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
efficacy of denosumab and how it is taken
antifracture at all sites vertebral fx decreased by 70% subQ q 6 months
26
denosumab MOA
monoclonal antibody to RANK-L (functions like OPG)
27
what is the sole SE for denosumab?
increased risk of infections bc RANK-L has signaling role in immune cells
28
which class is the main stay treatment for osteoporosis?
biphosphonates
29
which osteoporosis treatment is an anabolic?
Teriparatide
30
which medication shows the most significant gains in BMD
teriparatide
31
efficacy of teriparatide
significant gains in BMD decrease vertebral fx by 65% decrease nonvertebral fx by 50%
32
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
33
if stopping teriparatide in a patient, what must you do?
follow it with an anti-resorptive to maintain the gains!!
34
what are the three SE of teriparatide?
nausea dizziness weakness
35
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
36
what is thiazide diuretics used to treat?
hypercalciuria
37
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?
38
how does furosemide work?
blocks Na/K/Cl transport to block Ca reabsorption