[PHARMA] BONE DISORDERS

Question 1

1st line of treatment in osteoporosis

Answer 1

Bisphosphonates

Question 2

bisphosphonates mechanism of action

Answer 2

↑osteoclastic apoptosis
(-) cholesterol metabolism
=↑ in bone mass & ↓ fractures risk

Question 3

discontinuation of bisphosphonates leads to

Answer 3

gradual loss of effect

Question 4

bisphosphonates uses (3)

Answer 4

1-hypercalcemia associated w/ malignancy
2-osteoporosis
3- Paget’s disease (↓bone turnover)

Question 5

used in paget’s disease

Answer 5

bisphosphonates

Question 6

bisphosphonates adverse effects (2)

Answer 6

1-Gastric & esophageal irritation
2-osteonecrosis of jaw

Question 7

bisphosphonates CI (3)

Answer 7

1-Peptic ulcer
2-esophageal motility disorders
3-renal impairement

Question 8

RANKL

Answer 8

receptor activator of nuclear Kappa B-ligand

Question 9

monoclonal antibody

Answer 9

denosumab

Question 10

denosumab mechanism of action

Answer 10

(-) RANKL
(-) osteoclasts formation
(-) resorption

Question 11

denosumab characteristics

Answer 11

monoclonal antibody
SC
given every 6 months

Question 12

used in patients intolerant to other drugs

Answer 12

denosumab
Teriparatide

Question 13

denosumab uses (2)

Answer 13

1-Pregnant women (@ risk of fractures)
2-patients intolerant to other drugs

Question 14

denosumab adverse effects (5)

Answer 14

1-hypocalcemia
2-osteonecrosis of the jaw
3-atypical features
4- ↑ risk of infections
5-dermatological reactions`

Question 15

raloxifene characteristics

Answer 15

SERM
estrogen like on bone (↓resorption)
antiestrogenic on breast & uterus (no cancer)

Question 16

raloxifene adverse effects (5)

Answer 16

1- thrombophlebitis
2-thromboembolism
3-hot flashes
4- sweating
5- leg cramps

Question 17

raloxifene contraindications

Answer 17

venous thromboembolism

Question 18

tissue specific estrogen complex (TSEC)

Answer 18

Bazedoxifene + estrogen

Question 19

TSEC uses (2)

Answer 19

1-osteoporosis
2-menopausal vasomotor symptoms

Question 20

TSEC mechanism of action

Answer 20

SERM
estrogen like on bone (↓ resorption & ↑density)
estrogen like on lipid (↓ LDL)
antiestrogenic on uterus & breast (prevent endometrial hyperplasia)

Question 21

teriparatide mechanism of action

Answer 21

(+) osteoblasts
↑bone formation

Question 22

Teriparatide uses

Answer 22

osteoporosis in high risk patients/have or intolerant to other therapies

Question 23

calcimimetic drugs

Answer 23

Strontium
Cinacalcet

Question 24

stronium mechanism of action

Answer 24

Calcimimetic
(+) Ca++ sensing receptors
(+) osteoblastic differentiation
(-)osteoclasts
= ↑ formation & ↓ resorption

Question 25

strontium uses

Answer 25

severe osteoporosis in older women

Question 26

strontium side effects (2)

Answer 26

1-myocardial infarction 2-allergic reactions

Question 27

strontium CI

Answer 27

IHD

Question 28

cinacalcet mechanism of action

Answer 28

Calcimimetic (+) Ca++ sensing receptors ↓↓ PTH ↓Ca

Question 29

cinacalcet uses

Answer 29

hyperparathyroidism

Question 30

Vitamin D mechanism of action

Answer 30

enters cell (+) mRNA synthesis (+) Ca++ - PO4 carrier protein SI: ↑ Ca2+ & PO4 reabsorption Bone: ↑ resorption (excess in norma) & ↑ deposition (in rickets) Kidney: ↑ PCT Ca++ & PO4 reabsorption

Question 31

Vitamin D uses

Answer 31

rickets osteomalacia osteoporosis hypoparathyroidism

Question 32

used in hypoparathyroidism

Answer 32

Vitamin D

Question 33

used in hyperparathyroidism

Answer 33

cinacalcet

Question 34

drugs used in renal rickets & RF

Answer 34

alfacalcidiol & calcitriol