Pharm review

Question 1

Osteoporosis drugs

Answer 1

slow resorption, 
Give estrogen
Calcitonin 
Raloxifene- Selective estrogen receptor agonist
Bisphosphonates- 
Denosumab- renal insufficiency

Question 2

Bisphosphonates

Answer 2

Inhibit conversion of mevalonate to farnesyl
Inhibits protein farnesylation
Causes osteoclast apoptosis

Oral- Alendronate, risedronate, ibandronate,–> esophageal irritation, Administration details critical

IV bisphosphonates- Pamidronate, Zoledronic Acid, Ibandronate, acute phase reaction, empty stomach full glass water, no other meds, remain upright for 30 min

Rare adverse effects of both are atypical fractures and osteonecrosis of the jaw

Question 3

Denosumab

Answer 3

Denosumab binds to RANKL

Factors that stimulate bone resoprtion to the osteoblasts

RANKL binds to RANK and stimulates osteoblasts to osteoclasts formation

Denosumab inhibits this whole process

Question 4

Teriparatide

Answer 4

Efficacy relies on short half life, action on osteoblasts is sustained
Action on osteoclasts is transient
Net- increased matrix synthesis

Question 5

Pagets treatment

Answer 5

bisphosphonates are an effective treatment for treatment pagets disease

Alendronate and risedronate are given at high doses for pagets disease than for osteoporosis

Zoledronic acid is more potent than either of these and is used without dose adjustment

Most experts consider zoledronic acid to be the agent of choice

Question 6

Insulin

Answer 6

Regular insulin- human sequnce, the only insulin for IV use

NPH insulin- colloidal suspension (cloudy, human sequence

Short acting insulin analogs- lisproinsulin, insulin, insulin glulisine

Intermediate and long acting insulins: insulin glargine, detemir, degludec

Question 7

insulin side effects

Answer 7

hyoglycemia, insulin allergy, lipoatrophy, lipohypertrophy, insulin edema, weight gain

Question 8

Meglitinides

Answer 8

MOA: non sulfonylurea secretagogues, they close the potassium ATP channel in Beta cells

Repaglinide, nateglinide

Question 9

Metformin a biguanide

Answer 9

increases activity of AMP activated protein kinases, maj effect is to make the liver more sensitive to insulin, decreases hepatic gluconeogenesis,

Most serious side effect is lactic acidosis
First tier med for type 2 diabetic

Question 10

Thiazolinediones the glitazones

Answer 10

Fat and muscle more sensensitive to insulin (PPAR gamma receptors)

Liver toxicitue and weight gain an dfluid retentions

Rosiglitazones- cardiovascular mortality

Pioglitazone- bladder cancer

Question 11

GLp 1 analogs

Answer 11

exenatide, lirglutide, albiglutide, dulaglutide, lixisenatide
Augments insulin secretion, increases beta cell mass, inhibits glucagon secretion, promotes a bit of weight loss
Side effects of nausea, emesis, diarrhea, headaches, delays gastric emptying and pancreatitis

Question 12

DPP4 inhibitors (dipeptidyl protease 4)

Answer 12

Sitagliptin, saxagliptin, linagliptin, alogliptin

Inhibitor of protease that breaks down GLP 1 slows the metabolism of GLP 1

Question 13

SGLT 2 inhibitors

Answer 13

Cause glucose loss (glycosuria

Yeast infection and dehydration, ketoacidosis

Canagliflozins, dapaglifozin, empagliflozin