pharm-- osteoporosis & hypercalciuria Flashcards
name the 5 antiresorptive meds
estrogen
SERMs/raloxifene
bisphosphonates
calcitonin
denosumab
how does estrogen help with bone health? (2 ways)
supports bone formation
suppresses bone resorption
effect of estrogen on BMD and fractures
improves BMD
prevents fractures
why is estrogen not used as first line treatment?
has other risks like CHD, stroke, cancer, etc
does estrogen affect RANKL? If so, how?
yes
it inhibits RANKL expression which decreases osteoclast activity
how does Raloxifene improve osteoporosis?
lowers risk of vertebral fracture by 30-50%
Raloxifene MOA
binds to estrogen receptors to make varying effects depending on tissue
what effect does Raloxifene have in bone?
“estrogen-like”
small improvement in bone density to prevent further loss
what effect does Raloxifene have in breast?
anti-estrogen effect
decreases breast cancer risk
what effect does Raloxifene have in endometrium
neutral– no risk of endometrial hyperplasia
ADR of Raloxifene
increased hot flashes
risk of thromboembolic dz
how does biphosphonates help osteoporosis?
small improvement in bone density to prevent further loss
name the 4 meds in the biphosphonates class
Alen-dronate
Rise-dronate
Iban-dronate
Zole-dronic Acid
NOTE: they end with -dronate
what are the 3 shared ADR of biphosphonates?
upper GI sx/heartburn
jaw osteonecrosis
atypical femoral fractures
instruct a patient on how to avoid GI side effects of biphosphonates
take it on an empty stomach and do not lay down for at least 30mins after
which two biphosphonates decreases all types of fractures by 50%? what is the difference between them?
alendronate & risedronate
Alendronate is PO weekly, risedronate is weekly or monthly
which biphosphonate is ONLY effective with vertebral fractures? how often is it taken?
Ibandronate (2nd line)
PO monthly or IV q 3 mo
which biphosphonates has NO GI side effects AND can be taken for prevention of osteoporosis?
zoledronic acid/reclast bc its not PO
efficacy of zoledronic acid and how often its taken
effective at all sites
70% decrease in vertebral fractures
IV yearly for tx, Q 2 yrs for prevention
name the most potent biphosphonate
zoledronic acid
which biphosphonate has the risk of acute phase rxn to the first infusion?
zoledronic acid
which medication is the salmon-derived version used pharmacologically?
caclcitonin
how would calcitonin help with osteoporosis? why isn’t it used much?
some data shows pain control in acute vertebral compression fractures
not used d/t cancer risk
when is calcitonin best used?
in severe hypercalcemia– acutely reduces Ca
efficacy of denosumab and how it is taken
antifracture at all sites
vertebral fx decreased by 70%
subQ q 6 months
denosumab MOA
monoclonal antibody to RANK-L (functions like OPG)
what is the sole SE for denosumab?
increased risk of infections bc RANK-L has signaling role in immune cells
which class is the main stay treatment for osteoporosis?
biphosphonates
which osteoporosis treatment is an anabolic?
Teriparatide
which medication shows the most significant gains in BMD
teriparatide
efficacy of teriparatide
significant gains in BMD
decrease vertebral fx by 65%
decrease nonvertebral fx by 50%
teriparatide MOA
it is a short acting recombinant PTH 1-34
causes pulsatile PTH release to induce osteoblastic > osteoclastic causing net gain in bone density
if stopping teriparatide in a patient, what must you do?
follow it with an anti-resorptive to maintain the gains!!
what are the three SE of teriparatide?
nausea
dizziness
weakness
what is Furosemide (Lasix) used to treat?
severe hypercalciuria
only after normal saline is given to avoid impairing renal function from diuretic induced volume contraction
what is thiazide diuretics used to treat?
hypercalciuria
how do thiazide diuretics work?
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?
how does furosemide work?
blocks Na/K/Cl transport to block Ca reabsorption
