANKL inhibitor

Question 10

Denosumab MOA

“Dense those bones”

Answer 10

Increases bone density and strength; decreases formation of osteoclasts

Question 11

Denosumab treats

Answer 11

post-menopausal women w/ high fracture risk and prevents skeletal events w/ bone metastases

Need to take Ca2+ and vitamin D to prevent hypocalcemia

Question 12

Denosumab forms

Answer 12

Inject every 6 months SubQ

Bone mets req. 120 mg injected subQ every 4 weeks

Question 13

Denosumab side effect

Answer 13

Jaw osteonecrosis, MSK pain, hypercholestermia, UTI

Question 14

Teriparatide

Answer 14

PTH

Question 15

Teriparatide MOA

Answer 15

Truncated version of endogenous 1-84 PTH made by recombinant DNA retaining full activity of PTH

Question 16

Teriparatide is special because

“Terry builds bones”

Answer 16

this is only drug for osteoporosis that increases bone formation

Question 17

Teriparatide administration

Answer 17

Pulsed therapy

NOT continuous

Question 18

Zolendronic acid

“Zoe is a bish”

Answer 18

Bisphosphonate, IV once per year

Avoids GI issues, associated with osteonecrosis of jaw, dose-dependent kidney damage

Question 19

Treatment of osteoporosis in men

Answer 19

1. Bisphosphonates
2. Denosumab

Need testosterone replacement

Question 20

Drugs for hypercalcemia

Answer 20

1. Furosemide
2. Glucocorticoids
3. Gallium nitrate (nephrotoxic)
4. Bisphosphonates
5. Inorganic phosphates (IV)
6. Edetate disodium (Ca2+ chelator)

Question 21

Cinacalcet

Answer 21

Calcimimetic drug

Question 22

Cinacalcet MOA

Answer 22

binds CaSR to increase sensitivity to extracellular Ca2+, decreases PTH

Question 23

Cinacalcet treats

Answer 23

primary hyperparathyroidism, secondary hyperparathyroidism due to CKD

Question 24

How to manage osteoarthritis

Answer 24

NSAIDs

Question 25

Osteomyelitis treatment

Answer 25

Clindamycin, rifampin, TMP-SMX, fluoroquinolone

Question 26

Gout treatment

Answer 26

NSAIDs: naproxen, indomethacin, celexocib Effective if initiated <48 hours

Question 27

Gout glucocorticoid treatment

Answer 27

Betamethasone, methylprednisone, triamcinolone

Question 28

Colchicine "Cold stop the traffic"

Answer 28

Microtubule formation disrupter diffuses into cells to bind tubulin and block microtubule formation => stops migration

Question 29

Colchicine treats gout for patients who are intolerant to

Answer 29

NSAIDs

Question 30

Colchicine warning

Answer 30

Do not give to renal, hepatic, GI pts

Question 31

Febuxostat

Answer 31

Xanathine oxidase inhibitor

Question 32

Xanathine oxidase inhibitor treats

Answer 32

recurrent gout, cancer chemo induced hyperuricemia

Question 33

Side effects of XO inhibitors

Answer 33

SJS increased risk for HLA-B*5801 positive pts like chinese/thai

Question 34

Febuxostat is used for

Answer 34

pts who cannot tolerate Allopurinol non-competitive inhibitor of xanthine oxidase

Question 35

Pegloticase and rasburicase

Answer 35

Recombinant uricase

Question 36

Pegloticase and rasburicase MOA

Answer 36

recombinant mammalian uricase - attached to methoxypolyethylene glycol converts uric acid to far more soluble allantoin treats chronic gout

Question 37

Rasburicase special because

Answer 37

Non-pegylated recombinant uricase that prevents acute uric acid nephropathy due to tumor lysis syndrome in patients w/ high risk lymphoma or leukemia

Question 38

Recombinant uricase forms

Answer 38

IV every 2 weeks

Question 39

Probenecid and sulfinpyrazone

Answer 39

uricosurics

Question 40

Probenecid "I am pro-bending the kidney"

Answer 40

organic acid blocking urate reabsorption in renal tubule

Question 41

What increases urate reabsorption for probenacid?

Answer 41

Low dose ASA

Question 42

Probenecid MOA

Answer 42

increases urate fractional excretion Treats underexcretion of urate w/ GFR > 60 mL/min No stones to decrease pool of urate

Question 43

Probenecid treats

Answer 43

Hyperurecemia and tophi attacks

Question 44

Probenecid side effects

Answer 44

gouty arthritis flare, kidney stones, sulfa drug