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NMSP Exam II > Osteoporosis and Gout Drugs (Wolff) > Flashcards

Osteoporosis and Gout Drugs (Wolff) Flashcards

1
Q

What are the category of drugs used to treat osteoporosis?

A

Calcium salts
Vitamin D
Calcitonin
PTH
Bisphonates
SERMS
RANKL inhibitor

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2
Q

What are the two forms of Vitamin D?

A

ergocalciferol (D2) - plants
cholecalciferol (D3) - sunlight

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3
Q

What is the calcitonin agent used to treat osteoporosis?

A

calcitonin-salmon

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4
Q

What is the parathyroid hormone analog used to treat osteoporosis?

A

teriparatide

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5
Q

What are the bisphosphonates used to treat osteoporosis?

A

alendronate and other “drenate’s”
zoledronic acid (IV once a year) - avoids GI probs (esophagitis)

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6
Q

What is the one SERM agent used to treat osteoporosis?

A

raloxifene

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7
Q

What is the one RANKL inhibitor used to treat osteoporosis?

A

denosumab

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8
Q

Calcium salts in the treatment of osteoporosis?

A

mild hypocalcemia (oral calcium salts)
severe hypocalcemia (parenteral calcium salts)
toxicity - constipation, lethargy and kidney stones

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9
Q

Too much calcium intake via calcium salt treatment can result in what side effects?

A

constipation, lethargy and kidney stones

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10
Q

ergocalciferol

A

Vitamin D2 - found in plants

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11
Q

cholecalciferol

A

Vitamin D3 - sunlight

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12
Q

calcitonin-salmon

A

calcitonin agent used to treat established osteoporosis (NOT PREVENTION); longer half life than human calcitonin; intranasal spray; very safe

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13
Q

alendronate

A

bisphosphonates used to treat osteoporosis; DRUG OF CHOICE; inhibits bone resorption; can cause esophagitis (prevent by waiting 30 mins before any liquids or food); can cause osteonecrosis of the jaw and atypical femur fractures

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14
Q

What are some side effects of alendronate?

A

esophagitis (prevent by waiting 30 mins before any liquids or food); can cause osteonecrosis of the jaw and atypical femur fractures

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15
Q

What is the drug of choice for osteoporosis?

A

alendronate; inhibits bone resorption

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16
Q
A

osteonecrosis of the jaw; commonly caused by bisphosphonates (alendronate) used to treat osteoporosis

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17
Q
A

atypical femur fracture; commonly caused by bisphosphonates (alendronate) used to treat osteoporosis

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18
Q

raloxifene

A

SERM; blocks estrogen receptors in the breast and uterus but agonist to receptors in the bone; also reduces the risk of estrogen dependent breast cancer; risk for DVT, PE and stroke; contraindicated in pregnancy (fetal death)

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19
Q

Which drug used to osteoporosis also has some benefit to reduce the risk of developing estrogen dependent breast cancer?

A

raloxifene; SERM; blocks estrogen receptors in the breast and uterus but agonist to receptors in the bone

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20
Q

teriparatide

A

truncated parathyroid hormone analog used to treat osteoporosis; ONLY drug for osteoporosis that increases bone formation; given in pulsed therapy (continuously given will cause osteoclast to predominate = worsen OA); add once daily and generally well tolerated

21
Q

What is the ONLY drug for osteoporosis that increases bone formation?

A

teriparatide; truncated parathyroid hormone analog

22
Q

How is teriparatide administered and why?

A

given in pulsed therapy (continuously given will cause osteoclast to predominate = worsen OA)

23
Q

denosumab

A

monoclonal antibody RANKL inhibitor used to treat osteoporosis; decreases the formation of functional osteoclasts; should be taken with calcium and Vitamin D; injected every 6 months; found to delay fracture healing and increases risk of new fractures and osteonecrosis of the jaw

24
Q

What does RANKL stand for?

A

Receptor activator of nuclear factor kappaB ligand (RANKL)

25
Q

What are the adverse effects of denosumab?

A

delay fracture healing and increases risk of new fractures and osteonecrosis of the jaw

26
Q

Treatment for osteoporosis in men?

A

testosterone replacement (hypogonadism)
glucocorticoids and androgen-deprivation therapy (decrease prostate cancer risk)
bisphophonates are the agent of choice

27
Q

Cinacalcet

A

a calcimimetic drugs used to primary hyperparathyroidism and secondary hyperparathyroidism due to CKD (unable to eliminate phosphate = hypocalcemia = increased PTH = bone resorption); most common side effect is n/v and diarrhea

28
Q

What is the drug used to treat secondary hyperparathyroidism due to CKD?

A

Cinacalcet; a calcimimetic drugs; (unable to eliminate phosphate = hypocalcemia = increased PTH = bone resorption); most common side effect is n/v and diarrhea

29
Q

What are the category of drugs used to treat gout?

A

NSAIDs
Glucocorticoids
Xanthine oxidase inhibitors
Recombinant uricase
Microtubule formation disrupter
Uricosurics

30
Q

What are the 3 NSAIDs used to treat gout?

A

naproxen (non-selective)
indomethacin (COX 1 > COX 2)
celecoxib (COX 2)

31
Q

What are the 3 glucocorticoids used to treat gout?

A

betamethasone
methylprednisone
triamcinolone

32
Q

What is the one microtubule formation disrupter used to treat gout?

A

colchicine

33
Q

What are the two xanthine oxidase inhibitors used to treat gout?

A

allopurinol (competitive inhibitor)
febuxostat (non-competitive inhibitor)

34
Q

What are the two recombinant uricase agents used to treat gout?

A

“case”
pegloticase
rasburicase (also used in high-risk lymphoma)

35
Q

What are the two uricosuric agents used to treat gout?

A

probenecid
sulfinpyrazone

36
Q

How does alcohol affect gout?

A

alcohol increases purine synthesis which then increases the rate concentration in the plasma (worsens gout symptoms)

37
Q

Drugs used to increase uric acid renal excretion in recurrent gout?

A

uricosuric agents; probenecid and sulfinpyrazone

38
Q

Drugs used to reduce uric acid renal production in recurrent gout?

A

xanthine oxidase inhibitors (allopurinol and febuxostat)
recombinant uricase agents “case’s” (pegloticase and rasburicase)

39
Q

colchicine

A

microtubule formation disrupter used to treat gout; blocks formation of MTs (inhibits movement of inflammatory cells); contraindicated in renal and hepatic impairments; adverse effects of GI symptoms n/v and diarrhea

40
Q

colchicine is contraindicated in which patients?

A

contraindicated in patients with renal and hepatic impairments

41
Q

allopurinol

A

competitive xanthine oxidase inhibitors used to treat gout; hypoxanthine and xanthine are excreted; toxicity can cause a skin rash, a severe hypersensitivity reaction (fatal); there is increased risk if patient is HLA-B 5801 positive

42
Q

allopurinol toxicities

A

skin rash, a severe hypersensitivity reaction (fatal); there is increased risk if patient is HLA-B 5801 positive

43
Q
A

severe skin rash seen in allopurinol toxicity

44
Q

febuxostat

A

non-competitive xanthine oxidase inhibitor used to treat gout; hypoxanthine and xanthine are excreted; used in those who cannot tolerate allopurinol; generally well tolerated but has been seen to have increased CV death

45
Q

febuxostat toxicity

A

generally well tolerated but has been seen to have increased CV death

46
Q

pegloticase

A

recombinant uricase agents used to treat gout; converts uric acid to allantoin (more soluble); watch for infusion reactions (VERY EXPENSIVE)

47
Q

Which gout drug works by converting uric acid into allantoin (a more soluble compound)?

A

pegloticase; a recombinant uricase agent; (VERY EXPENSIVE)

48
Q

probenecid

A

uricosuric agent used to treat gout; blocks rate of reabsorption more than of rate secretion; CANNOT BE USED IN OVERPRODUCERS!!; GFR > 60 ml/min and no kidney stones; is a sulfa drug (watch for hypersensitivity)

49
Q

probenecid cannot be used in what patient populations?

A

CANNOT BE USED IN OVERPRODUCERS!!; GFR > 60 ml/min and no kidney stone

NMSP Exam II (12 decks)

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