Pharm of Osteoporosis and Gout

Question 1

Function of Calcitonin

Answer 1

Increased bone deposition
decreased intestinal Ca2+ absorption
Decrease renal Ca2+ resabsorption

Question 2

What are some other drugs that increase osteoporosis risk?

Answer 2

Anticoags
Barbiturates
Glucocorticoids
PPI's 
SSRI's

Question 3

Function of PTH

Answer 3

Increase bone resorption
increase intestinal Ca absorption
increase renal Ca reabsorption and conversion 25-OHD to 1,25-OHD (active form of Vit D)

Question 4

Calcitonin-Salmon

Answer 4

longer 1/2 life than human calcitonin

Used for established Osteoporosis

Question 5

Bisphosphonates

Answer 5

MOA- analogous to pyrophosphate in bone material, decreases bone resorption by decreasing osteoclast number and activity

1st line drug for osteoporosis, glucocorticoid-induced osteoporosis, Paget Disease, and Hypercalcemia of Malignancy

Question 6

Examples of Bisphosphonates

Answer 6

Alendronate
Risedronate
Ibandronate
Tiludronate

Question 7

2 Primary side effects of Bisphosphonates

Answer 7

Osteonecrosis of the Jaw

Atypical Femur Fracture

Question 8

Raloxifene

Answer 8

Selective Estrogen Receptor Modulator
MOA: Blocks breast/uterus estrogen effects, enhances bone “toughness” by acting as an estrogen agonist in bone

Use for: Post-menopausal osteoporosis

SE: DVT, PE, Stroke

Question 9

Teriparatide

Answer 9

MOA: PTH analog, Pulsed therapy INCREASES bone formation via osteoclast/osteoblast activation

Question 10

Denosumab

Answer 10

MOA: RANKL inhibitor, decreased osteoclast formation
Taken with Vit D

SE: delays fracture healing, risk of new fractures, ONJ

Question 11

What is released by osteoblasts to bind RANKL and inhibit it?

Answer 11

Osteoprotegrin (OPG)

Question 12

Cinacalet

Answer 12

“Calcimimetic”

Decreased PTH secretion in Primary/secondary Hyperparathyroidism

Question 13

Osteoarthritis symptoms

Answer 13

Pain worse with movement
Stiffness in inactivity
hypoflexibility
Bone spurs (break off and form “joint mice” in synovial fluid)

Question 14

Pain management in OA

Answer 14

NSAIDs/Acetaminophen
Duloxetine (SNRI)
Avoid opioids unless in the short term

Question 15

What is osteomyelitis?

Answer 15

Infection of bone most commonly Staph Aureus.
Canaliculi of bone is big enough for bacteria but not for WBCs.
May compromise blood flow

Question 16

Gout

Answer 16

Hyperuricemia caused mostly by under secretion of uric acid formed from the breakdown of Purines.
Crystal deposition in joints that is painful

Question 17

A defect in HGPRT, which converts hypoxanthine to AMP and guanine to GMP, results in what disorder?

Answer 17

Lesch-Nyhan Syndrome- severe gout, mental problems, and self mutilation

Question 18

Management of Gout

Answer 18

1. NSAID
2. Colchicine if NSAID contraindicated
3. > 2 joints= Glucocorticoids

Question 19

Colchicine

Answer 19

Binds tubulin and blocks formation of microtubules.
Inhibits leukocyte migration/phagocytosis

SE: GI, Diarrhea, Vomiting

Question 20

Allopurinol

Answer 20

Xanthine Oxidase Inhibitor used for interval gout

SE: Steven-Johnson Syndrome

Question 21

Febuxostat

Answer 21

Xanthine Oxidase Inhibitor used when people can’t tolerate Allopurinol

Expensive*

Question 22

Pegloticase

Answer 22

converts uric acid to allantoin

VERY expensive

Question 23

Probenecid

Sulfinpyrazone

Answer 23

Blocks urate réabsorption in kidneys to increase excretion.