Pharm - Osteoporosis Flashcards
what drugs increase risk of osteoporosis
- anticoags
- anticonvulsants
- glucocorticoids
- methotrexate
indications for oral calcium salts
- mild hypocalcemia
- dietary supplements in adolescents, elderly, and post-menopausal women
adverse effects oral calcium salts
hypercalcemia, GI disturbances (constipation), lethargy, renal dysfunction
indications for parenteral calcium salts
rapidly increase calcium levels in patients with severe hypocalcemia
compare ergocalciferol and cholecalciferol
ergocalciferol: vitamin D2, occurs in plants and is used as a prescription drug and to fortify foods
cholecalciferol: vitamin D3, produced when our skin is exposed to sunlight, also available as a prescription drug
MOA and effects calcitonin-salmon
similar in structure and function to human calcitonin (decreases plasma calcium) but has a longer half life and greater potency
decreases plasma calcium, keeps calcium in the bones
inhibits activity of osteoclasts –> decreases bone resorption
also inhibits renal tubular absorption of calcium and increases calcium excretion
indications calcitonin-salmon
tx of establish osteoporosis but NOT prevention
also Paget dz of bone
administration calcitonin-salmon
intranasal spray and as parenteral for SC or IM
adverse effects calcitonin-salmon
- nasal dryness (from the nasal spray)
- inflammatory reaction (from injection site)
MOA and effects of biphosphonates - alendronate
structural analogs of pyrophosphate, a normal constituent of bone
inhibits bone resorption by decreasing # and activity of osteoclasts
indications biphosphonates - alendronate
- postmenopausal osteoporosis
- osteoporosis in men
- glucocorticoid induced osteoporosis
- paget dz of bone
- hypercalcemia of malignancy
administration of biphosphonates - alendronate
PO
other biphosphonates can be given PO or IV
side effects biphosphonates - alendronate
esophagitis***
osteonecrosis of jaw
atypical femur fractures
list the other biphosphonates (other than alendronate) and how they are administered
- risedronate (PO)
- ibandronate (PO, IV)
- tiludronate (PO)
- zolendronic acid (IV)
adverse effects zolendronic acid
osteonecrosis of jaw and dose-dependent kidney damage
sometimes a fib
avoids GI problems
MOA and effects raloxifene
selective estrogen receptor modulator (SERM)
blocks estrogen effects in breast and uterus and is an agonist of estrogen effects in bone
indications raloxifene
prevent and treat postmenopausal osteoporosis
reduces risk of estrogen dependent breast cancer
administration and half life of raloxifene
administration: oral
half life: 28 hours
adverse effects raloxifene
- increases risk of DVT, PE, stroke
- pregnancy category X
- hot flashes
MOA and effects teriparatide (PTH 1-34)
recombinant PTH that retains activity of full length PTH
given as a daily pulsed therapy, allowing osteoblast responses to predominate over osteoclast –> increases bone formation
indications teriparatide (PTH 1-34)
osteoporosis in postmenopausal women
osteoporosis in men
glucocorticoid-induced osteoporosis
administration of teriparatide (PTH 1-34)
20 mcg given once daily by using pre-filled injectors with 28 doses
pulsed therapy
adverse effects teriparatide (PTH 1-34)
nausea, headache, back pain, leg cramps
MOA and effects denosumab
monoclonal antibody that is a RANKL inhibitor
decreases formation and function of osteoclasts –> decreased bone resorption
indications denosumab
treatment of osteoporosis in menopausal women at high risk of fractures
prevention of skeletal related events in pts w/ bone mets form solid tumors
denosumab should be taken with what
calcium and vitamin D to prevent hypocalcemia
administration denosumab
injected every 6 months SQ
adverse effects denosumab
women w/ osteoporosis: back pain, pain in extremities, hypercholesteremia, UTI
bone mets pts: fatigue, hypophosphatemia, nausea
delays fracture healing
osteonecrosis of jaw
skin reactions
compare high and low ratios of RANKL/OPG
high: osteoclasts functioning and bone resorption occurs
low: apoptosis of osteoclasts –> decreased breakdown of bone
what are some specific aspects of osteoporosis treatment in men
testosterone replacement
what are some drugs for hypercalcemia
- furosemid
- glucocorticoids
- biphosphenates
- EDTA
- gallium nitrate
MOA and effects cinacalcet
a “calcimemtic” drug (mimics calcium)
binds to CaSR in parathyroid gland and increases their sensitivity to calcium and decreases PTH secretion
indications cinacalcet
primary and secondary hyperparathyroidism
administration and half life of cinacalcet
administration: oral
half life: 30-40 hrs
adverse effects cinacalet
N/V/D
what is the management for osteoARTHRITIS
- weight management/exercises, braces
- NSAIDs
- duloxetine
- opioid analgesics
what is the treatment for osteomyelitis
antibiotic treatment
- clindamycin
- rifampin
- trimethoprim-sulfamethoxazole (bactrim)
- fluoroquinolone
