Pharm Test 3 Bone Mineral Homeostasis

Question 1

Cholecalciferol
Ergocalciferol
Calcitrol
Doxercalciferol
Paricalcitrol
Calcipotriol

Answer 1

MOA: activates steroid nuclear receptors
Effects: Other vitamin D supplements are used in osteoporosis, Chronic renal failure, nutritional rickets, and liver disease
AE: Hypercalcemia, Hyperphosphatemia
**Calcitrol: 2 hyperparathyroidism in pt’s with chronic renal and liver disease
***Calcipotriol: topical psoriasis treatment
*Defeficiency causes rickets in children:
- Type 1 -> defective 1alpha-hydroxylase
-Type 2 -> defective Vit D receptor
*Osteomalacia in adults

Question 2

Sevelamer

Answer 2

MOA: binds dietary phosphate and prevents it absorption
Effects: Prevents hyperphosphatemia in pt’s with renal failure
*Does not alter Calcium, Aluminum, or bicarb

Question 3

Calcium Salts

Answer 3

Oral: Ca-carbonate, citrate or lactate. IV: Ca gluconate
Effects: IV calcium guconate is used for treatment of hypocalcemic tetany and to counteract overdose of Mg used in preeclampsia
AE: Thrombophlebitis, Necrosis, abscess formation when given IM

Question 4

Calcitonin

Answer 4

Peptide hormone
MOA: antagonizes PTH, inhibiting osteoclastic bone resorption
Effect: Treat osteoporosis
*Salmon calcitonin has a longer t1/2

Question 5

Tamoxifen

Raloxifene

Answer 5

Effective in preventing bone loss
MOA: SERMs tam: agonist on boneand uterus. Ralo: agonist on bone
Effects: HRT in post menopausal women
AE: thrombophlebitis, Migraine, hot flush, increased risk for breast and endometrial cancer

Question 6

Etidronate
Alendronate
Pamidronate
Risedronate

Answer 6

Bisphosphonates, oral bioavailavility decrease osteoclast activity through disruption of the mevalonate pathway
Effects: Tx of osteoporosis, hypercalcemia, Paget’s disease of the bone
AE: Erosive esophagitis, decrease bone cell activity, osteonecrosis of the jaw, fracture
**Chronic etidronate use for >12 months can cause osteomalacia

Question 7

Cinacalcet

Answer 7

MOA: Activates CA receptors in the parathyroid -> decrease PTH synthesis and release
Effects: Treatment of secondary hyperparathyroid in chronic renal disease, Parathyroid CA
AE: Nausea, Hypocalcemia

Question 8

Glucocorticoids

Answer 8

May cause osteoporosis (along with Li, heparin, anastrazole, EtOH)

Question 9

Fluoride

Answer 9

Chronic exposure causes formation of dense brittle bone

Question 10

Gallium nitrate

Answer 10

Inhibits bone resorption in CA related hypercalcemia

Nephrotoxic

Question 11

Plicamycin

Answer 11

Cytotoxic anti-CA drug for hyper calcemia

AE: Thrombocytopenia, Hepatic/renal toxicity

Question 12

thiazides

Answer 12

Increase Calcium reabsorption and reduce risk of Calcium stones

Question 13

Hypercalcemia

Answer 13

Usually asymptomatic, but severe cases present with “stones, bones, groans and psychotic moans”
Treatment: furosemide + saline, bisphosphonates, calcitonin, and parathyroidectomy

Question 14

Teriparatide

Answer 14

Recombinant PTH, useful in the treatment of osteoporosis
MOA: Increase osteoblast and osteoclast activity via RANKL (TNF), binds Gs in the renal tubular cells
Effects: high dose: subperiosteal bone resorption
-Low Dose/intermittent Dose: Increased bone formation
AE: Hypercalcemia and hypercalciuria
**Denosumab: RANKL inhibitor preventing osteoclast differentiaion and function that can also be used to treat osteoporosis (Risk for infection)