Parathyroid pharm - French Flashcards
Calcium supplements
Calcium carbonate Calcium gluconate Calcium acetate Calcium chloride Calcium citrate Calcium lactate
Cholecalciferol
D3 (C is the 3rd letter of the alphabet).
Ergocalciferol
D2 (E for Even)
(Less efficient at raising stores of 25OH D3, according to French
Calcifediol
25 (OH) D3. Useful in patients with liver disease.
25-Hydroxyvitamin D3
Calcitriol
1,25 (OH)2 D3
Useful in patients with renal disease. Must watch for hypercalcemia.
Dihydrotachysterol
Calcitriol alternative. Requires hydroxylation for the liver (Think of this as 1 (OH) D3)
Biphosphates
Alendronate
Risedronate
Zoledronate
Ibandronate
First line for osteoporosis!
Inhibit resorption of bone by osteoclasts. Mimic phosphate in structure, hide in bone, assasinate osteoclasts.
SERMs (Raloxifene) Mechanism
Induce apoptosis of osteoclasts
3rd line behind estrogen or bisphosphonates
Teriparatide
Parathyroid hormone analog. $$$
Only osteoporosis analog that STIMULATES formation of new bone. All other tx prevent resorption. (High levels of PTH consistently will cause resorption, but intermittent dosing with this will stimulate deposition).
Calcitonin
Expensive. Indicated for treatment only (not prevention) of osteoporosis.
Denosumab
Anti RANKL antibody. sq injection c/6 months
How do estrogens help strengthen bone?
Major effect of estrogens is to decrease number and activity of osteoclasts.
They also increase osteoblast production of osteoprotegrin, a “decoy” RANK receptor that sequesters RANKL
Side effects of bisphosphonates
Heartburn, abdominal pain, diarrhea, ESOPHAGITIS
JAW NECROSIS with high dose (eg chemotherapy)
Hypercalcemia of malignancy should be treated with:
bisphosphonates
