Osteoporosis Drugs

Question 1

what are the drug classes for osteoporosis (7)

Answer 1

calcium salts- to combat hypocalcemia

vitamin D

calcitonin

parathyroid hormone

bisphosphonates

selective estrogen receptor modulator

RANKL inhibitor

Question 2

what are the drug classes for Gout

Answer 2

NSAIDS

Glucocorticoids

Microtubule formation disrupter

Xanthine Oxidase inhibitor

Recombinant Uricase

Uricosurics

Question 3

two types of vitamin D

Answer 3

ergocalciferol D2- in plants

cholecalciferol- D3 from out skin upon exposure to sunlight (prescription)

**high in salmon and tuna- fortified foods

Question 4

calcitonin-salmon MOA , effects, Clinical applications

Answer 4

same as normal calcitonin in the body, to stop osteoclastic resobrtion of bone

used for treatment of established osteoporosis not the prevention of it

can be given intranasally

(works but not as well as other agents)

Question 5

what is the suffix most bisphophonates have?

Answer 5

-dronate

Question 6

what is the MOA of bisphophonates? effects, CA, toxcitiy

which bisphophonate has the highest risk of toxicity and is give IV

Answer 6

they are analogs of pyrophosphate (normal consitute of bone)

they are incorporated into the bone and they stop bone resorption by decreasing osteoclastic function/number

first drug of choice in osteoporosis and pagers disease

toxicity: esophagitis, osteonecrosis of the jaw, atypical femur fractures (break in thick cortical bone)

Question 7

taking bisphosphonates stops the healing of ?

Answer 7

micro fractures

Question 8

what is raloxifene

side effects

Answer 8

this is a selective estrogen receptor modulator that blocks estrogen in the breast and uterus and is an agonist at bone to make the bone tough and not crack

it is used to treat and present postmenopasusal osteoporosis

can cause DVT. PE. and stroke, DO NOT USE IN PREGNANCY, and can cause hot flashes

Question 9

what is teriparatide (PTH 1-34)

Answer 9

this is a shortened version of PTH that acts just like it

normally has osteoclastic and osteoblastic actvity

when given in pulses its osteoblastic activity predominants and is the only drug known to increase bone formation!!!!

given as pre filled injections

Question 10

what is denosumab

what does rank L stand for

how often do we give denosumab in osteoporsos

side effects

Answer 10

this is a monoclonal antibody that is a rank L inhibitor used to decrease osteoclastic function

receptor activator of nuclear factor kappa B and ligand

injected every 6 months subcutaneously

delayed fracture healing, osteonecrosis of the jaw

Question 11

MCCs of osteoporosis in men

Answer 11

hypogonadism - low T

glucorticoids

androgen deprivation

***van give T replacement
bisphoponates are the first line
denosumab is 2nd line

Question 12

what drug is approved to treat hypercalcemia of malignancy

Answer 12

bisphophonates

Question 13

what drug can chelate calcium

Answer 13

edetate disodium

Question 14

what is cinacalet

Answer 14

this is a calcimimetic drug that binds to CaSR in the parathyroid gland it increases their sensitivity to extracellular calcium which decreases pTH being released

used in primary hyperparathyroidism or secondary hyperparathyroidism due to CKD

Question 15

treatment for osteoarthritis

Answer 15

NOTHING can stop or prevent!!!- just to treat pain

NSAIDS!
TOPICAL NSAIDS, CAPSACIN
duloxetine
opioid anaglesics
intraarticular (platelet rich plasma)

Question 16

treatment of osteomyelitis

Answer 16

clindamycin, rifampin, TMX-SMP, fluoroquinolone

to treat the bone wound that won’t heal - for 4-6 week course

Question 17

acute gout can be treatment with _ to reduce inflammation

Answer 17

anti-inflammatory drugs

Question 18

recurrences of gout can be treated with

Answer 18

increasing uric acid excretion (uricosuric drugs)

and

reduce uric acid production with xanthin oxidase inhibitors, recominante uricase

or diet

Question 19

general principles for acute gout

Answer 19

NSAIDS

if contraindicated

colchicine

if contrainticated

glucocorticoid

Question 20

NSAIDS for gout

Answer 20

naproxen- non selective

indomethacin -COX1

celecoxib- COX 2

Question 21

colchicine MOA and clinical applications

Answer 21

binds tubulin and blocks microtubule formation which leads to the inhibition and migration of phagocytosis

**used if NSAID contraindication or intolerance in gout

Question 22

xanthine oxidase inhibitors

Answer 22

allopurinol, feboxustat

Question 23

allopurinol MOA

effects

clinical applications

toxicity

Answer 23

competitive inhibitor of xanthine oxidase

blocks conversion to urate- hypoxanthine builds up instead

used in recurrent gout and cancer induces hyperurecemia from tumor lysis syndrome

stevens johnson syndrome with HLA b*5801

-acute gout attack

Question 24

febuxustate

MOA

clinical applications

toxicities (BBW)

Answer 24

non competitive inhibitor of xanthine oxidase leading to hypoxanthine excretion

used in recurrent gout for people who cannot tolerate allopurinol or chemo induced hyperurecemia

BBW: can cause cardiovascular death in those with cardiovascular disease

(EXPENSIVE)

Question 25

what is pegloticase

Answer 25

uricase that is attached to methods polyethylene glycol that converts uric acid to allotoin used in refractory gout can cause infusion reactions

Question 26

what is rasburicase

Answer 26

a uricase that is cont conjugated to polyethylene that converts uric acid to allantoin used to prevent uric acid neuropathy in lymphoma and tumor lysis syndrome

Question 27

what are the probenecid and sulfinpyrazone

Answer 27

organic acids that act in the renal tubule to block urate reabsorption (URAT1) than urate secretion increases the fractional excretion of urate (pee out more) only used in underexcreters of uric acid and the GFR must be greater than 60 with no stones can cause stones and contains sulfur low dose aspirin( increased reabsorption)