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ENDO 2 > pharm-- osteoporosis & hypercalciuria > Flashcards

pharm-- osteoporosis & hypercalciuria Flashcards

1
Q

name the 5 antiresorptive meds

A

estrogen
SERMs/raloxifene
bisphosphonates
calcitonin
denosumab

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2
Q

how does estrogen help with bone health? (2 ways)

A

supports bone formation
suppresses bone resorption

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3
Q

effect of estrogen on BMD and fractures

A

improves BMD
prevents fractures

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4
Q

why is estrogen not used as first line treatment?

A

has other risks like CHD, stroke, cancer, etc

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5
Q

does estrogen affect RANKL? If so, how?

A

yes
it inhibits RANKL expression which decreases osteoclast activity

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6
Q

how does Raloxifene improve osteoporosis?

A

lowers risk of vertebral fracture by 30-50%

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7
Q

Raloxifene MOA

A

binds to estrogen receptors to make varying effects depending on tissue

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8
Q

what effect does Raloxifene have in bone?

A

“estrogen-like”
small improvement in bone density to prevent further loss

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9
Q

what effect does Raloxifene have in breast?

A

anti-estrogen effect
decreases breast cancer risk

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10
Q

what effect does Raloxifene have in endometrium

A

neutral– no risk of endometrial hyperplasia

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11
Q

ADR of Raloxifene

A

increased hot flashes
risk of thromboembolic dz

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12
Q

how does biphosphonates help osteoporosis?

A

small improvement in bone density to prevent further loss

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13
Q

name the 4 meds in the biphosphonates class

A

Alen-dronate
Rise-dronate
Iban-dronate
Zole-dronic Acid
NOTE: they end with -dronate

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14
Q

what are the 3 shared ADR of biphosphonates?

A

upper GI sx/heartburn
jaw osteonecrosis
atypical femoral fractures

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15
Q

instruct a patient on how to avoid GI side effects of biphosphonates

A

take it on an empty stomach and do not lay down for at least 30mins after

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16
Q

which two biphosphonates decreases all types of fractures by 50%? what is the difference between them?

A

alendronate & risedronate
Alendronate is PO weekly, risedronate is weekly or monthly

17
Q

which biphosphonate is ONLY effective with vertebral fractures? how often is it taken?

A

Ibandronate (2nd line)
PO monthly or IV q 3 mo

18
Q

which biphosphonates has NO GI side effects AND can be taken for prevention of osteoporosis?

A

zoledronic acid/reclast bc its not PO

19
Q

efficacy of zoledronic acid and how often its taken

A

effective at all sites
70% decrease in vertebral fractures
IV yearly for tx, Q 2 yrs for prevention

20
Q

name the most potent biphosphonate

A

zoledronic acid

21
Q

which biphosphonate has the risk of acute phase rxn to the first infusion?

A

zoledronic acid

22
Q

which medication is the salmon-derived version used pharmacologically?

A

caclcitonin

23
Q

how would calcitonin help with osteoporosis? why isn’t it used much?

A

some data shows pain control in acute vertebral compression fractures
not used d/t cancer risk

24
Q

when is calcitonin best used?

A

in severe hypercalcemia– acutely reduces Ca

25
Q

efficacy of denosumab and how it is taken

A

antifracture at all sites
vertebral fx decreased by 70%
subQ q 6 months

26
Q

denosumab MOA

A

monoclonal antibody to RANK-L (functions like OPG)

27
Q

what is the sole SE for denosumab?

A

increased risk of infections bc RANK-L has signaling role in immune cells

28
Q

which class is the main stay treatment for osteoporosis?

A

biphosphonates

29
Q

which osteoporosis treatment is an anabolic?

A

Teriparatide

30
Q

which medication shows the most significant gains in BMD

A

teriparatide

31
Q

efficacy of teriparatide

A

significant gains in BMD
decrease vertebral fx by 65%
decrease nonvertebral fx by 50%

32
Q

teriparatide MOA

A

it is a short acting recombinant PTH 1-34
causes pulsatile PTH release to induce osteoblastic > osteoclastic causing net gain in bone density

33
Q

if stopping teriparatide in a patient, what must you do?

A

follow it with an anti-resorptive to maintain the gains!!

34
Q

what are the three SE of teriparatide?

A

nausea
dizziness
weakness

35
Q

what is Furosemide (Lasix) used to treat?

A

severe hypercalciuria
only after normal saline is given to avoid impairing renal function from diuretic induced volume contraction

36
Q

what is thiazide diuretics used to treat?

A

hypercalciuria

37
Q

how do thiazide diuretics work?

A

block Na-Cl cotransporter to reduce Cl going into cell which opens the voltage gated Ca channels, allowing Ca to be reabsorbed
acts in DCT?

38
Q

how does furosemide work?

A

blocks Na/K/Cl transport to block Ca reabsorption

ENDO 2 (6 decks)

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