Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

825 > Osteoporosis Pharmacology > Flashcards

Osteoporosis Pharmacology Flashcards

1
Q

Regulation of Plasma Calcium Levels

A
  • Coordination of multiple organs

- Kidney, bone, parathyroid glands, GI tract, thyroid glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Plasma Calcium Levels

A
  • Maintained at ~10 ng/dL

- Calcitonin and PTH utilized to help maintain these levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PTH stimulates…

A
  • Ca+ release from bone
  • Ca+ reuptake from urine
  • Ca+ upake from intestine via active Bitamin D3 (1,25 dihydroxy-vitamin D3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Calcitonin inhibits

A
  • Ca+ release from bone

- Ca+ reuptake from urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Active D3

A
  • multi-step generation process
  • Can be synthesized from cholesterol after its exposure to sunlight or from dietary intake of D3 (fish, meat, supplements)
  • Liver and kidney utilized in conversion to active form
  • 25-hydroxy-vitamin D3 is what is tested to monitor levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bone Remodeling

A
  • Continuous process with synthesis by osteoblasts and destruction by osteoclasts
  • Gives bone mature structure and maintains normal blood calcium levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Osteoclasts

A
  • Resorbs bones
  • Creates acidic micro-environment
  • Contains lysosomal enzymes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acidic Micro-environment

A
  • Sealing zone
  • Ruffled border (increase SA)
  • Vacuolar-type hydrogen pump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Osteoporosis

A
  • Clasts > blasts
  • Loss of bone mineral density (BMD)
  • Increased risk of fragility fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk Factors for Osteoporosis

A
  • Older age
  • Female
  • Small stature
  • Low sex hormones - menopause
  • Chronic glucocorticoid therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Osteoporosis Lifestyle Risks

A
  • Smoking
  • Alcohol abuse
  • Inadequate physical activity
  • Diet (low Ca+, vitamin D intake)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Osteoporosis most common in…

A
  • Postmenopausal women

- Low estrogen levels and increased osteoclast activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Estrogen is

A

Protective!!

Deficiency:

  • Increased bone remodeling
  • Increased bone resportion - increased osteoclast differentiation
  • Decreased bone formation - increased apoptosis of osteoblasts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Glucocorticoids

A
  • Decreased osteoblast numbers and survivability

- Risk of fragility fractures depends on steroid dose and duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diseases treated with Glucocorticoids

A

Autoimmune Diseases

  • Rheumatoid arthritis
  • Lupus
  • IBS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bisphosphonates (BP)

A
  • Binds to hydroxyapatite (bone matrix)
  • Release during resportion
  • Absorbed into osteoclasts and inhibits their activity and survivability
  • First line therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

BP Mechanisms

A
  • Inhibit farnesyl pyrophosphate synthade
  • Inhibit transfer of prenyl group to protein
  • Disrupts osteoclast ruffle border
  • Inhibits generation of H+
  • Disrupts sealing zone
18
Q

BP Examples

A
  • Alendronate (Fosamax) - oral, once a week
  • Ibandronate (Boniva) - oral, once a month
  • Risedronate (Actonel) - oral, once a day/week/or month
  • Zoledronic acid (Reclast) - IV, once every 1-2 years
19
Q

BP PK

A
  • Poorly absorbed orally
  • 70% excreted by kidney
  • 30% binds to bone
  • T1/2 in bone is 10 years
20
Q

BP SE/CI

A
  • Heartburn, esophageal/stomach inflammation
  • Jaw osteonecrosis (rare)
  • Low trauma, atypical femur fractures (rare)
  • CI: GFR < 30 mL/min
21
Q

BP Duration of Therapy

A
  • Low Risk of Fracture: 2-3 years
  • Mild Risk of Fracture: 2-5 years
  • Moderate Risk of Fracture: 3-5 years
  • High Risk of Fracture: Up to 10 years
  • *Follow-up with a drug holiday**
22
Q

Low Risk of Fracture

A
  • BMD < -2.0
  • No risk factors
  • Low BTMs
23
Q

Mild Risk of Fracture

A
  • BMD >= -2.0 but =< 2.5
  • Stable over the treatment
  • Family history of hip fracture
24
Q

Moderate Risk of Fracture

A
  • BMD: initially >= -2.5 with improvement but still >= -2.0

- No prior hip or spine fracture

25
Q

High Risk of Fracture

A
  • BMD >= -2.5
  • History of a recent hip or spine fracture
  • Ongoing high-dose glucocorticoid therapy
  • High BTMs
26
Q

Denosumab

A
  • Prolia
  • First line therapy
  • Monoclonal antibody that binds to RANKL
  • Decrease in osteoclast differentiation and survival
  • Approved for postmenopausal women with high risk of fracture
27
Q

Prolia PK

A
  • SQ injection every 6 mo- 1 year
  • T1/2 - 25 days
  • Ensure adequate Ca+/Vitamin D3 intake
28
Q

Prolia SE

A
  • Joint/muscle pain
  • Low osteonecrosis (rare)
  • Low trauma, atypical femur fractures (rare)
29
Q

Estrogen Therapies for Osteoporosis

A
  • Premarin - conjugated estrogens
  • Raloxifene - SERM
  • Duavee - estrogen + estrogen agonist/antagonist
30
Q

Estrogen Therapy MoA

A
  • Increase OPG
  • Inhibit RANK
  • Inhibit osteoclasts
31
Q

Premarin Limitations

A
  • Increased risk of MI, stroke
  • Increased risk of breast cancer
  • Increased risk of DVT
32
Q

Raloxifene Limitations

A
  • Fewer SE

- Can worsen VM symptoms

33
Q

Calcitonin MoA

A
  • Inhibits osteoclast activity

- Directly binds to receptors

34
Q

Calcitonin Limitations

A

-Poor efficacy compared to BP

35
Q

PTH Analogs

A
  • Teriparatide

- Abaloparatide

36
Q

PTH Analog MoA

A
  • Transient stimulation of osteoblasts

- Stimulation of bone formation

37
Q

PTH Analog Limitations

A
  • Expensive

- $7 K annually

38
Q

PTH

A
  • initiates bone remodeling
  • Release Ca+ from bone through induction of RANKL
  • Stimulate bone formation when given as intermittent, non-sustained preparations
39
Q

PTH Analog PK

A
  • Route: SQ
  • Frequency: daily
  • T1/2 - 60 minutes
40
Q

PTH Analog SE

A
  • Nausea
  • Leg cramps
  • Headaches
  • Dizziness
41
Q

PTH Analog Precautions

A
  • Patients at risk of osteosarcoma

- Limit use to no more than 2 years

825 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions