Osteoporosis and Paget's Dz

Question 1

Parathyroid hormone

Answer 1

• increase bone turnover.
• low and intermetent dosing increaass bone formation w/o resorption
• Regulates calcium & phosphate using bone and kidney
• calcium from the bone as a reservoir to keep the calcium in the blood at a stable level
• increases Ca uptake in small intesting
• increase reabsorption of Ca from pee

Question 2

Vit. D

Answer 2

• fat soluble
• phormone- needs to be changed by body to work
  stim. intestinal Ca nad phosphate transport and bone resorption

Question 3

High continuous exposure of PTH and Vit D

Answer 3

decrease bone density

Question 4

Low intermittend exposure of PTH and Vit D

Answer 4

increase bone density

Question 5

Vitamin D

Answer 5

Increased ca and phosphate in blood, may increase bone formation

Question 6

PTH-

Answer 6

increase Ca in blood and decreases phsophate in blood

Question 7

Calcitonin

Answer 7

-increase blood Ca stimulate calcitonin release
-secreted by thyroid
-decrease osteoclast activity
-lower serum Ca and phosphate in serum by blockin resoprtion
-decreases osteoclast activity and increase lifespan of osteocblast
-over time formation and resoprtion are reduced
decreasedd phosphate reabsorption

Question 8

Steroid

Answer 8

• antagonize Vit D
• Stimulate Renal Ca excretion
• blocks bone formation
• reverses hypercalcimia associated w/ lymphomas

Question 9

ESTROGEN

Answer 9

• MAINTAIN BONE MASS

- decrease resoprtion by PTH

Question 10

estrogen drug

Answer 10

Raloxifene

Question 11

Use of estrogen

Answer 11

prevent postmenopausal osteoporosis

Question 12

Bisphosphonates

Answer 12

-dronate
-treat osteoperosis
ibandronate- only 1 not first line

Question 13

MOA Bisphosphonates

Answer 13

-inhibit bone resorption by messing with osteoclast precursor, increases mineral density

Question 14

Pharmokinetics of bisphosphonates

Answer 14

small % stay in bone for 10 years

Question 15

5 uses of bisphosponates

Answer 15

1) prevent/ treat osteoperosis
2) in crease BMD in men
3) steroid induced osteoporosis
4) hypercalcemia due to CA
5) paget Dz

Question 16

ADR Bisphosphonates

Answer 16

GI minor studd
OSTEONECROSIS OF JAW- mostly with IV use
ESOPHAGEAL CA

Question 17

How to take bisphosphonates

Answer 17

with full glass of water and remaining upright for 30 – 60 minutes, empty stomach

Question 18

PTH RX name

Answer 18

Teriparatide

Question 19

What is the only anabolic therapy for bone

Answer 19

teriparatide- increase bone mass, strength, and density, other meds just prevent resorption

Question 20

MOA of Teriparatide

Answer 20

-stimulates osteoblasts
increases intestinal CA absorption
increases rneal tubular reabsorption of Ca nad phosphate

Question 21

Contraindication of Teriparatide

Answer 21

• dont use if at risk for osteosarcoma
• hypercalcemia
• bone metastases

Question 22

clinical use of Teriparatide

Answer 22

• Reserved for treating women at high risk of fracture, including those with very low BMD and a previous vertebral fracture
• Only give for 2 years (during a patients life time) then switch to Bisphosphonates
• IF GIVEN MORE= BONE CA

Question 23

SERM

Answer 23

selective estrogen receptor modulators

Question 24

SERM MOA

Answer 24

reduction in resorption of bone, decrease in overall bone turnover

Question 25

Raloxifene

Answer 25

SERM, reduces vertebral fractures

Question 26

RALOXIFENE ADRS

Answer 26

hot flashes, clots ( first 4 months)

Question 27

contraindications of raloxifene

Answer 27

pregnancy, nursing, pediatrics, VTE

Question 28

Calcitonin

Answer 28

• inhibits resoprtion
• farmed from salmone
• decreases vertebral fractures of effect on hip

Question 29

Miacalcin

Answer 29

SQ calcitonin

Question 30

Calcium

Answer 30

maintains Ca concentrations

Question 31

Vit D

Answer 31

Maximizes absorption of Ca via intestine

Question 32

Bisphosphonates

Answer 32

drug of choice

Question 33

Teriparatide

Answer 33

super expensive

Question 34

Calcitonin

Answer 34

unimpressive effects

Question 35

Male osteoporosis

Answer 35

-treat with bisphosphonates, if testosterone is low give testosterone

Question 36

Paget’s Dz

Answer 36

-Resorb bone and then lay down, new poorly organized bone.

-

Question 37

treatment goal of pagets

Answer 37

reduce bone pain & stabilize or prevent other problems

Question 38

drugs used to treat pagets

Answer 38

calcitonin + bisphosphonates, bisphosphonate dosing 4x higher than for osteoporosis