pharm-- osteoporosis & hypercalciuria

Question 1

name the 5 antiresorptive meds

Answer 1

estrogen
SERMs/raloxifene
bisphosphonates
calcitonin
denosumab

Question 2

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

Answer 2

supports bone formation
suppresses bone resorption

Question 3

effect of estrogen on BMD and fractures

Answer 3

improves BMD
prevents fractures

Question 4

why is estrogen not used as first line treatment?

Answer 4

has other risks like CHD, stroke, cancer, etc

Question 5

does estrogen affect RANKL? If so, how?

Answer 5

yes
it inhibits RANKL expression which decreases osteoclast activity

Question 6

how does Raloxifene improve osteoporosis?

Answer 6

lowers risk of vertebral fracture by 30-50%

Question 7

Raloxifene MOA

Answer 7

binds to estrogen receptors to make varying effects depending on tissue

Question 8

what effect does Raloxifene have in bone?

Answer 8

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

Question 9

what effect does Raloxifene have in breast?

Answer 9

anti-estrogen effect
decreases breast cancer risk

Question 10

what effect does Raloxifene have in endometrium

Answer 10

neutral– no risk of endometrial hyperplasia

Question 11

ADR of Raloxifene

Answer 11

increased hot flashes
risk of thromboembolic dz

Question 12

how does biphosphonates help osteoporosis?

Answer 12

small improvement in bone density to prevent further loss

Question 13

name the 4 meds in the biphosphonates class

Answer 13

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

Question 14

what are the 3 shared ADR of biphosphonates?

Answer 14

upper GI sx/heartburn
jaw osteonecrosis
atypical femoral fractures

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

zoledronic acid/reclast bc its not PO

Question 19

efficacy of zoledronic acid and how often its taken

Answer 19

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

Question 20

name the most potent biphosphonate

Answer 20

zoledronic acid

Question 21

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

Answer 21

zoledronic acid

Question 22

which medication is the salmon-derived version used pharmacologically?

Answer 22

caclcitonin

Question 23

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

Answer 23

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

Question 24

when is calcitonin best used?

Answer 24

in severe hypercalcemia– acutely reduces Ca

Question 25

efficacy of denosumab and how it is taken

Answer 25

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

Question 26

denosumab MOA

Answer 26

monoclonal antibody to RANK-L (functions like OPG)

Question 27

what is the sole SE for denosumab?

Answer 27

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

Question 28

which class is the main stay treatment for osteoporosis?

Answer 28

biphosphonates

Question 29

which osteoporosis treatment is an anabolic?

Answer 29

Teriparatide

Question 30

which medication shows the most significant gains in BMD

Answer 30

teriparatide

Question 31

efficacy of teriparatide

Answer 31

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

Question 32

teriparatide MOA

Answer 32

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

Question 33

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

Answer 33

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

Question 34

what are the three SE of teriparatide?

Answer 34

nausea dizziness weakness

Question 35

what is Furosemide (Lasix) used to treat?

Answer 35

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

Question 36

what is thiazide diuretics used to treat?

Answer 36

hypercalciuria

Question 37

how do thiazide diuretics work?

Answer 37

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?

Question 38

how does furosemide work?

Answer 38

blocks Na/K/Cl transport to block Ca reabsorption