Pharmacology

Question 1

In terms of bisphosphonate:

• What is it an analogue of
• What does it do
• What are some side effects

Answer 1

• Pyrophosphatase
• Used for osteoporosis; Decreases osteoclasts (decrease recruitment and increase apoptosis). This reduces fracture risk.
• osteophagitis

Question 2

How are selective oestrogen receptor modulators used in osteoporosis?
What is one?
Whats a side effect?

Answer 2

Raloxifene
Used as HRT for postmenopausal women with osteoporosis.
It is tissue specific, in bone it promotes life of osteoblasts and osteocytes and decreases osteoclasts to maintain bone mass and slow its decline
Increased DVT and PE

Question 3

What is the action of Denosumab?

Answer 3

• binds and inhibits RANKL
• so decreases osteoblast activation
• associated with increased BD in PM women

Question 4

What does Strontium Ranelate do?

Why is it last line therapy?

Answer 4

Dual agent to increase osteoblasts and decrease osteoclasts.

Increases MI’s though

Question 5

How can PTH used for osteoporosis?

What are some other drugs that can be used to increase bone mass?

Answer 5

At low doses it can favour bone formation

• Ca2+
• Vit D
• Calcitonin

Question 6

How does NSAIDS have an adverse effect on the GIT?

Answer 6

Block PGE2 which
- Increases mucus
- Decreases gastric acid secretion
- Promotes vasodilation and angiogenesis
Therefore more prone to ulcers

Question 7

How does low dose aspirin protect against CV disease?

Answer 7

It is selective for TXA produced from platelets so PGI2 from endothelial cells dominate.
Means less plaque and more vasorelaxtion of coronary vessels

Question 8

What are the renal adverse affects of NSAIDS? what group is this more an issue?

Answer 8

Blocks prostacyclin vasodilation of renal blood flow
Blocks PGE2 natiuresis so get sodium and fluid retention.
Not as well tolerated in elderly

Question 9

What happens to 10% of asthmatics using NSAIDS and why?

Answer 9

Aspirin induced asthma

from increased production of leukotrienes which are spasmolytics.

Question 10

What are some unique possible adverse effects of aspirin?

Answer 10

• Reye syndrome (more likely to happen in children/adolescents so dont use in them)
• Tinnitis
• Uric acid retention (contraindicated in gout)

Question 11

When is paracetamol’s safety compromised?

Answer 11

In those with hepatic failure as doesn’t detoxify as well and so can get hepatotoxicity easier