Osteoporosis Pharm Flashcards
What stimulates calcitoin secretion?
Pentagastrin
Calcitonin-Lowers serum calcium and phosphate levels via bone and kidney
Inhibits osteoclasts
CU- Paget’s disease, hypercalcemia, and postmenopausal osteoporosis
Off label for bone pain (cancer), vertebral fracture
What OTC product will inc calcitonin secretion?
Calcitonin-salmon
MOA- reduces the number of osteoclast and prevents resorptive activity of the bone:
reduce bone turnover rate;
osteoblastic activity. ◦
PK-Nasal spray or IV
t1/2- 43min vs natural 10min
What are FDA SE for salmon calcitonin?
potential increase in the risk of cancer.” (0.7% oral to 2.4% nasal)
What are other secondary hormonal regulators for bone health?
Estrogens◦Prevent accelerated bone loss postmenopausal
Glucocorticoids◦Antagonize vitamin D-stimulated intestinal calcium transport, causes osteoporosis,
What non hormonal class drug inhibit osteoclast?
Bisphosphonates alendronate (Fosamax), risedronate (Actonel), Zoledronate (Zometa, Reclast), ibandronate (Boniva)
ADR-Esophagitis. AVOID Barrett’s esophagus
morning on empty stomach with nothing but plain water, remain upright for 30 min.
risk of osteonecrosis of the jaw,
drug holiday” after 5 years
What blocks pTH secretion in parathyroid gland?
Calcimimetics-Cinacalcet (Sensipar)
lowers serum Ca levels◦
txt of secondary hyperparathyroidism (chronic kidney dz,
Hypercalcemia- parathyroid cx
What othe non-hormonal agents help bone growth?
Thiazides-reduce renal calcium excretion◦
Fluoride- stabilizes hydroxyappatite crystal
What drug has high toxicity and last resort for hypercalcemia
Plicamycin
What increase hypercalcemia and need to be careful?
Thiazide diuretics, lithium, volume depletion, inactivty, dietary Ca
What are cause of HYPOcalcemia?
Caused by vit D def, CKD, malabsorption hypoparathyroidism-neuromuscular sxs
What is important when reading Calcium levels?
Always calculate corrected calcium Lab will not provide Steps Check Albumin d/t boud effect to Ca If Albumin lower than 4. EX. albumin=2, Ca 7.5 80% of 2= 1.6 Add to SERum Ca= 1.6+7.5 Corrected Ca= 9.1
what is special about Ca and Phos?
The precipitate thus form a solid in solution. ogeher in solution.
PHostphate binder
Sevelamer- inhibits intestinal absorption
Calcium supp
Lanthanum
How do you treat HYPOPHOsphatemia
Causes-
Hyperparathyroidism, vit D deficiency, parenteral nutrition lacking Phos, ◦Muscle weakness abnormal bone mineralization
Sodium or potassium phosphate salts
what if patient has uncontolled osteoclast activity d/t virus w/ bone pain?
Pagets- mal formed bone after or b4 epipheyeal plates close d/t virus
TX- Bisphosphonates or calcitonin
what if child has uncontolled osteoclast activity w/ bone deformity?
Rickets- children b4 plates close
TX- Calcitrol
